ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Weekend Educational Course: Cardiovascular MRI: The Basic Principles & Applications

Skill Level: Basic

Organizers: Martin J. Graves Ph.D. & Jeanette Schulz-Menger, M.D.

Saturday 07 May 2016

An introduction to the cardiac MRI examination. The course will explain the basic clinical applications together with technical critiques of the methodologies. Sessions will describe i) the basic cardiac MRI examination; ii) the evaluation of systolic and diastolic function ; iii) the evaluation of ischemic heart disease using both myocardial perfusion and dobutamine stress imaging and finally; iv) the role of late gadolinium enhanced MRI in ischemic and non-ischemic heart disease followed by an appraisal of emerging techniques for fibrosis imaging.

Target Audience
Clinicians who wish to acquire an understanding of the main clinical applications of cardiac MRI and identify the main technical challenges and limitations associated with the methods. Physicists and Engineers who wish to obtain a basic understanding of clinical needs.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Describe the basic cardiac MRI examination and evaluate if their own practice could be improved;
  • Critically assess the methods used in MRI in cardiac function, ischemia and fibrosis imaging and review if they could be applied in their own practice; and
  • Recognize the limitations of MRI for cardiac function, ischemia and fibrosis imaging and reflect on their own practice.

Moderator: Daniel Ennis, Harald Kramer
      The Basic Cardiac MRI Exam  
Key Clinical Cardiac MRI Concepts: How We Do It
Reza Nezafat1
Key Clinical Cardiac MRI Applications: Where CMR Makes a Difference & Why - Permission Withheld
Michael Salerno1
1Medicine, Radiology and BME, University of Virginia, Charlottesville, VA, United States
CMR has a key role in multiple clinical application where it provides unique and important information.  This talk will discuss the role of CMR in a number of these applications including: evaluation of congenital heart disease, evaluation of cardiomyopathy, understanding the etiology of acute chest pain, the evaluation of cardiac masses, and the evaluation of pericardial disease.  For each application, we will discuss the CMR techniques used and how and why CMR makes a difference.
      Evaluation of Cardiac Function  
Systolic Function
Alistair A. Young and Ambale Bharath Venkatesh
This course will provide an understanding of systolic function assessment using MRI that goes beyond left ventricular ejection fraction. We will delve in detail on strain quantification for regional myocardial function assessment. The attendee will be able to definition the meaning of strain and understand how to interpret the different components of strain. Each topic will include acquisition methods, post-processing and analysis methods. We will finally end with examples of a few applications of systolic function assessment from MRI.

Diastolic Function - Permission Withheld
Daniela Föll1
1Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany
Diastolic dysfunction is a sensitive marker of cardiac disease and an important cause of heart failure. MRI offers a variety of possibilities for the diagnosis of diastolic dysfunction. MRI markers of diastolic dysfunction directly related to structural remodeling are increased left atrial sizes or left ventricular masses. Functional MR parameters of disturbed diastolic function include both altered mitral inflow curves and pulmonary vein flow curves as well as increased E/Ea values assessed by MR phase-contrast imaging. Furthermore, a comprehensive regional analysis of diastolic ventricular motion and deformation is enabled using MR Tagging, Tissue Phase Mapping or MR Feature Tracking. These methods also allow the assessment of single motion/deformation parameters such as untwist or long-axis strain-rate or velocities, as indicators of active relaxation.

Break & Meet the Teachers
      Evaluation of Ischemia  
Contrast Enhanced Perfusion At Rest & Stress
Sanjay Agrawal1
1Radiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, United Kingdom
Dobutamine Stress Imaging
Sanjay Agrawal1
1Papworth Hospital
Challenges & Limitations in Ischemia Imaging
Ed DiBella1
1Department of Radiology and Imaging Sciences, University of Utah
Myocardial perfusion acquisitions have high sensitivity/specificity for the detection of ischemia though are challenged by motion, dark rim artifact, and issues with quantification. These issues are briefly addressed in this syllabus, with references to more of the work done in these areas.
      Evaluation of Fibrosis  
Late Gadolinium Enhancement in Ischemic Heart Disease
Ulrich Kramer1
1Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
Late Gadolinium Enhancement in Non-Ischemic Heart Disease
Victor Ferrari1
1Univ. of Pa Medical Center
Challenges & Limitations in Diffuse Fibrosis Imaging
Peter Gatehouse1
1Brompton Hospital, London, United Kingdom
Early detection of diffuse fibrosis in myocardium would offer the hope of treatment for reversing it before irreversible damage becomes evident from other symptoms. Currently there is no established early-stage clinical test for diffuse fibrosis except myocardial biopsy, but MRI may deliver this test. Most cardiac MRI of diffuse fibrosis is based on T1&ECV measurements. The T1 of myocardium and its response to Gad is therefore fundamental in understanding some limitations and is described first. Methods of cardiac T1 mapping are described with some of the issues affecting their accuracy and precision. Potential alternative diffuse fibrosis methods in MRI are mentioned briefly. Clinical research by MRI in diffuse fibrosis is plentiful as group studies, but for early-stage diffuse fibrosis assessment the scatter still defeats it. Here is a challenge with a strong clinical call: improve MRI for individual patient diagnosis or monitoring of early changes in myocardial diffuse fibrosis.

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.