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Cardiac MR imaging at Southern Ohio Medical Center

Best Practice

Recently the Phillips Achieva 1.5 T MRI unit from the Southern Ohio Medical Center underwent a major upgrade that has improved on the state of the art cardiac MRI imaging. The upgrade included stronger magnetic gradients (Nova Dual gradient system), a 32-channel cardiac coil and the Cardiac Explorer package on our dedicated workstation. After this upgrade the center is using faster imaging, allowing shorter breath hold sequences, higher temporal resolution and added imaging functionality. Visit http://www.healthcare.philips.com/main/products/mri/clinical_solutions/cardiac/ for more information. 
 Achieva 1.5 with cardiac coil
Achieva 1.5 with cardiac coil
 
MRI has better soft tissue contrast discrimination than CT and greater spatial resolution than nuclear medicine by a factor of 10 (typically 1 mm vs. 1 cm). It also has high temporal resolution and an ability to visualize turbulence created by valvular disease or shunts. Because of these attributes, contrast-enhanced cardiac MRI is a most sensitive method to non-invasively evaluate cardiac structure and function.
 Delayed contrast enhancement of inferior wall infarct Left ventricle systolic contour
Delayed contrast enhancement of inferior wall infarct
Left ventricle systolic contour

Small subendocardial infarcts can be detected that are not apparent on SPECT imaging. MRI can also help evaluate the extent of infarction (myocardial viability imaging). This can aid in determining the potential for functional recovery after CABG or stenting procedures.

MR cine series allows for using stenotic or regurgitant jets to measure velocity yielding a regurgitation fraction. Such turbulence can also be utilized to recognize the presence of cardiac shunts. Evaluation of cardiac mass, myocarditis, causes of cardiomyopathy, diagnoses of ARVD and pericardial evaluation including constriction are other entities approved by the American College of Cardiology Appropriateness statement on cardiac MRI.

In young patients cardiac MRI has the added benefit of no radiation exposure and is the method of choice to evaluate congenital heart disease.
 Right atrial myxoma Inferior wall thinning and akinesis due to infarction
Right atrial myxoma
Inferior wall thinning and akinesis due to infarction

When Echocardiography evaluation is suboptimal or further imaging warranted, cardiac MRI could be used for cardiac function and valvular evaluation.
 Turbulent regurgitant jet extends from the aortic valve into left ventricle. Mitral valve regurgitant jet extends into left atrium
Turbulent regurgitant jet extends from the aortic valve into left ventricle.
Mitral valve regurgitant jet extends into left atrium
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Common indicators for Cardiac MRI

Anatomy

  • Myocardial infarct imaging
       Did the patient have an infarct?
       Extent of infarct? 
  • Assess myocardial viability prior to PCI or CABG
  • Characterize mass or thrombus
  • Evaluate:
       Cause of cardiomyopathy
       New onset of CHF
       Myocarditis
       Congenital Heart Disease
       Constrictive Pericarditis
       Pulmonary veins prior to RFA

Function

  • Left or right ventricular function
  • Cardiac wall motion on cine loop
  • Valvular evaluation (stenosis, regurgitation, regurgitant fraction)
  • Cardiac shunts 


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Aug 28, 2012

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Best Practice
Achieva 1.5T
Release 3
Nova Dual
Cardiac, Cardiac Explorer, Cardiac Morphology, Function Cine, Function Non-Cine
 

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