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The Current Role of Cardiovascular Magnetic Resonance Imaging According to European Society of Cardiology Guidelines and Statements (First part)

Ramona Bica
Ramona Bica
, 
Virgil Ionescu
Virgil Ionescu
, 
Jan Bogaert
Jan Bogaert
 et 
Anca Florian
Anca Florian
   | 05 mai 2022
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Article Category: Review
Publié en ligne: 05 mai 2022
Pages: 795 - 805
DOI: https://doi.org/10.47803/rjc.2020.31.4.795
© 2021 Ramona Bica et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Schematic exemplification of an adenosine stress-CMR protocol used in the work-up of patients with coronary syndromes, including edema (T2-STIR), stress/rest contrast myocardial perfusion, functional (cine) and tissue characterization (late gadolinium enhancement - LGE) sequences. * - 0.075 mmol/kg.
Schematic exemplification of an adenosine stress-CMR protocol used in the work-up of patients with coronary syndromes, including edema (T2-STIR), stress/rest contrast myocardial perfusion, functional (cine) and tissue characterization (late gadolinium enhancement - LGE) sequences. * - 0.075 mmol/kg.

Figure 2

Stress perfusion during adenosine-hyperemia (A, B, C) and LGE images (D, E, F) in basal (A, D), mid-ventricular (B, E) and apical (C, F) short-axis. In the lateral wall segments, an inducible perfusion deficit can be visualized (red arrows) in the absence of scar (LGE), suggesting a hemodynamically relevant stenosis in the territory of the circumflex coronary artery.
Stress perfusion during adenosine-hyperemia (A, B, C) and LGE images (D, E, F) in basal (A, D), mid-ventricular (B, E) and apical (C, F) short-axis. In the lateral wall segments, an inducible perfusion deficit can be visualized (red arrows) in the absence of scar (LGE), suggesting a hemodynamically relevant stenosis in the territory of the circumflex coronary artery.

Figure 3

Stress perfusion during adenosine-hyperemia (A, B, C) and LGE images (D, E, F) in a chronic coronary syndrome patient with known two-vessel CAD: chronic total right coronary artery (RCA) occlusion and intermediate circumflex artery (LCX) stenosis as well as a history of lateral myocardial infarction. In the inferoseptal and inferior segments an ischemic scar (white arrow heads) with residual viability at basal, mid-ventricular level (subendocardial LGE with < 50% transmural extent) as well as a transmural inducible perfusion deficit (red arrow heads) exceeding the scar, can be seen, evidence of ischemic, viable myocardium in the RCA territory. On the other hand, the transmural scar (LGE, white arrows) in the lateral wall segments with corresponding perfusion deficit (red arrows) after lateral infarction demonstrates no relevant residual viability in the LCX territory.
Stress perfusion during adenosine-hyperemia (A, B, C) and LGE images (D, E, F) in a chronic coronary syndrome patient with known two-vessel CAD: chronic total right coronary artery (RCA) occlusion and intermediate circumflex artery (LCX) stenosis as well as a history of lateral myocardial infarction. In the inferoseptal and inferior segments an ischemic scar (white arrow heads) with residual viability at basal, mid-ventricular level (subendocardial LGE with < 50% transmural extent) as well as a transmural inducible perfusion deficit (red arrow heads) exceeding the scar, can be seen, evidence of ischemic, viable myocardium in the RCA territory. On the other hand, the transmural scar (LGE, white arrows) in the lateral wall segments with corresponding perfusion deficit (red arrows) after lateral infarction demonstrates no relevant residual viability in the LCX territory.

Figure 4

Edema sensitive T2-STIR (A, B, C) and T2-Mapping images (D, E, F) as well as LGE images (G, H, I) in a patient with acute anterior myocardial infarction. Acute ischemic myocardial damage in the anteroseptal and anterior myocardial segments can be seen with edema (white arrows): transmural T2-hyperintesity (A, B, C) and corresponding elevated T2 times (D, E, F), together with subendocardial to transmural LGE (G, H, I, red arrows).
Edema sensitive T2-STIR (A, B, C) and T2-Mapping images (D, E, F) as well as LGE images (G, H, I) in a patient with acute anterior myocardial infarction. Acute ischemic myocardial damage in the anteroseptal and anterior myocardial segments can be seen with edema (white arrows): transmural T2-hyperintesity (A, B, C) and corresponding elevated T2 times (D, E, F), together with subendocardial to transmural LGE (G, H, I, red arrows).

Figure 5

Edema sensitive T2-STIR in apical short-axis (A) and LGE images in apical short-axis (B) and two-chamber (C) view in a patient with myocardial infarction and no obstructive coronary arteries (MINOCA). A small, acute ischemic myocardial damage in the septal/inferior apical myocardial segments with edema (T2-hyperintesity, red arrow) and LGE (white arrows) can be seen. Within the LGE area, a small dark core of microvascular obstruction is also noticeable.
Edema sensitive T2-STIR in apical short-axis (A) and LGE images in apical short-axis (B) and two-chamber (C) view in a patient with myocardial infarction and no obstructive coronary arteries (MINOCA). A small, acute ischemic myocardial damage in the septal/inferior apical myocardial segments with edema (T2-hyperintesity, red arrow) and LGE (white arrows) can be seen. Within the LGE area, a small dark core of microvascular obstruction is also noticeable.
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