Cardiac MRI (an approach)

Last revised by Joachim Feger on 11 Dec 2021

Citation, DOI, disclosures and article data

Citation:

Feger J, Foster T, Elfeky M, Cardiac MRI (an approach). Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-83395

DOI:

https://doi.org/10.53347/rID-83395

Permalink:

https://radiopaedia.org/articles/83395

rID:

83395

Article created:

21 Oct 2020, Joachim Feger ◉

Disclosures:

At the time the article was created Joachim Feger had no recorded disclosures.

View Joachim Feger's current disclosures

Last revised:

11 Dec 2021, Joachim Feger ◉

Disclosures:

At the time the article was last revised Joachim Feger had no recorded disclosures.

View Joachim Feger's current disclosures

Revisions:

7 times, by 3 contributors - see full revision history and disclosures

Systems:

Cardiac

Sections:

Approach

Tags:

cases

Synonyms:

Cardiac MRI an approach

A cardiac MRI can be a more or less frequent examination faced in daily practice also depending on the institution. In general radiological practices and institutions other than cardiac imaging centres, cardiac MRI examinations are not necessarily gladly enlisted into the appointment schedule partly due to their sheer time requirements. Therefore their acquisition protocol is usually tailored to the clinical question.

What is presented below is a ’basic approach' for how to organise findings within a radiological report of a cardiac MRI without claim for completeness. This does not cover the workup of every clinical question and every cardiac problem that might be investigated.

Systematic review

Although the clinical question is paramount, many findings and differential diagnoses can be worked off with a few standardised protocols and help the clinician with the further diagnostic process. Thus a systematic review is essential including morphology, function and tissue characteristics.

Morphology

The morphological assessment includes the following:

cardiac situs, position, cardiac chambers and connections
pulmonary artery, ascending aorta as well as pulmonary veins
left and right ventricular size (end-diastolic diameter)
atrial size
valvular heart disease
foramen ovale, atrial and ventricular septal defects
other forms of congenital heart disease
pericardial effusion/pericardial thickening
cardiac tumours
adjacent mediastinal and pulmonary structures

Function

A left ventricular functional analysis is part of every cardiac MRI and includes the following:

contraction pattern: synchrony/dyssynchrony

left ventricular end-diastolic diameter
left ventricular end-diastolic volume index (LV EDVI) [mL/m²]
left ventricular end-systolic volume index (LV ESVI) [mL/m²]
left ventricular stroke volume index (LV SVI) [mL/m²]
left ventricular ejection fraction (LV EF) [%]
left ventricular mass index [g/m²]*
left ventricular regional wall motion abnormalities
- hypokinesia, akinesia, dyskinesia
- localisation according to the 17 segment model
- left ventricular clefts, cardiac recesses

Optional: (e.g. arrhythmogenic right ventricular cardiomyopathy, valvular disease, pericardial disease)

right ventricular end-diastolic diameter
right ventricular end-diastolic volume index (RV EDVI) [mL/m²]
right ventricular end-systolic volume index (RV ESVI) [mL/m²]
right ventricular stroke volume index (RV SVI) [mL/m²]
right ventricular ejection fraction (RV EF) [%]
right ventricular regional wall motion abnormalities
- right ventricular aneurysm

Cardiac tissue characterisation

The extent of the cardiac tissue characterisation module will vary with the clinical question and might include an assessment of the following:

myocardial oedema: focal or global
late gadolinium enhancement:
- patterns: subendocardial/transmural, mid-myocardial, subepicardial
- localisation according to the 17 segment model
- pericardial enhancement

Optional:

cardiac perfusion
- patterns: subendocardial/transmural
- localisation according to the 17 segment model
- comparison to regional myocardial oedema and myocardial scar tissue
myocardial mapping:
- native T1 mapping [ms] and possibly extracellular volume (ECV) [%]
- T2 mapping [ms]
- T2* mapping [ms]

Flow measurements

Flow measurements are usually acquired for suspected cardiac shunts and might be acquired in the setting of valvular disease. They might be also acquired in the assessment of hypertrophic cardiomyopathy.

In-plane flow measurements can depict and characterise the direction of flow and shunts.

Through-plane flow measurements are usually conducted in the pulmonary artery and ascending aorta at several locations as well as in the left ventricular outflow tract.