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Silva Ferreira MV, Soares CSP, Araujo-Filho JDAB, Dantas RN, Torres RVA, Morais TC, Avila LFR, Ishikawa W, Nomura CH, Rajiah PS, Parga Filho J. Mitral Annular Disease at Cardiac MRI: What to Know and Look For. Radiographics 2024; 44:e230156. [PMID: 38870043 DOI: 10.1148/rg.230156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Accurate evaluation of the mitral valve (MV) apparatus is essential for understanding the mechanisms of MV disease across various clinical scenarios. The mitral annulus (MA) is a complex and crucial structure that supports MV function; however, conventional imaging techniques have limitations in fully capturing the entirety of the MA. Moreover, recognizing annular changes might aid in identifying patients who may benefit from advanced cardiac imaging and interventions. Multimodality cardiovascular imaging plays a major role in the diagnosis, prognosis, and management of MV disease. Transthoracic echocardiography is the first-line modality for evaluation of the MA, but it has limitations. Cardiac MRI (CMR) has emerged as a robust imaging modality for assessing annular changes, with distinct advantages over other imaging techniques, including accurate flow and volumetric quantification and assessment of variations in the measurements and shape of the MA during the cardiac cycle. Mitral annular disjunction (MAD) is defined as atrial displacement of the hinge point of the MV annulus away from the ventricular myocardium, a condition that is now more frequently diagnosed and studied owing to recent technical advances in cardiac imaging. However, several unresolved issues regarding MAD, such as the functional significance of pathologic disjunction and how this disjunction advances in the clinical course, require further investigation. The authors review the role of CMR in the assessment of MA disease, with a focus on MAD and its functional implications in MV prolapse and mitral regurgitation. ©RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Stojanovska and Fujikura in this issue.
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Affiliation(s)
- Marcus Vinicius Silva Ferreira
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Clarice Santos Parreira Soares
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose de Arimateia Batista Araujo-Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Nery Dantas
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Vitor Almeida Torres
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Thamara Carvalho Morais
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Luis Francisco Rodrigues Avila
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Walther Ishikawa
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Cesar Higa Nomura
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose Parga Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
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