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2015 ; 5
(4
): 290-310
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Cardiac MR imaging: current status and future direction
#MMPMID26331113
Saeed M
; Van TA
; Krug R
; Hetts SW
; Wilson MW
Cardiovasc Diagn Ther
2015[Aug]; 5
(4
): 290-310
PMID26331113
show ga
Coronary artery disease is currently a worldwide epidemic with increasing impact
on healthcare systems. Magnetic resonance imaging (MRI) sequences give
complementary information on LV function, regional perfusion, angiogenesis,
myocardial viability and orientations of myocytes. T2-weighted short-tau
inversion recovery (T2-STIR), fat suppression and black blood sequences have been
frequently used for detecting edematous area at risk (AAR) of infarction. T2
mapping, however, indicated that the edematous reaction in acute myocardial
infarct (AMI) is not stable and warranted the use of edematous area in evaluating
therapies. On the other hand, cine MRI demonstrated reproducible data on LV
function in healthy volunteers and LV remodeling in patients. Noninvasive first
pass perfusion, using exogenous tracer (gadolinium-based contrast media) and
arterial spin labeling MRI, using endogenous tracer (water), are sensitive and
useful techniques for evaluating myocardial perfusion and angiogenesis. Recently,
new strategies have been developed to quantify myocardial viability using
T1-mapping and equilibrium contrast enhanced MR techniques because existing
delayed contrast enhancement MRI (DE-MRI) sequences are limited in detecting
patchy microinfarct and diffuse fibrosis. These new techniques were successfully
used for characterizing diffuse myocardial fibrosis associated with myocarditis,
amyloidosis, sarcoidosis heart failure, aortic hypertrophic cardiomyopathy,
congenital heart disease, restrictive cardiomyopathy, arrhythmogenic right
ventricular dysplasia and hypertension). Diffusion MRI provides information
regarding microscopic tissue structure, while diffusion tensor imaging (DTI)
helps to characterize the myocardium and monitor the process of LV remodeling
after AMI. Novel trends in hybrid imaging, such as cardiac positron emission
tomography (PET)/MRI and optical imaging/MRI, are recently under intensive
investigation. With the promise of higher spatial-temporal resolution and 3D
coverage in the near future, cardiac MRI will be an indispensible tool in the
diagnosis of cardiac diseases, coronary intervention and myocardial therapeutic
delivery.
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