{"title":"MRI interactions with medical devices","authors":"F. Censi, E. Mattei, G. Calcagnini","doi":"10.1093/MED/9780198779735.003.0012","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0012","url":null,"abstract":"Given the particular environment created by a magnetic resonance imaging (MRI) scanner, various kinds of interaction can occur with other medical devices, depending on the nature of the device, active or passive, on the materials. Generally speaking, manufacturers of medical devices must analyse and indicate any potential risk related to reasonably foreseeable environmental conditions such as magnetic fields and to other medical treatments such as MRI. Thus, information about the compatibility of a medical device with MRI should be available on the device user manual. According to the latest international standard (ASTM 2503), a medical device can be magnetic resonance (MR) Safe, MR Conditional, and MR Unsafe. MR Safe poses no known hazards in all MRI environments; MR Conditional has been demonstrated to pose no known hazards in a specified MRI environment with specified conditions of use; MR Unsafe is known to pose hazards in all MRI environments. Implanted medical devices are those raising major concerns in MR environments. Each implanted device must be clearly identified, and it is important to screen each patient before MRI examination. The prevalence of patients with various kinds of implants is increasing. For these devices, it could be important to refer not only to the user manual, but also to the scientific literature. Indeed, it could happen that it is necessary to perform an MRI examination which does not completely respect the MRI conditions indicated by the device manufacturer. In these cases, the clinical or in vitro experiences reported in the scientific literature could help in yielding elements to support the medical decision.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":" 44","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120832226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adapting CMR sequences for CHD and imaging small patients","authors":"V. Muthurangu","doi":"10.1093/MED/9780198779735.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0048","url":null,"abstract":"In this chapter, the necessary modifications to common cardiovascular magnetic resonance sequences will be discussed. Specific areas that will be covered are: optimization of steady-state free precession cine imaging for the assessment of function, whole heart imaging in infants and children, velocity-encoded phase contrast magnetic resonance for the assessment of flow in paediatrics, and modification of contrast-enhanced magnetic resonance angiographic sequences in childhood. In addition, various methods of dealing with respiratory motion in children will be discussed.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125034562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Athlete’s heart and prevention of sudden cardiac death in athletes","authors":"J. Scharhag, Katherine C. Wu, P. Bohm, C. Basso","doi":"10.1093/MED/9780198779735.003.0035","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0035","url":null,"abstract":"Athlete’s heart is a physiological adaptation to regular exercise. It is characterized by harmonic, eccentric dilatation of all cardiac chambers, typically seen in endurance athletes and athletes who engage in disciplines with high volumes of endurance exercise. In contrast to eccentric hypertrophy of the heart in endurance athletes, which has been demonstrated in echocardiographic and cardiovascular magnetic resonance (CMR) studies, the early hypothesis of concentric hypertrophy in strength athletes has not been confirmed by most of the newer echocardiographic and CMR studies. Because CMR offers high sensitivity and specificity to differentiate between physiological and pathological cardiac adaptations, CMR has become an important tool to examine athlete’s heart and to evaluate athletes’ sports eligibility. Therefore, modern CMR plays an important role in the scientific and clinical assessment of exercise-induced cardiac adaptations and the prevention of sudden cardiac death in athletes.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115062985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dynamic contrast-enhanced perfusion CMR","authors":"E. Nagel, J. Schwitter, A. Arai","doi":"10.1093/MED/9780198779735.003.0015","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0015","url":null,"abstract":"Dynamic contrast-enhanced perfusion cardiovascular magnetic resonance (CMR) visualizes the first passage of a peripherally injected contrast agent bolus through the left ventricle and myocardium. The presence and extent of myocardial ischaemia is assessed during vasodilation using adenosine or regadenoson and, in most cases, is repeated at rest. Contrast-enhanced perfusion CMR methods use electrocardiogram-gated fast T1-sensitive imaging to capture the signal changes during contrast agent passage with high temporal (every or every other heartbeat) and spatial (below 3 × 3 mm in-plane, up to submillimetre) resolution, allowing the detection of subendocardial ischaemia and microvascular disease. In clinical routine, perfusion CMR data are mostly visually interpreted but can also be analysed semi-quantitatively by describing or quantitatively. Perfusion CMR is highly accurate in detecting significant coronary artery stenoses. Combined with cine and late gadolinium enhancement imaging, it provides comprehensive assessment and risk stratification of patients with known or suspected coronary artery disease and is gaining an increasing role in international practice guidelines.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122622604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Motion compensation","authors":"S. Kozerke, R. Boubertakh, M. Miquel","doi":"10.1093/med/9780198779735.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0006","url":null,"abstract":"This chapter introduces the different methods used to synchronize pulse sequences with both cardiac and respiratory motions, to suppress motion-related blurring and image artefacts. A single frame or a series of images (cine imaging) can be acquired at different time points (cardiac phases) throughout the cardiac cycle by detecting the patient’s heart rate, usually by using an electrocardiogram (ECG) or, in case of poor ECG signals, a pulse oximeter signal. Fast single-shot and segmented k-space acquisition techniques are introduced, and for segmented cine imaging, both prospective and retrospective gating techniques are described. To suppress breathing motion artefacts, acquisitions use respiratory motion techniques. For short acquisition durations, breath-holding is the easiest method to stop the patient’s breathing during data collection. However, for long scans, respiratory gating or respiratory navigated techniques can be used. The principles of these techniques and their applications are presented.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126875294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Prieto, René M. Botnar, H. Sakuma, M. Ishida, M. Makowski
