Table Of ContentAtlas of Practical Applications of Cardiovascular Magnetic Resonance
Developments in Cardiovascular Medicine
232. A. Bayes de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.):
Arrhythmias and Sudden Death in Athletes. 2000 ISBN; 0-7923-6337-X
233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease. 2000. ISBN: 0-7923-7829-6
234. J. Candell-Riera, J. Castell-Conesa, S. Aguade Bruiz (eds):
Myocardium at Risk and Viable Myocardium Evaluation by SPET. 2000. ISBN: 0-7923-6724-3
235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing:
New Concepts for the New Century. 2001. ISBN: 0-7923-7378-2
236. Douglas L. Mann (ed.): The Role of Inflammatory Mediators in the Faihng Heart. 2001 ISBN: 0-7923-7381-2
237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac Contractile Force,
Second Edition. 2001 ISBN: 0-7923-7157-7
238. Brian D. Hoit, Richard A. Walsh (eds.): Cardiovascular Physiology in the
Genetically Engineered Mouse, Second Edition. 2001 ISBN 0-7923-7536-X
239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Genetics for Clinicians 2001 ISBN 1-4020-0097-9
240. Stephen M. Factor, Maria A. Lamberti-Abadi, Jacobo Abadi (eds.):
Handbook of Pathology and Pathophysiology of Cardiovascular Disease. 2001 ISBN 0-7923-7542-4
241. Liong Bing Liem, Eugene Downar (eds): Progress in Catheter Ablation. 2001 ISBN 1-4020-0147-9
242. Pieter A. Doevendans, Ste&n Kaab (eds): Cardiovascular Genomics:
New Pathophysiological Concepts. 2002 ISBN 1-4020-7022-5
243. Daan Kromhout, Alessandro Menotti, Henry Blackburn (eds.):
Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the
Seven Countries Study. 2002 ISBN 1-4020-7123-X
244. Antonio Pacifico (ed.), Phihp D. Henry, Gust H. Bardy, Martin Bor^refe,
Francis E. Marchhnski, Andrea Natale, Bruce L. Wilkoff (assoc. eds):
Implantable Defibrillator Therapy; A Clinical Guide. 2002 ISBN 1-4020-7143-4
245 Hein J.J. Wellens, Anton P.M. Gorgels, Pieter A. Doevendans (eds.);
The ECG in Acute Myocardial Infarction and Unstable Angina:
Diagnosis and Risk Stratification. 2002 ISBN 1-4020-7214-7
246. Jack Rychik, Gil Wemovsky (eds.):
Hypoplastic Left Heart Syndrome. 2003 ISBN 1-4020-7319-4
247. Thomas H. Marwick: Stress Echocardiography. Its Role in the Diagnosis and Evaluation
of Coronary Artery Disease 2nd Edition. ISBN 1-4020-7369-0
248. Akira Matsumori: Cardiomyopathies and Heart Failure: Biomolecular,
Infectious and Immune Mechanisms. 2003 ISBN 1-4020-7438-7
249. Ralph Shabetai: The Pericardium. 2003 ISBN 1-4020-7639-8
250. Irene D. Turpie; George A. Heckman (eds.):
Aging Issues in Cardiology. 2004 ISBN 1-40207674-6
251. C.H. Peels; L.H.B. Baur (eds.);
Valve Surgery at the Turn of the Millennium. 2004 ISBN 1-4020-7834-X
252. Jason X.-J. Yuan (ed.); Hypoxic Pulmonary Vasoconstriction:
Cellular and Molecular Mechanisms. 2004 ISBN 1-4020-7857-9
253. Francisco J. Villarreal (ed.); Interstitial Fibrosis In Heart Failure 2004 ISBN 0-387-22824-1
254. Xander H.T. Wehrens; Andrew R. Marks (eds.):
Ryanodine Receptors: Structure, fiinction and dysfiinction in clinical disease. 2005 ISBN 0-387-23187-0
255. Giullem Pons-Llado; Francesc Carreras (eds.):
Adas of Practical Applications of Cardiovascular Magnetic Resonance. 2005 ISBN 0-387-23632-5
Previous volumes are still available
Atlas of Practical Applications
of Cardiovascular IVIagnetic
Resonance
edited by
Guillem Pons-Llado, M.D.
Director, Cardiac Imaging Unit
Cardiology Department
Hospital de la Santa Creu I Sant Pau
Universitat Autonoma de Barcelona
Barcelona, Spain
Francesc Carreras, M.D.
Cardiac Imaging Unit
Cardiology Department
Hospital de la Santa Creu I Sant Pau
Universitat Autonoma de Barcelona
Barcelona, Spain
Springe]
GuiHem Pons-Llado, M.D. Francesc Carreras, M.D.
