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Cardiac Magnetic Resonance Imaging

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Cardiac MRI basics
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Cardiac Magnetic Resonance Imaging

  1. 1. Cardiac MRI Rahman Ud Din Lecturer Medical Imaging NWIHS
  2. 2. Introduction • CMRI • Information to assess the abnormality of heart • Anatomical and functional information • Acquired or congenital heart diseases • Modality of choice ▫ ARVD, ▫ Differentiation from constrictive pericarditis from restrictive pericarditis, aortic dissection ▫ Precise quantification of ventricular dimensions ▫ Myocardial viability and perfusion ARVD
  3. 3. ECG Gating • ECG/EKG gating essential for motion-free image of heart • Images are acquired in a particular phase of cardiac cycle in every cardiac cycle • To avoid image blur and motion artifacts • The image is decided by ECG gating • Usually R-wave is used to trigger the acquisition • Such data acquired in the diastolic phase • Peripheral pulse also used for gating • But less effective than ECG gating
  4. 4. Imaging Sequences • Pulse sequences used ▫ Dark-blood sequences ▫ Bright-blood sequences • Dark-blood tech • Spin-echo seq; that show the flowing blood as flow void • Seqs; include breath-hold turbo or FSE (TSE, FSE) • Single shot FSE • Double inversion recovery FSE (Double-IR-FSE)
  5. 5. Bright blood technique • GRE seq: based shows blood bright • Seqs; include spoiled GRE ▫ (turboFLASH/SPGR/T1-FSE) ▫ Balanced SSFP (TrueFISP/FIESTA/balanced TFE) • Balanced TFE is mainstay seq; in CMRI • Motion loop is obtained rapid cine imaging (RCI) • Used RCI used ventricular function • To calculate EF, SV as well as valvular & RWM • Phase contrast useful in velocity & flow direction • Initial CMRI starts from black blood than bright blood techniques used to assess functions
  6. 6. Imaging planes • Orthogonal planes (axial, sagittal and coronal) • Used for chest imaging and not suitable in CMRI • Because cardiac axes are not parallel to body axes • Three axes images are taken and used as localiser
  7. 7. 1. Vertical long-axis plan (two chamber view) • Axial image • Large oblique diameter image of LV • Chambers; LA and LV
  8. 8. 2. Horizontal long-axis (Four Chamber view) • Planned on two chamber view • By a drawing line passing through LA, MV & LV • All four chambers, MV and TV assessed • Cine GRE images obtained on this plane to assess function of MV, TV, AV and LV, RV wall motion
  9. 9. 3. Short-axis plane • Multiple cross sections are obtained perpendicular to LV long axis as seen on a two-chamber view • Sections are taken from the base to the apex of the heart • Cine GRE images allow visualization and quantification of systolic myocardial wall thickening • Images in this plane are used for calculating ventricle volume, mass and EF by postprocessing
  10. 10. 4. Five-Chamber view • View obtained parallel to the line passing through the LV apex and aortic outflow tract on coronal images • Apart from all four chambers, this view also shows aortic root • This describe MV and AV
  11. 11. 5. RVOT • Plane passing through the RV outflow tract
  12. 12. Clinical Applications of CMRI 1. Congenital Heart Disease (CHD) • Complex information about heart anatomy • When echocardiography fail • ASD, VSD detected with high sensitivity & specificity • Calculate shunt size • Conditions like ▫ TGA (transposition of Greater Arteries) ▫ Truncus arteriosus ▫ Many anomalies CMRI in children are having limitation
  13. 13. ASD Truncus arteriosus
  14. 14. 2. Valvular Heart Disease (VHD) • Arrhythmogenic right ventricular dysphagia • Enlargement and dilatation of RV • Thinning of wall, area of dyskinesia, focal bulging of free wall in systole • Decreased EF and impair ventricular filling during diastole • HCM (Hypertrophied) ▫ Echo detect but RV involvement is checked CMRI • RCM (Restrictive) vs Constrictive ▫ Constrictive calcified pericardium, WT + 4mm • Hemochromatosis ▫ Myocardial iron deposition i.e. Thalasemia ▫ Quantified by T2*-w seq;
  15. 15. 4. Ventricular Function • CMRI more accurate than Echo • It measure EF, EDV & ESV (end systolic vol) • Done on short axis image using software • Balanced SSFP, good contrast b/w blood pool and myocardium
  16. 16. 5. Coronary artery assessment • Not good enough for visualisation of coronary arteries and its branches • Presently it is used for such purpose, to find anomalies, aneurysms and bypass grafting patency • GRE seq; balanced SSFP C+ or C-
  17. 17. 6. Myocardial perfusion and viability • IV Gd • T1-weighted GRE seq; turboFLASH • Low signal areas of underperfusion on these images correspond with regions of ischemia or infarct • Myocardial viability ▫ Viability seq; run after 10-15 minutes after Gd contrast ▫ T1-w GRE or inversion recovery balanced SSFP seq ▫ IR pulse used to suppress myocardium to get LV info ▫ Proper TI is important ▫ Infracted area on viability imaging shows enhancement ▫ This imaging is ‘Bright is dead’ ▫ Answer feasibility revascularisation procedure like angioplasty and bypass or not ▫ CMRI viability is superior compared to the PET
  18. 18. 7. Cardiac and Pericardial masses • CMRI accurate method for cardiac and pericardial masses evaluation • Thrombus the most common filling defect in cardiac chamber • Gd enhancement differentiate b/w mass or thrombus • Most cardiac neoplasm are metastatic • Primary neoplasm are rare and 80% benign
  19. 19. 8. Pericardial disease • Visualised with spin echo or GRE images • Normal pericardium seen on SE images • As a line of low signal intensity located b/w high signals of pericardial and epicardial fat • Normal thickness 1-2 mm; more than 4 mm is considered thickening

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