Myocardial MR Imaging in Ischemic Heart Disease

Abstract

In developed countries, coronary artery disease (CAD) continues to be a major cause of death and disability. By 2020, ischemic heart disease will be the first cause of deaths worldwide. Since introduction of the cardiac MRI as a non-invasive tool for depiction of the coronary artery disease, the clinical value of myocardial MRI has been subject for research work. Several comparative studies for evaluation of cardiac MRI as a diagnostic tool for coronary artery disease using the conventional angiography as the gold standard have been published. The results of these researches concluded that cardiac MRI is considered as accurate imaging tool in detection of myocardial ischemia and viability. Recently developed high field MR magnet and improvements of the used MR protocols allows high spatial and temporal resolutions with considerably reduced acquisition times, reflecting on the image quality leading to better results. The current studies demonstrates that CMR using multimodality protocol including cine function, rest perfusion and delayed enhancement could be valuable in detection of coronary artery disease with relatively high sensitivity. However, stress first pass perfusion MR technique is essential for increasing sensitivity for detection of diseased coronary territory, particularly ischemic viable myocardial segments. Potential role for cardiac MRI as a non-invasive modality in evaluation of the coronary artery disease, include the following conditions:  Detection of diseased coronary territory in patients suspecting or known to have CAD with high sensitivity and specificity.  Differentiation between ischemic and dilated cardiomyopathy.  Assessment of myocardial viability, delineation of myocardial scarring with no need of stress agents, and thus it is necessary to preoperatively predict the functional recovery.  Accurate determination of ischemic viable myocardial segments provided using rest/stress first pass perfusional MR sequences.  Diagnosis of the associated complications of myocardial infarction in one examination setting.

In conclusion, resting cardiac MR could be valuable in detection of significant coronary artery disease with relatively higher sensitivity values. In addition, it shows high accuracy in detection and delineation of myocardial scarring, particularly the subendocardial scarring.