Cardiac MRI

Cardiac MRI consists of using MRI to study heart anatomy and pathology.

Advantages

Main advantages of cardiac MRI in comparison with other techniques are:

• a better definition of soft tissues
• use of different types of sequences improves diagnostic accuracy
• avoid ionizing radiation
  • nevertheless, there are some safety issues that must be considered.

Limitation

MainThe main limitation of MRI, in comparison with cardiac CT, is a worse evaluation of coronary arteries.

In addition, cardiac MRI employs some particular imaging planes.

Imaging

Dark blood Imaging

Dark blood imaging involves spin echo sequences. Its main advantage is a fast acquisition that minimizes respiratory and cardiac movement artifacts. It’s the main issue is a low signal/noise ratio and, therefore, a deficient spatial resolution. 

They can be T1, T2 or PD weighted sequences:

• T1 weighted sequences achieve better anatomic definition
• T2 and DP weighted sequences reach better tissue characterization

White blood Imaging

White Blood Imaging involves gradient echo sequences and steady-state free precession MRI (SSFP). In practice, the difference between both is SSFP is less vulnerable to T2* effect.

MainThe main advantage of white blood imaging is its fast acquisition. It can obtain movement sequences and allows studying cardiac function and movement.

Flux quantification sequences

The most usual sequence of this group is phase contrast imaging. It encodes flux direction and speed, similarly to CSF flow studies.

Inversion Recovery sequences

This imaging techniques use additional 180º pulses to null signal from blood and other tissues, and, therefore, improving contrast.

MostThe most used sequence is STIR.

Contrast-enhanced techniques

Perfusion imaging (also known as first-pass images)

They are T1 weighted, gradient-echo sequences. Image acquisition is performed 3 minutes after gadolinium contrast administration. If there’s a hypoenhanced area, this implies a zone of myocardial infarction that is nonviable.

Viability study delayed (also known as myocardial enhancement study)

They are T1 weighted, gradient-echo sequences. Image acquisition is performed 10 minutes after gadolinium contrast administration. 

Focal myocardial fibrosis has a delayed gadolinium contrast wash out. So an hyperenhancement indicates a myocardial scar, thus an evolved myocardial infarction.

Usually, an extra inversion pulse is used to improve contrast between fibrosis and the surrounding myocardium.