Cardiovascular Magnetic Resonance Imaging: State of the Art

Cardiovascular magnetic resonance (CMR) imaging is one of the newest and most versatile imaging modalities in cardiovascular medicine, specifically in the evaluation of ischemic heart disease. Due to its excellent blood-pool-tomyocardium contrast and to its three-dimensional coverage, CMR has emerged as the "gold standard" in the assessment of resting left ventricular (LV) and right ventricular (RV) size and function. CMR can also be applied for stress testing, using vasodilator stress for perfusion analysis or dobutamine stress for functional analysis. Lately, CMR has become an invaluable tool in the assessment of myocardial viability. A recently introduced, novel inversion recovery gradient echo sequence for infarct imaging is the first in-vivo technique to assess the transmural extent of myocardial infarction. The predictive value of late contrast enhancement for functional recovery after revascularization has been validated both in acute and chronic human myocardial infarction. Contractile reserve during low-dose dobutamine infusion may have incremental predictive value in nontransmural infarction. Coronary magnetic resonance angiography (CMRA) can be used for the evaluation of anomalous coronary arteries and bypass grafts. CMRA of the native coronary arteries will need further development before routine clinical application. CMR also plays an important role in the evaluation of arrhythmogenic right ventricular cardiomyopathy, pericardial disease, cardiac masses, congenital heart disease, and pulmonary venous anatomy. Its potential applications continue to expand as more cardiovascular imagers are trained in these techniques.