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Magnetic Resonance Imaging of the Cardiovascular System: Title and subTitle BreakPresent State of the Art and Future Potential FREE

Donald R. Bennett, MD, PhD; Kathleen Davis, MD; Robert C. Canby, MEE; Henry N. Wagner, Jr, MD; Robert Spetzler, MD; George A. Sisson, Sr, MD; Gerald M. Pohost, MD; William H. Oldendorf, MD, DSc; Thomas F. Meaney, MD; Alexander R. Margulis, MD; Lawrence D. Jacobs, MD; Jack Greenberg, MD; Ira R. Friedlander, MD; Donald Bennett, MD; William T. McGivney, PhD; William R. Hendee, PhD; Henry N. Wagner, Jr, MD; Jack P. Strong, MD; Richard M. Steinhilber, MD; Joseph H. Skom, MD; William C. Scott, MD; Paul S. Salva, PhD; John H. Moxley, III, MD; William R. Kennedy, MD; Ira R. Friedlander, MD; E. Harvey Estes, Jr, MD; George M. Bohigian, MD; John R. Beljan, MD
[+] Author Affiliations

This report was submitted to the House of Delegates at the 1986 Interim Meeting as an informational report.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of scientific literature as of December 1986.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (William R. Hendee, PhD).


JAMA. 1988;259(2):253-259. doi:10.1001/jama.1988.03720020055037
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State-of-the-art magnetic resonance imaging (MRI) generates high-resolution images of the cardiovascular system. Conventional MRI techniques provide images in six to ten minutes per tomographic slice. New strategies have substantially improved the speed of imaging. The technology is relatively expensive, and its cost-effectiveness remains to be defined in relation to other effective, less expensive, and noninvasive technologies, such as echocardiography and nuclear medicine. The ultimate role of MRI will depend on several factors, including the development of specific applications such as (1) noninvasive angiography, especially of the coronary arteries; (2) noninvasive, highresolution assessment of regional myocardial blood flow distribution (eg, using paramagnetic contrast agents); (3) characterization of myocardial diseases using proton-relaxation property changes; and (4) evaluation of in vivo myocardial biochemistry. The three-dimensional imaging capability and the ability to image cardiovascular structures without contrast material give MRI a potential advantage over existing noninvasive diagnostic imaging techniques. This report analyzes current applications of MRI to the cardiovascular system and speculates on their future.

(JAMA 1988;259:253-259)

