Table 1.

Cardiovascular Evaluation of Structure and Function Using Cardiovascular Magnetic Resonance

Target of Evaluation	Technique	Description	Advantage	Common Clinical Indication(s)
Dimension and morphology	SE and double IR	“Dark blood”	• Vessel and myocardial wall evaluation	• LV dimensions, relationships of heart to other structures in chest
				• Myocardial masses, pericardial disease
	GRE/SSFP (not cine)	“Bright blood”	• Less sensitive to motion artifact than dark blood SE	• Aortic dimensions and internal lesions, including intimal flap of dissection
Function	Cine SSFP (1.5-T) or cine GRE (higher field strengths; eg, 3.0-T)	“Bright blood” cine with temporal resolution of ~30–60 ms	• High temporal resolution • Relatively flow-independent • 2D and 3D high accuracy and reproducibility	• LV and RV volumes and ejection fraction, such as in heart failure • LV and RV regional wall motion • Valvular heart disease
	Tissue tagging			• With tagging, useful for quantifying LV and RV systolic and diastolic function
Metabolism	MR spectroscopy with 31P	Detection of spectral peaks for 31P metabolites	• High specificity	• Ischemia evaluation
Blood flow velocity	Phase-contrast imaging	Blood velocity leads to phase shift displayed on gray scale	• High accuracy • Velocity and flow quantitation • Locating and identifying intracardiac shunts or valvular lesions	• Valvular poststenotic and regurgitant flow • Large (aorta) and medium (renal, femoral, carotid) arterial flow • Pulmonary artery and vein blood flow • Qp/Qs (intracardiac shunts) • Determination of true and false lumen blood flow
Perfusion	T1-sensitive sequences, single-shot, multislice acquisitions w/GRE or GRE-EPI hybrid sequences	Contrast-based first-pass imaging for detection of hypoperfused myocardial segments	• High spatial resolution (~2 mm in-plane) • Rapid results	• Ischemia evaluation, including detection of CAD under stress • Microvascular disease
Angiography	Noncontrast MRA (eg, TOF, proximal compression, SSFP)	Relies on blood flow (TOF and proximal compression) or T2/T1 ratio (SSFP)	• No contrast required	• Coronary artery angiography for detection of stenosis or anomalous origin/course
	3D CE-MRA	T1 shortening with contrast-enhanced MRA image	• Fast and reliably provides “luminogram” for most vascular territories	• Bypass graft stenosis • Aortography • Carotid angiography • Renal angiography • Peripheral angiography
Tissue characterization	Noncontrast
	T1-weighted spin echo	Fat has very high signal intensity	• Sensitive for increased fat content	• ARVC/D • Cardiac mass
	T2-weighted spin echo	Low signal-to-noise ratio but very sensitive to edema	• Sensitive for increased water content	• Acute infarction • Acute myocarditis
	T2*-weighted sequences	Iron leads to T2* shortening, quantitative evaluation is required	• Sensitive for iron	• Hemochromatosis
	Contrast based
	T1-weighted spin echo	Early enhancement reflects hyperemia and capillary leak	• Inflammation	• Myocarditis • Acute MI
	T1-weighted/inversion recovery Late enhancement	Late enhancement reflects areas with delayed wash out of gadolinium	• Sensitive for necrosis, fibrosis, and myocardial amyloid	• MI • Myocarditis • Infiltrative disease (eg, amyloid, sarcoid) • Hypertrophic or eosinophilic cardiomyopathy

2D indicates 2-dimensional; 3D, 3-dimensional; ARVC/D, arrhythmogenic right ventricular cardiomyopathy/dysplasia; CAD, coronary artery disease; CE-MRA, contrast-enhanced magnetic resonance angiography; GRE, gradient echo; GRE-EPI, gradient echotype planar imaging; IR, inversion recovery; LV, left ventricular; MI, myocardial infarction; MR, magnetic resonance; Qp/Qs, pulmonary to systemic flow ratio; RV, right ventricular; SE, spin echo; SSFP, steady state free precession; T, Tesla; and TOF, time-of-flight.