RC 1503 - Imaging of cardiac function, perfusion and viability by MR
Ischaemic cascade is usually triggered by the presence of a flow-limiting stenosis inducing a perfusion defect which is initially reversible and progressively evolves to tissue necrosis with a subendocardial to transmural expansion of necrotic frontwave. Cardiac MR is able to comprehensively assess the entire spectrum of events characterizing this complex process from the regional and global functional impairment occurring in the early phase of ischaemia usually combined with rest-stress perfusion, to the direct visualization of necrotic areas/scars in post-infarct imaging. This has been achieved already almost twenty years ago and was recently integrated with novel imaging techniques providing further insight into the pathophysiology of ischaemic heart disease. Present session will focus on this crucial indication of cardiac MR offering precious information regarding image quality optimization in this setting and imaging features for differentiation between ischaemic vs non-ischaemic heart disease. An overview about CMR application of tissue perfusion in congenital heart disease will also be presented and session will close with a discussion focusing on the real and clinical reliability of CMR "comprehensiveness" in this clinical scenario.
1. To become familiar with the latest technical and methodological advances in cardiac MRI.
2. To learn about important and typical pitfalls in cardiac MRI and how to avoid or overcome these.
3. To consolidate the knowledge about an optimised, integrated approach using cardiac MRI depending on the clinical question.
Reading cardiac MRIs require high-quality scans to be available to the radiologist interpreting the scan. There are many issues to be considered to ensure optimal quality, signal-to-noise and artefact-free scans. Current advances are 1. 3T scanning: it has become easier to scan on 3.0T as compared to 1.5T scanners and the situation a few years ago. The differences will be discussed along with current state-of-the art cine and perfusion sequences. 2. Parametric imaging and tissue characterization: T1 and T2 mapping, STIR images and late gadolinium enhancement help us assess myocardial oedema, inflammation, infiltration and fibrosis. These will be discussed. Pitfalls are 1. shim artefacts: these can create bad-looking scans. 2. Rhythm abnormalities: these affect the quality of the scans but can be taken care off, with a little understanding of cardiac physiology. 3. Artefactual enhancement: this occurs in some segments of the myocardium and can simulate disease. 4. Wall motion pitfalls: left bundle branch block can simulate septal hypokinesia. These and other such issues need to be understood. Integrated approach: different clinical questions need different protocols. A viability scan has a different protocol from a scan for suspected amyloidosis or arrhythmogenic right ventricular cardiomyopathy (ARVC). While some aspects of scanning (basic cine imaging) remain the same for all types of indications, there are many other differences that allow us to highlight the specific issue at hand.
1. To correctly define various causes of cardiomyopathies and compare functional and structural changes occurring with ischaemic and non-ischaemic cardiomyopathies.
2. To recognise common and less common signal intensity abnormalities and late enhancement patterns to provide etiological differentiation of the various forms of cardiomyopathies.
3. To review the prognostic significance of various functional and tissue abnormalities observed by cardiac magnetic resonance in cardiomyopathies.
"no abstract submitted"
1. To decide which modality (MDCT/MRI) is the most appropriate for which indication in CHD.
2. To learn about the role of various MR applications in the diagnosis and planning of therapy of CHD.
3. To be able to perform a morphological and functional assessment of the right and left ventricle in CHD.
Congenital heart disease (CHD) comprises a wide-ranging of specific anomalies of the heart and the pulmonary vessels. Detailed knowledge of embryology, anatomy, and pathophysiology is crucial for diagnosis by imaging. Additionally, patient’s age ranges from newborn to adults with an increasing life expectancy due to advancing in treatment. Apart from cardiac ultrasound and catheterization, traditionally in the hand of the cardiologist, cardiac MRI and MDCT are integral parts of the diagnostic workup. In this context, radiologists should be familiarized with indications, imaging protocols and standardized reporting. Advances in imaging technology are resulting in higher temporal resolution with better assessment of disorders and patient’s comfort. Furthermore, radiation exposure essentially decreases in the past decade. In the case of MRI, 4D-imaging of blood flow opens a new horizon for treatment planning. The applications are related to patient management and treatment options. The domain of MDCT is the detailed visualization of morphology whereas MRI is the reference standard for functional analysis. However, there is overlap for both modalities. Thus, very complex anatomy or emergency cases are suitable indications for MDCT, while MRI determines the time point of (re)intervention by assessment of cardiac function.