Director, Cardiac Imaging Unit Cardiac Imaging Unit
Cardiology Department Cardiology Department
Hospital de la Santa Creu I Sant Pau Hospital de la Santa Creu I Sant Pau
Universitat Autonoma de Barcelona Universitat Autonoma de Barcelona
Barcelona, Spain Barcelona, Spain
Library of Congress Cataloging-in-Publication Data
Atlas of practical applications of cardiovascular magnetic resonance / edited by
Guillem Pons-Llado and Francesc Carreras
p. ; cm. — (Developments in cardiovascular medicine ; 255)
Includes bibliographical references and index.
ISBN 0-387-23632-5 (alk. paper) e-ISBN 0-387-23634-1
1. Heart—Magnetic resonance imaging—^Adases. I. Pons-Llado, Guillem, 1951 - II.
Carreras, Francesc. III. Developments in cardiovascular medicine ; v. 255.
[DNLM: 1. Cardiovascular Diseases—diagnosis—^Atlases. 2. Magnetic Resonance
Imaging—methods—Atlases. WG 17 A8843947 2005]
RC670.5.M33A85 2005
616.1'207548—dc22
2004059144
© 2005 Springer Science -I- Business Media, Inc.
AU rights reserved. This work may not be translated or copied in whole or in part without
the written permission of the pubUsher (Springer Science-|-Business Media, Inc., 233
Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with
reviews or scholarly analysis. Use in connection with any form of information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now know or hereafter developed is forbidden.
The use in this pubUcation of trade names, trademarks, service marks and similar terms,
even if the are not identified as such, is not to be taken as an expression of opinion as to
whether or not they are subject to proprietary rights.
Printed in the United States of America.
987654321 SPIN 11053354
springeronIine.com
List of Contributors x
introduction 2
Giossary 4
Chapter 1: Basics of Cardiovascular Magnetic Resonance
and Normal Views 8
Sandra Pujadas, Oliver Weber
1.1 Definition and historical background 8
1.2 Physical basis 8
1.2.1 MR signal: Free Induction Decay 9
1.2.2 Relaxation 9
1.2.3 RF pulse and MR imaging 11
1.3 Pulse sequences 11
1.3.1 Classic sequences 11
1.3.1.1 Spin-Echo 11
1.3.1.2 Gradient-Echo 12
1.3.1.3 Velocity-encoded (phase contrast) MR imaging 12
1.3.1.4 MR angiography 15
1.3.2 New Modalities 15
1.3.2.1 Fast Spin-Echo o Turbo Spin-Echo 15
1.3.2.2 Fast Gradient-Echo and Steady State Free Precesion
Imaging (SSFP) 16
1.3.2.3 Inversion-Recovery and Saturation-Recovery 16
1.3.2.4 Echo-Planar Imaging (EPI) 16
1.4 Image formation 16
1.4.1 SHce selection 16
1.4.2 Image reconstruction 16
1.4.2.1 Frequency-encoding gradient 16
1.4.2.2 Phase-encode direction 17
1.4.3 K-space 17
1.5 Study Methodology and potential problems 17
1.5.1 Technical equipment 18
1.5.2 Medical personnel 18
1.5.3 Patient preparation 18
1.5.3.1 EGG synchronization 18
1.5.3.2 Artefacts 19
1.5.3.3 Safety considerations 19
1.6 Normal CMR anatomy 20
1.6.1 Orthogonal planes 20
1.6.2 Oblique planes 20
Ciiapter 2: Ventricular Morphology and Function:
Study of Cardiomyopathies 28
Guillem Pons-Llado
2.1 Morphological Study of Heart Chambers 28
a. Left ventricle 28
b. Right ventricle 29
2.2 Ventricular Function 33
a. Left ventricular function 33
b. Right ventricular function 33
2.3 Cardiomyopathies 36
a. Dilated cardiomyopathy (DCM) 36
b. Hypertrophic cardiomyopathy (HCM) 37
c. Restrictive cardiomyopathy (RCM) 39
d. Arrhythmogenic right ventricular cardiomyopathy (ARVC) 42
Chapter 3: Acquired Diseases of the Aorta 46
Guillem Pons-Llado
3.1 Technical Aspects of the Aortic Study by CMR : Imaging the Normal Aorta 46
3.2 Aortic Aneurysm 47
3.3 Aortic Dissection and Related Entities 47
a. Strategy for the study of aortic dissection by CMR 47
b. Differential diagnosis of aortic dissection by CMR 54
c. Post-operative or follow-up studies 58
3.4 Study of the atherosclerotic plaque by CMR 58
Chapter 4: Study of Valvular Heart Disease 60
Lufs J. Jimenez Borreguero
4.1 Introduction 60
4.2 Velocity Calculation and Flow^ Quantitation 61
4.3 Anatomic Evaluation 61
4.4 Aortic Regurgitation 63
a. Quantitation with cine velocity mapping 63
b. Quantitation of regurgitant volume using Simpson's method 63
