Practical Applications of Magnetic Resonance in Congenital Heart Disease

Cardiac imaging in adults with congenital heart disease: unknowns and issues related to diagnosis

OPINION STATEMENT

Many adults with simple and complex congenital heart disease (CHD) survive to adulthood. The goal of imaging is to diagnose the underlying anomalies and to detect late complications of their CHD and past surgical repair, in order to assess the need for further intervention and better prepare for endovascular or open-heart surgery. Cardiac magnetic resonance imaging (MRI) and computerized tomography (CT) are increasingly utilized in this patient population, due to the technical advances made to these modalities in the past decade regarding image acquisition and reconstruction, spatial and temporal resolution, and radiation dose reduction. Here, we aim to review the role of cardiac MR in initial diagnosis, pre-treatment planning and post-surgical follow-up of adults with CHD, and to discuss the ancillary role of cardiac CT in these patients.

Magnetic resonance imaging in the evaluation of congestive cardiac failure

Congestive cardiac failure is the end-result of various cardiac disorders, and is a major contributor to morbidity, mortality, and financial burden throughout the world. Due to advances in the knowledge of the disease and scanner technology, magnetic resonance imaging (MRI) is playing an increasingly important role in the evaluation of cardiac failure, including in establishing diagnosis, problem solving, risk stratification, and monitoring of therapy. This review discusses and illustrates the role of MRI in the assessment of congestive cardiac failure.

The role of cardiovascular magnetic resonance imaging in heart failure

Noninvasive imaging plays a central role in the diagnosis of heart failure, assessment of prognosis, and monitoring of therapy. Cardiovascular magnetic resonance (CMR) offers a comprehensive assessment of heart failure patients and is now the gold standard imaging technique to assess myocardial anatomy, regional and global function, and viability. Furthermore, it allows assessment of perfusion and acute tissue injury (edema and necrosis), whereas in nonischemic heart failure, fibrosis, infiltration, and iron overload can be detected. The information derived from CMR often reveals the underlying etiology of heart failure, and its high measurement accuracy makes it an ideal technique for monitoring disease progression and the effects of treatment. Evidence on the prognostic value of CMR-derived parameters in heart failure is rapidly emerging. This review summarizes the advantages of CMR for patients with heart failure and its important role in key areas.

MR and CT imaging of the pediatric patient with structural heart disease

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are imaging modalities increasingly used in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future.