Clinical situations where cardiac MR is a useful investigation

• cardiac magnetic resonance (CMR) provides outstanding anatomical and functional detail. Consequently its main clinical uses are:
  • to characterise congenital heart disease and its complications
  • to measure right and left ventricular mass (CMR is the gold standard for quantifying left ventricular hypertrophy)
  • to differentiate forms of cardiomyopathies, such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and infiltrative diseases such as sarcoid and amyloid
  • to assess left and right ventricular function, regional wall motion abnormalities, myocardial viability and myocardial perfusion. Areas of myocardial infarction can be identified following administration of intravenous gadolinium
  • to identify stress induced myocardial ischaemia during infusions of dobutamine or adenosine
• In addition, CMR has a role in the assessment of intra-cardiac masses and quantifying intra- and extra-cardiac shunt flows
  • can image the entire aorta it is increasingly used for diagnosis and follow-up of patients with several aortic pathologies e.g. dissection, Marfan and aneurysm

Notes:

• however, although CMR can visualise the large proximal portions of coronary arteries, such that it is used to diagnose rare congenital anomalies of the coronaries, CMR currently cannot produce images of sufficient quality to assess coronary artery disease

Reference:

• 1) British Heart Foundation Factfile (January 2010). Cardiac imaging with MRI, CT and Nuclear techniques.