c. Evaluation of regurgitation vwth cine gradient echo 63
4.5 Mitral and Tricuspid Regurgitation 63
a. Quantitation with cine velocity mapping 63
b. Quantitation of regurgitant volume using Simpson's method 64
c. Evaluation with cine gradient echo 64
4.6 Pulmonary Regurgitation 64
4.7 Pulmonary Hypertension 64
4.8 Valvular Stenosis 64
a. Quantitation with cine velocity mapping 64
b. Cine gradient echo 66
4.9 Prosthetic valves 66
Chapter 5: Cardiovascular Magnetic Resonance of Ischemic
Heart Disease 70
Sandra Pujadas, Francesc Carreras
5.1 Introduction 70
5.2 Study of Ventricular Function 70
a. Global ventricular function 71
b. Regional ventricular fiinction 71
c. Myocardial tagging 71
5.3 Assessment of myocardial ischemia by stress CMR 73
a. Myocardial perfiision by contrast first-pass CMR study 73
Practice of a CMR perfiision study 74
b. Wall motion study by dobutamine-CMR 74
Image analysis 74
5.4 Acute and Chronic Myocardial Infection 75
5.5 Comphcations of Myocardial In&rction 78
a. Ventricular aneurysm 78
b. Subacute ventricular rupture and ventricular pseudoaneurysm 78
c. Intraventricular thrombosis 78
d. Mitral regurgitation 78
5.6 Assessment of myocardial viability 78
Practice of a delayed contrast-enhanced study 83
5.7 Imaging of Coronary Arteries 83
Chapter 6: Cardiac and Paracardiac fulasses 92
Francesc Carreras
6.1 Introduction 92
6.2 Technical Aspects in the Evaluation of Masses with CMR 93
6.3 Malignant Primary Cardiac Tumors 94
a. Angiosarcoma 97
b. Myxosarcoma 97
6.4 Benign Primary Cardiac Tumors 97
a. Myxoma 97
b. Fibroma 99
c. Lipoma 99
d. Pericardial masses and tumors 99
6.5 Secondary Cardiac Tumors 99
a. Mediastinal lymphomas 99
b. Lung carcinoma 102
c. Melanoma 102
d. Pericardial secondary tumors 102
6.6 Benign Paracardiac Masses or Pseudotumors 102
6.7 Intracavitary Thrombi 102
Chapter 7: Diseases of tlie Pericardium no
Guillem Pons-Llado
7.1 The Normal Pericardium 110
7.2 Acute Pericarditis 111
7.3 Pericardial EfHision 111
7.4 Constrictive Pericarditis 111
7.5 Congenital Pericardial Diseases 115
Chapter 8: Congenital Heart Disease 120
Maite Subirana, Xavier Borras
8.1 Segmental Study of Congenital Heart Disease 120
8.2 Study of Atria and Venous connections 120
8.3 Atrioventxicular Connections 124
8.4 Ventriculoarterial Connexions 125
8.5 Smdy of Shunts 126
8.6 Atrial Septal Defect 126
8.7 Ventricular Septal Defect 128
8.8 Atrioventricular Defects 131
8.9 Patent Ductus Arteriosus 131
8.10 Obstructive Lesions 132
a. Right ventricular outflow tract obstruction 132
b. Valvular and supravalvular pulmonary stenosis 132
c. Subvalvular and supravalvular aortic stenosis 132
d. Coarctation of the aorta 133
8.11 Complex Congenital Heart Diseases 133
a. Tetralogy of Fallot 133
b. Truncus arteriosus 137
c. Complete transposition of the great arteries 137
d. Tricuspid atresia 140
e. Single ventricle 144
f. Double oudet right ventricle 145
8.12 Postoperative Studies 145
a. Surgical arteriovenous fistulas 145
b. Banding of the pulmonary artery 149
Xavier Borras, MD. Cardiac Imaging Unit. Cardiology Department, Hospital de la Santa Creu i
Sant Pau, Associate Professor of Medicine, Universitat Autonoma de Barcelona. Barcelona, Spain.
Francesc Carreras, MD. Cardiac Imaging Unit. Cardiology Department, Hospital de la Santa
Creu i Sant Pau, Universitat Autonoma de Barcelona. Barcelona, Spain.
Luis J. Jitnenez-Borreguero, MD. Cardiology Department. Hospital Principe de Asturias, Alcala
de Henares, Madrid, Spain.
Guilletn Pons-Llado, MD. Director, Cardiac Imaging Unit. Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona. Barcelona, Spain.
Sandra Pujadas, MD. Cardiac Imaging Unit. Cardiology Department, Hospital de la Santa Creu i
Sant Pau, Universitat Autonoma de Barcelona. Barcelona, Spain.
Maite Subirana, MD. Director, Unit of Congenital Heart Diseases. Cardiology Department,
Hospital de la Sant Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
Oliver M. Weber, PhD. Department of Radiology, University of California, San Francisco,
CaUfomia, USA.
CO
o
o
O
CO
