Recent Advances in Cardiac Magnetic Resonance Imaging

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Abstract

Cardiac magnetic resonance (CMR) imaging provides accurate anatomic information and advanced soft contrast, making it the reference standard for assessing cardiac volumes and systolic function. In this review, we summarize the recent advances in CMR sequences. New technical development has widened the use of CMR imaging beyond the simple characterization of myocardial scars and assessment of contractility. These novel CMR sequences offer comprehensive assessments of coronary plaque characterization, myocardial fiber orientation, and even metabolic activity, and they can be readily applied in clinical settings. CMR imaging is able to provide new insights into understanding the pathophysiologic process of underlying cardiac disease, and it can help physicians choose the best treatment strategies. Although several limitations, including the high cost and time-consuming process, have limited the widespread clinical use of CMR imaging so far, recent advances in software and hardware technologies have made the future more promising.

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Most cited references 55

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From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.

Morteza Naghavi, Peter Libby, Erling Falk … (2003)

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

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Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI.

Jinyuan Zhou, Jean-Francois Payen, David A H Wilson … (2003)

In the past decade, it has become possible to use the nuclear (proton, 1H) signal of the hydrogen atoms in water for noninvasive assessment of functional and physiological parameters with magnetic resonance imaging (MRI). Here we show that it is possible to produce pH-sensitive MRI contrast by exploiting the exchange between the hydrogen atoms of water and the amide hydrogen atoms of endogenous mobile cellular proteins and peptides. Although amide proton concentrations are in the millimolar range, we achieved a detection sensitivity of several percent on the water signal (molar concentration). The pH dependence of the signal was calibrated in situ, using phosphorus spectroscopy to determine pH, and proton exchange spectroscopy to measure the amide proton transfer rate. To show the potential of amide proton transfer (APT) contrast for detecting acute stroke, pH effects were noninvasively imaged in ischemic rat brain. This observation opens the possibility of using intrinsic pH contrast, as well as protein- and/or peptide-content contrast, as diagnostic tools in clinical imaging.

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Magnetic Resonance Imaging of Glutamate

Kejia Cai, Mohammad Haris, Anup Singh … (2012)

Glutamate (Glu) exhibits a pH and concentration dependent chemical exchange saturation transfer effect (CEST) between its -amine group and bulk water, here termed GluCEST. GluCEST asymmetry is observed at ~3 parts per million downfield from bulk water. Following middle cerebral artery occlusion in the rat brain, an approximately 100% elevation of GluCEST in the ipsilateral side compared to the contralateral side was observed, and is predominantly due to pH changes. In a rat brain tumor model with blood brain barrier disruption, intravenous Glu injection resulted in a clear elevation of GluCEST and a comparable increase in the proton magnetic resonance spectroscopy signal of Glu. GluCEST maps from healthy human brain at 7T were also obtained. These results demonstrate the feasibility and potential of GluCEST for mapping relative changes in Glu concentration as well as pH in vivo. Potential contributions from other brain metabolites to the GluCEST effect are also discussed.

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Author and article information

Journal

Journal ID (nlm-ta): Korean Circ J

Journal ID (iso-abbrev): Korean Circ J

Journal ID (publisher-id): KCJ

Title: Korean Circulation Journal

Publisher: The Korean Society of Cardiology

ISSN (Print): 1738-5520

ISSN (Electronic): 1738-5555

Publication date Collection: February 2019

Publication date (Electronic): 20 November 2018

Volume: 49

Issue: 2

Pages: 146-159

Affiliations

[1 ]Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.

[2 ]Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, Korea.

[3 ]Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

[4 ]Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA.

[5 ]Harvard Medical School, Boston, MA, USA.

Author notes

Correspondence to Hyuk-Jae Chang, MD, PhD. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. hjchang@ 123456yuhs.ac

Author information

Yibin Xie https://orcid.org/0000-0002-0333-567X

Hyuk-Jae Chang https://orcid.org/0000-0002-6139-7545

Article

DOI: 10.4070/kcj.2018.0246

PMC ID: 6351278

PubMed ID: 30468040

SO-VID: 103e02cf-4663-4fe0-9771-c93d8df076c3

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 July 2018

Date revision received : 25 September 2018

Date accepted : 23 October 2018

Funding

Funded by: National Research Foundation of Korea, CrossRef http://doi.org/10.13039/501100003725;

Award ID: 2012027176

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Recent Advances in Cardiac Magnetic Resonance Imaging

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Most cited references 55

From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.

Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI.

Magnetic Resonance Imaging of Glutamate

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