REFERENCES

For an explanation of the scoring system see the dagger footnote section of the Table.
Pohost GM, Canby RC:  Nuclear magnetic resonance imaging: Current applications and future prospects. Circulation 1987;;75:88-95.
Pohost GM, Reeves RC, Evanochko WT:  Nuclear magnetic resonance: Potential clinical relevance to the cardiovascular system. Circulation 1985;;72; (5) :IV-111-121.
Dinsmore RE, Wismer GL, Levin RA, et al:  Magnetic resonance imaging of the heart: Positioning and gradient angle selection for optimal imaging planes. AJR 1984;;143:1135-1142.
Haase A, Frahm J, Matthaei D, et al:  FLASH imaging: Rapid NMR imaging using low flip-angle pulses. J Magn Reson 1986;;67:258-266.
Frahm J, Haase A, Matthaei D:  Rapid NMR imaging of dynamic processes using the FLASH technique. Magn Reson Med 1986;;3:321-327.
Ratner AV, Okada RD, Newell JB, et al:  The relationship between proton NMR relaxation parameters and myocardial perfusion with acute coronary artery occlusion and reperfusion. Circulation 1985;;71:823-828.
Wesbey G, Higgins CB, Lanzer P, et al:  Imaging and characterization of acute myocardial infarction in vivo by gated nuclear magnetic resonance. Circulation 1984;;69:125-130.
McNamara MT, Higgins CB, Schechtmann N, et al:  Detection and characterization of acute myocardial infarction in man with use of gated magnetic resonance. Circulation 1985;;71:717-724.
Von Schulthess GK, Fisher M, Crooks LE, et al:  Gated MR imaging of the heart: Intracardiac signals in patients and healthy subjects. Radiology 1985;;156:125-132.
Filipchuk NG, Peshock RM, Malloy CR, et al:  Detection and localization of recent myocardial infarction by magnetic resonance imaging. Am J Cardiol 1986;;58:214-219.
Higgins CB, Lanzer P, Stark D, et al:  Imaging by nuclear magnetic resonance in patients with chronic ischemic heart disease. Circulation 1984;;69:523-531.
Fletcher BD, Jacobstein MD, Nelson AD, et al:  Gated magnetic resonance imaging of congenital cardiac malformations. Radiology 1984;;150:137-140.
Higgins CB, Byrd BF, McNamara MT, et al:  Magnetic resonance imaging of the heart: A review of the experience in 172 subjects. Radiology 1985;;155:671-679.
Schiebler ML, Axel L, Reichek N, et al: Rapid small flip angle (CINE) magnetic resonance imaging (C-MRI) of mitral valve insufficiency. Abstracts from the fifth annual meeting of the Society of Magnetic Resonance Imaging, San Antonio, Tex, Feb 28—March 4, 1987.
Goldman MR, Brady TJ, Pykett IL, et al:  Quantification of experimental myocardial infarction using nuclear magnetic resonance imaging and paramagnetic ion contrast enhancement in excised canine heart. Circulation 1982;;66:1012-1016.
McNamara MT, Higgins CB, Ehman RL, et al:  Acute myocardial ischemia: Magnetic resonance contrast enhancement with gadolinium-DTPA. Radiology 1984;;153:157-163.
Van Dijk P:  Direct cardiac NMR imaging of heart wall and blood flow velocity. J Comput Assist Tomogr 1984;;8:429-436.
Wedeen VJ, Rosen BR, Chesler D, et al:  MR velocity imaging by phase display. J Comput Assist Tomogr 1985;;9:530-536.
Wedeen VJ, Rosen BR, Buxton R, et al:  Projective MRI angiography and quantitative flow-volume densitometry. Magn Reson Med 1986;;3:226-241.
Meuli RA, Weeden VJ, Geller SC, et al:  MR gated subtraction angiography: Evaluation of lower extremities. Radiology 1986;;159:411-418.
Herfkens RJ, Higgins CB, Hricak H, et al:  Nuclear magnetic resonance imaging of atherosclerotic disease. Radiology 1983;;148:161-166.
Higgins CB, Byrd BF, Farmer DW, et al:  Magnetic resonance imaging in patients with congenital heart disease. Circulation 1984;;70:851-860.
Boxer RA, Singh S, LaCorte MA, et al:  Cardiac magnetic resonance imaging in children with congenital heart disease. J Pediatr 1986;;109:460-464.
Higgins CB, Byrd BF, Starck D, et al:  Magnetic resonance imaging in hypertrophic cardiomyopathy. Am J Cardiol 1985;;55:1121-1126.
Thompson RC, Canby RC, Lojeski EW, et al:  Adriamycin cardiotoxicity and proton nuclear magnetic resonance properties, abstracted. Am Heart J 1987;;113:1444-1449.
Ratner AV, Barrett LV, Gang DL:  Alterations of the proton nuclear magnetic resonance spin-lattice relaxation time (T1) in rejecting cardiac allografts, abstracted. J Am Coll Cardiol 1984;;3:538.
Soulen RL, Stark D, Higgins CB:  Magnetic resonance imaging of constrictive pericardial disease. Am J Cardiol 1985;;55:480-484.
Amparo EG, Higgins CB, Hoddick W, et al:  Magnetic resonance imaging of aortic disease: preliminary results. AJR 1984;;143:1203-1209.
Lee JKT, Ling D, Heiken JP, et al:  Magnetic resonance imaging of abdominal aortic aneurysms. AJR 1984;;143:1197-1202.
Geisinger MA, Risius B, O'Donnell JA, et al:  Thoracic aortic dissections: Magnetic resonance imaging. Radiology 1985;;155:407-412.
Amparo EG, Higgins CB, Hricak H, et al:  Aortic dissection: Magnetic resonance imaging. Radiology 1985;;155:399-406.
Dinsmore RE, Liberthson RR, Wismer GL, et al:  Magnetic resonance imaging of thoracic aortic aneurysms: Comparison with other imaging methods. AJR 1986;;146:309-314.
Amparo EG, Higgins CB, Farmer D, et al:  Gated MRI of cardiac and paracardiac masses: Initial experience. AJR 1984;;143:1151-1156.

