Cardiovascular Imaging

Cardiac masses

Cardiac MR (magnetic resonance) imaging holds an important role in the evaluation of suspected cardiac masses. Even early in its development, MR was found to be diagnostically superior to echocardiography for diagnosis of cardiac masses, due in part to the modality’s high spatial resolution and in part to its large field of view, which allowed evaluation of mediastinal and paracardiac structures.

Congenital heart disease

One of the first applications of Cardiac MR (magnetic resonance) was the evaluation of congenital heart disease (CHD), and this remains as one of the leading indications for the procedure. The primary goals of the exam are to provide the morphologic details of the lesion as well as the sequelae of the disease.

Intracardiac thrombus

Patients with a history of ischemic heart disease or myocardial infarction can frequently suffer complications from ventricular thrombi. Thrombi in the left ventricle serve as a common source of stroke or peripheral arterial embolic syndromes. Right ventricular thrombi may be a source of pulmonary emboli. Given the severity of these complications, accurate diagnosis of intracardiac thrombi is considered emergent.

Myocardial viability

In patients with impaired left ventricular (LV) function, the accurate assessment of viable and non-viable tissue has important prognostic implications in terms of clinical planning for revascularization procedures such as angioplasty or coronary artery bypass grafts. It is known that patients with dysfunctional but viable myocardium usually benefit from revascularization.

Perfusion/coronary artery disease

Although currently only used as a research protocol, Cardiac MR (magnetic resonance) stress perfusion imaging is demonstrating its capability to non-invasively diagnose coronary artery disease (CAD) in patients with suspected CAD. The preliminary studies show promising results.

Pericardial imaging

Magnetic resonance (MR) imaging of the pericardium offers a useful, noninvasive method of evaluating various disorders affecting the pericardium, including characterization of pericardial effusions (loculated vs. hemorrhagic), distinguishing constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM), and delineation of pericardial masses.

Pulmonary vein mapping

The pulmonary veins are known sources of ectopic atrial beats in patients with chronic atrial fibrillation. These patients are increasingly being treated with radiofrequency ablation in which the radiofrequency current is applied within the left atrium at the level of the ostia of the pulmonary veins. The goal of the treatment is to electrically isolate all the pulmonary veins by creating circumferential lesions at their ostia.

Arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a type of cardiomyopathy which is diagnosed on the basis of number of criteria which include structural, functional, electrocardiographic, arrhythmic, and genetic factors. ARVD is recognized as a major cause of sudden death in adolescents, with one series reporting that it accounted for 20 percent of sudden deaths in all individuals younger than 35 years and 22 percent of sudden deaths in young atheletes.

Valvular disease

Valvular disease is ideally suited to evaluation with magnetic resonance imaging (MRI). Cine MRI is used to image the valve in multiple orientations. Stenotic or regurgitant jets show up as dark regions, where dephasing of the MR signal has occurred due to turbulent flow. The exact velocity and flow across the abnormal valve can be quantified with phase contrast imaging.

Vascular disease

MR angiography (MRA) has now become the first-line tool for imaging the vasculature in many centers. Numerous studies have proven its accuracy for detecting disease in different vascular territories. In our institution, the carotid, aorta, pulmonary, mesenteric, renal, hepatic and lower extremity arteries are routinely evaluated with MRA and catheter-based x-ray angiography is reserved for interventional procedures.