{"title":"Coronary imaging","authors":"C. Prieto, René M. Botnar, H. Sakuma, M. Ishida, M. Makowski","doi":"10.1093/med/9780198779735.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0019","url":null,"abstract":"Due to its high soft tissue contrast, high spatial resolution, and lack of ionizing radiation, cardiovascular magnetic resonance (CMR) is a promising imaging modality for non-invasive imaging of the coronary arteries. However, because of the high spatial resolution and large coverage required for visualization of the coronary arteries, scan times are relatively long. This can result in imaging artefacts from cardiac and respiratory motion. Usually, coronary CMR is therefore performed with respiratory and cardiac compensation methods. CMR has shown promising results for the detection of coronary stenosis, when compared against invasive and computed tomography coronary angiography, but in clinical practice, CMR is more often used to define the course of anomalous coronary arteries and for the detection and tracking of coronary artery aneurysms. CMR also allows imaging of the coronary vessel wall and coronary plaque imaging, as well as the detection of coronary thrombus. These emerging methods may have a future role in risk stratification of patients with known or suspected coronary artery disease.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114813855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Basso, P. Buser, S. Rizzo, M. Lombardi, G. Thiene
{"title":"Cardiac thrombi","authors":"C. Basso, P. Buser, S. Rizzo, M. Lombardi, G. Thiene","doi":"10.1093/med/9780198779735.003.0045","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0045","url":null,"abstract":"Thrombi are the most common intracardiac masses, located within atrial cavities, ventricular cavities, or both. Cardiac thrombi vary considerably in size, morphology, and mobility. On cardiovascular magnetic resonance (CMR), signal intensities on different CMR sequences allow a highly accurate diagnosis of thrombi.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127688979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The single ventricle and surgical palliation","authors":"M. Fogel, W. Helbing","doi":"10.1093/MED/9780198779735.003.0057","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0057","url":null,"abstract":"About 10% of patients with congenital heart disease have a univentricular heart, which includes a wide variation of diagnoses. These may occur in the setting of anomalies of cardiac and visceral situs. When considering treatment options, a practical approach has been to define univentricular heart disease as the heart in which just one ventricle is present that can sustain the circulation, whether anatomically or functionally. Treatment consists of staged palliation, starting with an aortic-to-pulmonary anastomosis, if required, and of stepwise separation of the systemic and pulmonary circulation, culminating in a total cavopulmonary connection where caval return passively flows into the lungs, bypassing the heart (called the Fontan procedure). Detailed anatomic, haemodynamic, and functional imaging is required throughout the staged treatment and during long-term follow-up. Cardiovascular magnetic resonance (CMR) is a widely recommended tool for this purpose. CMR imaging should include assessment of the pulmonary artery, the aortic arch to assess for arch obstruction, the ventricular outflow tract, systemic-to-pulmonary collaterals (aortic–pulmonary, veno-veno), anomalous venous structures, pulmonary or systemic veins, systemic venous return, ventricular size/function and blood flow, and tissue characterization for myocardial scarring. The focus of imaging may shift, depending on the stage of treatment. During staged palliation, CMR can be used to detect residual findings requiring additional interstage interventions. CMR is recommended after Fontan completion for serial follow-up of ventricular function, haemodynamics, physiology, and anatomical assessment of the Fontan pathway.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114908210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular magnetic resonance in cardiac resynchronization therapy","authors":"F. Leyva, C. Manisty","doi":"10.1093/MED/9780198779735.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780198779735.003.0034","url":null,"abstract":"Cardiovascular magnetic resonance (CMR) can inform on the aetiology of heart failure, global cardiac function, and myocardial viability, all of which are essential in cardiac resynchronization therapy (CRT). Late gadolinium enhancement (LGE)-CMR allows quantification of myocardial scarring and characterization of the pattern of scar, both of which may be useful in risk stratification. In addition, the ability of CMR to localize myocardial scar and provide reliable measures of segmental motion and deformation is being applied to targeting left ventricular lead deployment. The development of CMR-compatible devices may permit the use of CMR in the optimization of CRT after implantation.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122020478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Segmental approach to congenital heart disease","authors":"C. Frescura, G. Thiene","doi":"10.1093/med/9780198779735.003.0047","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0047","url":null,"abstract":"The knowledge of cardiac anatomy is a prerequisite to the application of the segmental classification. Atria, ventricles, and vessels present anatomical markers that allow their precise identification. The segmental–sequential classification, that considers the heart as formed by three segments—atria, ventricles, and great arteries, connected at the atrioventricular and ventriculo-arterial junctions, permits an easy classification of complex congenital heart disease, useful for clinicians, surgeons, and pathologists.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129203316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}