Cardiovascular Magnetic Resonance

500 Pages·2010·5.691 MB·English

by  S. Myerson, J. M. Francis, S. Neubauer

OXFORD MEDICAL PUBLICATIONS
Cardiovascular
Magnetic Resonance
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Cardiovascular
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Edited by
Saul G. Myerson
Consultant Cardiologist,
Honorary Senior Clinical Lecturer,
University of Oxford Centre for
Clinical Magnetic Resonance Research,
John Radcliffe Hospital, Oxford, UK
Jane Francis
Chief Technologist,
University of Oxford Centre for
Clinical Magnetic Resonance Research,
Oxford, UK
and
Stefan Neubauer
Professor of Cardiovascular Medicine,
Clinical Director,
University of Oxford Centre for
Clinical Magnetic Resonance Research,
Oxford, UK
1
1
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Disclaimer
The scan/analysis techniques described in this book are intended as a guide only, and
Oxford University Press and the authors make no representation, express or implied,
that these are universally applicable. Oxford University Press also make no representa-
tion that the drug dosages in this book are correct. Readers must therefore always
rely on their own good clinical practice, check with the MR system and software man-
ufacturers that the techniques applied are safe and appropriate, and check the drug
product information with the most up-to-date published product information and
data sheets provided by the manufacturers, and the most recent codes of conduct and
safety regulations. The authors and the publishers do not accept responsibility or legal
liability for any errors in the text or for the misuse or misapplication of material in this
work. Except where otherwise stated, drug dosages and recommendations are for the
non-pregnant adult who is not breastfeeding.
v
Foreword
Cardiovascular magnetic resonance (CMR) is fast becoming the gold
standard for visualizing the heart and large arteries. This book, one of
a series published by Oxford University Press, is written by established
experts in the fi eld, from internationally renowned CMR centres, and will
appeal both to those who want to learn more about this technique and
those who are already expert. Cardiologists have had excellent diagnostic
imaging tools at their disposal for decades, though in recent years CMR
has provided a much more accurate and refi ned look at the anatomy, func-
tion, and in particular, the tissue characteristics of the myocardium, such as
fi brosis and oedema – aspects which have previously been inaccessible. As
a result, this relatively new imaging modality has rapidly become an impor-
tant part of diagnostic cardiac imaging. There is still, however, a shortfall in
training opportunities, and this handbook should play an important role,
particularly with its focus on the practical aspects of acquiring and inter-
preting images. Established practitioners will also fi nd its quick reference
and practical format an invaluable aide-mémoire.
Chapters that particularly caught my eye, refl ecting my own interests,
included the fi rst chapter explaining the concept of CMR with clarity and
skill; the chapters on ventricular function, and in ischaemic heart disease
including myocardial viability, and a challenging fi nal chapter on ‘new hori-
zons’ for CMR. There are many areas where the book makes timely con-
tributions. For example, an exact assessment of myocardial infarct size
is rapidly becoming more and more important as the new therapeutic
concept of postconditioning takes hold. Current therapy is moving towards
a situation where prompt myocardial reperfusion is no longer suffi cient.
Rather, lethal reperfusion-induced cell necrosis must also be limited. To
meet these requirements, CMR will certainly be used, and its potential and
practical application is well explained here. When combined with myo-
cardial perfusion imaging, a comprehensive assessment in ischaemic heart
disease can be obtained – CMR acquires a dynamic sequence of images
during the passage of the contrast medium through the heart, with excel-
lent sensitivity and good specifi city for detecting myocardial ischaemia. Its
diagnostic potential is at least equal to that of nuclear perfusion imaging
and is likely to become an important mainstream clinical test. In the future,
using the blood oxygenation level-dependent (BOLD) effect, CMR may
even potentially assess myocardial tissue oxygenation without the need
for a contrast agent.
Although CMR is already the most versatile of all cardiovascular imaging
techniques, it is likely to see further major developments and the authors
conclude that ‘In future, targeted molecular imaging may accelerate and
re-defi ne diagnosis, provide more precise disease characterization, enable
specifi c treatments to be targeted in individual patients, enable drug
delivery to the site of pathology and monitor responses to treatment’.
vi FOREWORD
What more can we wish for? There has probably never been a more
interesting time to become a cardiac imager nor for those who want to
learn about CMR!
Professor Lionel H Opie, MD, DPhil (Oxon), DSc, FRCP
Director, Hatter Cardiovascular Research Institute,
Department of Medicine, University of Cape Town
Honorary Professor, Department of Medicine,
University College London
vii
Preface
Cardiovascular Magnetic Resonance (CMR) has become an important
imaging modality in clinical cardiology. Recent developments in magnet
and coil design, imaging sequences and image post-processing now allow
imaging of cardiac anatomy, function, perfusion and viability with superb
resolution, providing clinicians with unprecedented detail for the evalua-
tion of cardiovascular disease. The rapidly growing interest from cardi-
ology and radiology centres around the world is testimony to this. CMR
is a complex imaging modality however, with many aspects to master: MR
theory, image acquisition and analysis, interpretation and reporting. A
number of outstanding text books on CMR have been published in recent
years, but while these books provide scholarly and comprehensive infor-
mation on the state of the fi eld, no previous book has focused on the
practical aspects of CMR scanning in daily practice.
Cardiovascular Magnetic Resonance (Oxford Specialist Handbook) is
designed as a practical guide on performing, analysing and interpreting
CMR scans. It is not meant as a comprehensive text book, but covers all
major disease areas in suffi cient detail. It is aimed at all CMR users, par-
ticularly those new to CMR, though we hope that even the advanced user
will fi nd useful tips and tricks. The format is designed to be easily acces-
sible and is laid out in easy to navigate sections, as with other handbooks.
It is meant as a quick-reference guide to live near the MR console and case
viewing station, or on the offi ce shelf.
The book has three main sections: understanding CMR (the physics
and technical aspects), practical aspects of scan acquisition (including
patient safety and preparation, scan protocols, optimal image acquisi-
tion and standard views), and integrated pathology (what imaging to use
for each major cardiology diagnoses, and how to interpret the images).
Each chapter is focussed on the clinical context, and examples of typical
CMR reports are presented for the most common CMR indications. The
book is kept as generally applicable as possible, including all MR scanner
manufacturers, though where technical aspects are specifi c to individual
vendors, this has been noted.
We hope that you will fi nd Cardiovascular Magnetic Resonance an enjoy-
able and valuable tool for your CMR practice, and provide you with as
much satisfaction as we have enjoyed!
Saul G. Myerson
Jane Francis
Stefan Neubauer
Editors
viii
Acknowledgement
The editors are most grateful to Dr Carmel Hayes, Siemens Healthcare,
for her detailed, competent and excellent advice on all chapters of the
book, which has provided an MR system manufacturer perspective. The
book is not vendor-specifi c however, and is applicable to all MR system
manufacturers.
ix
Contents
Detailed contents xi
Contributors xvii
Symbols and abbreviations xix
1 Understanding cardiovascular magnetic resonance 1
2 Scan set-up and optimization 35
3 Image acquisition and standard views 71
4 Image processing 127
5 Ventricular function assessment 145
6 Ischaemic heart disease 155
7 Inheritable cardiomyopathies 177
8 Myocardial infl ammation and infi ltration 193
9 Tumours and masses 213
10 Valve disease 235
11 Pericardial disease 293
12 Congenital heart disease 309
13 Aortic disease 355
14 Peripheral arteries 383
15 Coronary magnetic resonance imaging 399
16 Systemic and pulmonary veins 409
17 Extracardiac fi ndings 425
18 New horizons for CMR 459
Index 467