CHAPTER 5 Cardiovascular Magnetic Resonance
This chapter summarizes the contemporary clinical role of cardiovascular magnetic resonance (CMR) in clinical cardiology. Techniques are described which can be applied widely in the cardiovascular system, and these include assessment of anatomy and function, blood flow, ventricular volumes and mass, myocardial abnormality, and the response to stress.The longest established indications for CMR are anatomical, including the great vessels, congenital heart disease, pericardium, and cardiac masses, but more recently increasing importance has been placed on assessment of myocardial abnormality. This has opened up new avenues of infarction and viability assessment in coronary artery disease, and phenotyping in cardiomyopathy with distinct distribution patterns of abnormality. The prognostic value of myocardial fibrosis in these settings is now under investigation.
CMR is also becoming more widely used to assess ischaemia, particularly with stress ventriculography and myocardial perfusion imaging. Both techniques have substantial clinical application, and the avoidance of X-ray exposure for high resolution myocardial perfusion imaging is very attractive. Coronary imaging is currently still limited to assessing the course of anomalous coronaries, for which it is ideally suited. Work in acute coronary syndromes has been promising with new techniques to assess areas at risk, as has the visualization of vessel wall changes for the earliest detection of atherosclerosis. Finally, interventional CMR continues to develop, but the question of whether MR might or might not replace X-ray based techniques remains an open long-term question.
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