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The Current Role of Cardiovascular Magnetic Resonance Imaging According to European Society of Cardiology Guidelines and Statements (Third 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: 819 - 829
DOI: https://doi.org/10.47803/rjc.2020.31.4.819
© 2021 Ramona Bica et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Cine (A, C) and LGE (B, D) images in two device patients with subsequent first diagnosis of cardiac sarcoidosis based on the CMR findings. In the first case (A, B), with pace-maker implantation for third degree atrioventricular block (lead artifact in RA, RV), extensive subepicardial to transmural LGE can be depicted in the septum and lateral wall (red arrows) as well as in the RV apex (white arrow), raising the suspicion of cardiac sarcoidosis. In the second case (C, D), with secondary prophylactic ICD (RV lead artifact) implantation after resuscitated cardiac arrest, subepicardial LGE in the hypertrophied basal anteroseptum can be seen (red arrows), also raising the suspicion of cardiac sarcoidosis. Note the signal loss (*) and artifact in the (not assessable) basal anterior wall (arrow head) caused by the larger generator of the ICD, not present in the case of the pacemaker.
Cine (A, C) and LGE (B, D) images in two device patients with subsequent first diagnosis of cardiac sarcoidosis based on the CMR findings. In the first case (A, B), with pace-maker implantation for third degree atrioventricular block (lead artifact in RA, RV), extensive subepicardial to transmural LGE can be depicted in the septum and lateral wall (red arrows) as well as in the RV apex (white arrow), raising the suspicion of cardiac sarcoidosis. In the second case (C, D), with secondary prophylactic ICD (RV lead artifact) implantation after resuscitated cardiac arrest, subepicardial LGE in the hypertrophied basal anteroseptum can be seen (red arrows), also raising the suspicion of cardiac sarcoidosis. Note the signal loss (*) and artifact in the (not assessable) basal anterior wall (arrow head) caused by the larger generator of the ICD, not present in the case of the pacemaker.

Figure 2

CMR images in a patient with bicuspid aortic valve (fusion of the right and left coronary cusps, B) and severe, eccentric, aortic valve regurgitation (red arrows, A), as shown in the cine images (A, B). The analysis of the flow CMR measurement in the proximal ascending aorta provided a regurgitation fraction of 52%, as calculated by the ratio between regurgitant and systolic (forward) volumes (C). CMR contrast angiography, here as 3D-volume rendering (D), revealed an associated aneurysm of the ascending aorta.
CMR images in a patient with bicuspid aortic valve (fusion of the right and left coronary cusps, B) and severe, eccentric, aortic valve regurgitation (red arrows, A), as shown in the cine images (A, B). The analysis of the flow CMR measurement in the proximal ascending aorta provided a regurgitation fraction of 52%, as calculated by the ratio between regurgitant and systolic (forward) volumes (C). CMR contrast angiography, here as 3D-volume rendering (D), revealed an associated aneurysm of the ascending aorta.

Figure 3

CMR images in a patient with atrial septal defect, superior sinus venosus type. In the cine images (A, B, C), a communication in the upper part of the atrial septum can be seen between the confluence of superior vena cava (VCS) to right atrium (RA) and left atrium (LA). In addition, partial anomalous venous return of the superior right pulmonary vein to VCS (C) and middle right pulmonary vein to the confluence of superior vena cava (VCS) to right atrium (RA) (B) is associated. Flow quantification in the proximal pulmonary artery and ascending aorta revealed a relevant left to right shunt, with a Qp/Qs of 2.3 (D).
CMR images in a patient with atrial septal defect, superior sinus venosus type. In the cine images (A, B, C), a communication in the upper part of the atrial septum can be seen between the confluence of superior vena cava (VCS) to right atrium (RA) and left atrium (LA). In addition, partial anomalous venous return of the superior right pulmonary vein to VCS (C) and middle right pulmonary vein to the confluence of superior vena cava (VCS) to right atrium (RA) (B) is associated. Flow quantification in the proximal pulmonary artery and ascending aorta revealed a relevant left to right shunt, with a Qp/Qs of 2.3 (D).

Figure 4

CMR images in a patient with severe pulmonary valve regurgitation after Fallot tetralogy repair. In the cine images (A, B) a wide, almost free, regurgitant jet can be observed (white arrows). A “through plane” flow CMR measurement in the proximal pulmonary artery (C) was planned on the cine images (red lines, A, B) and its analysis revealed a regurgitation fraction of 56% as well as a positive end-diastolic flow suggestive of a “RV restrictive physiology”, i.e. increased RV end-diastolic pressure (D).
CMR images in a patient with severe pulmonary valve regurgitation after Fallot tetralogy repair. In the cine images (A, B) a wide, almost free, regurgitant jet can be observed (white arrows). A “through plane” flow CMR measurement in the proximal pulmonary artery (C) was planned on the cine images (red lines, A, B) and its analysis revealed a regurgitation fraction of 56% as well as a positive end-diastolic flow suggestive of a “RV restrictive physiology”, i.e. increased RV end-diastolic pressure (D).

Figure 5

Edema sensitive T2-STIR (A, C) and LGE images (B, D) in a patient with acute pericarditis at baseline (A, B) and follow-up (FU; C, D), after a 3-month course of cortisone and colchicine. At baseline, marked, circular pericardial edema (T2-hyperintensity, A, white arrows) and LGE (B, red arrows) together with a small pericardial effusion (B, arrow heads) are depicted. At FU, an obvious regression of the above changes is noticed, with only minimal residual pericardial edema (C, white arrows) and LGE (D, red arrows) and no effusion.
Edema sensitive T2-STIR (A, C) and LGE images (B, D) in a patient with acute pericarditis at baseline (A, B) and follow-up (FU; C, D), after a 3-month course of cortisone and colchicine. At baseline, marked, circular pericardial edema (T2-hyperintensity, A, white arrows) and LGE (B, red arrows) together with a small pericardial effusion (B, arrow heads) are depicted. At FU, an obvious regression of the above changes is noticed, with only minimal residual pericardial edema (C, white arrows) and LGE (D, red arrows) and no effusion.
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Sujets de la revue:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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