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For an explanation of the scoring system see the dagger footnote section of the Table.
Pohost GM, Canby RC:  Nuclear magnetic resonance imaging: Current applications and future prospects. Circulation 1987;;75:88-95.
Pohost GM, Reeves RC, Evanochko WT:  Nuclear magnetic resonance: Potential clinical relevance to the cardiovascular system. Circulation 1985;;72; (5) :IV-111-121.
Dinsmore RE, Wismer GL, Levin RA, et al:  Magnetic resonance imaging of the heart: Positioning and gradient angle selection for optimal imaging planes. AJR 1984;;143:1135-1142.
Haase A, Frahm J, Matthaei D, et al:  FLASH imaging: Rapid NMR imaging using low flip-angle pulses. J Magn Reson 1986;;67:258-266.
Frahm J, Haase A, Matthaei D:  Rapid NMR imaging of dynamic processes using the FLASH technique. Magn Reson Med 1986;;3:321-327.
Ratner AV, Okada RD, Newell JB, et al:  The relationship between proton NMR relaxation parameters and myocardial perfusion with acute coronary artery occlusion and reperfusion. Circulation 1985;;71:823-828.
Wesbey G, Higgins CB, Lanzer P, et al:  Imaging and characterization of acute myocardial infarction in vivo by gated nuclear magnetic resonance. Circulation 1984;;69:125-130.
McNamara MT, Higgins CB, Schechtmann N, et al:  Detection and characterization of acute myocardial infarction in man with use of gated magnetic resonance. Circulation 1985;;71:717-724.
Von Schulthess GK, Fisher M, Crooks LE, et al:  Gated MR imaging of the heart: Intracardiac signals in patients and healthy subjects. Radiology 1985;;156:125-132.
Filipchuk NG, Peshock RM, Malloy CR, et al:  Detection and localization of recent myocardial infarction by magnetic resonance imaging. Am J Cardiol 1986;;58:214-219.
Higgins CB, Lanzer P, Stark D, et al:  Imaging by nuclear magnetic resonance in patients with chronic ischemic heart disease. Circulation 1984;;69:523-531.
Fletcher BD, Jacobstein MD, Nelson AD, et al:  Gated magnetic resonance imaging of congenital cardiac malformations. Radiology 1984;;150:137-140.
Higgins CB, Byrd BF, McNamara MT, et al:  Magnetic resonance imaging of the heart: A review of the experience in 172 subjects. Radiology 1985;;155:671-679.
Schiebler ML, Axel L, Reichek N, et al: Rapid small flip angle (CINE) magnetic resonance imaging (C-MRI) of mitral valve insufficiency. Abstracts from the fifth annual meeting of the Society of Magnetic Resonance Imaging, San Antonio, Tex, Feb 28—March 4, 1987.
Goldman MR, Brady TJ, Pykett IL, et al:  Quantification of experimental myocardial infarction using nuclear magnetic resonance imaging and paramagnetic ion contrast enhancement in excised canine heart. Circulation 1982;;66:1012-1016.
McNamara MT, Higgins CB, Ehman RL, et al:  Acute myocardial ischemia: Magnetic resonance contrast enhancement with gadolinium-DTPA. Radiology 1984;;153:157-163.
Van Dijk P:  Direct cardiac NMR imaging of heart wall and blood flow velocity. J Comput Assist Tomogr 1984;;8:429-436.
Wedeen VJ, Rosen BR, Chesler D, et al:  MR velocity imaging by phase display. J Comput Assist Tomogr 1985;;9:530-536.
Wedeen VJ, Rosen BR, Buxton R, et al:  Projective MRI angiography and quantitative flow-volume densitometry. Magn Reson Med 1986;;3:226-241.
Meuli RA, Weeden VJ, Geller SC, et al:  MR gated subtraction angiography: Evaluation of lower extremities. Radiology 1986;;159:411-418.
Herfkens RJ, Higgins CB, Hricak H, et al:  Nuclear magnetic resonance imaging of atherosclerotic disease. Radiology 1983;;148:161-166.
Higgins CB, Byrd BF, Farmer DW, et al:  Magnetic resonance imaging in patients with congenital heart disease. Circulation 1984;;70:851-860.
Boxer RA, Singh S, LaCorte MA, et al:  Cardiac magnetic resonance imaging in children with congenital heart disease. J Pediatr 1986;;109:460-464.
Higgins CB, Byrd BF, Starck D, et al:  Magnetic resonance imaging in hypertrophic cardiomyopathy. Am J Cardiol 1985;;55:1121-1126.
Thompson RC, Canby RC, Lojeski EW, et al:  Adriamycin cardiotoxicity and proton nuclear magnetic resonance properties, abstracted. Am Heart J 1987;;113:1444-1449.
Ratner AV, Barrett LV, Gang DL:  Alterations of the proton nuclear magnetic resonance spin-lattice relaxation time (T1) in rejecting cardiac allografts, abstracted. J Am Coll Cardiol 1984;;3:538.
Soulen RL, Stark D, Higgins CB:  Magnetic resonance imaging of constrictive pericardial disease. Am J Cardiol 1985;;55:480-484.
Amparo EG, Higgins CB, Hoddick W, et al:  Magnetic resonance imaging of aortic disease: preliminary results. AJR 1984;;143:1203-1209.
Lee JKT, Ling D, Heiken JP, et al:  Magnetic resonance imaging of abdominal aortic aneurysms. AJR 1984;;143:1197-1202.
Geisinger MA, Risius B, O'Donnell JA, et al:  Thoracic aortic dissections: Magnetic resonance imaging. Radiology 1985;;155:407-412.
Amparo EG, Higgins CB, Hricak H, et al:  Aortic dissection: Magnetic resonance imaging. Radiology 1985;;155:399-406.
Dinsmore RE, Liberthson RR, Wismer GL, et al:  Magnetic resonance imaging of thoracic aortic aneurysms: Comparison with other imaging methods. AJR 1986;;146:309-314.
Amparo EG, Higgins CB, Farmer D, et al:  Gated MRI of cardiac and paracardiac masses: Initial experience. AJR 1984;;143:1151-1156.
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