Part 1: Introduction to CMR

1. MRI physics

ONLINE

There are plenty of online physics courses. If you are an SCMR member, see the members’ only online education, where there is:

• a 15 module physics course from GE
• a 238 page physics course from Siemens
• a cardiac anatomy overview by Siemens
• a ‘cardiac views’ by Philips

see also:

• Revisemri.com also has great interactive and animated tutorials.
• Hull physics lecture series.
• The Basics of MRI
• Simply Physics
• MRI Tutor web site
• Magnetic Resonance - Technology Information Portal
• The Physics of MRI

BOOKS

• MRI made easy (…well almost). Published by Schering, author Prof Dr Hans H Schild. This is a really great introduction. It can be bought online, or via Schering (now Bayer), who make magnevist, and sometimes give away copies at meetings.
• MRI in practice, Catherin Westbrook, Carolyn Kaut Roth, Blackwell publishing; ISBN-13:978-14051-2787-5
• The Physics of Clinical MR Taught Through Images . Val M. Runge, ISBN-13: 9781588903228, ISBN-10: 1588903222 Publisher: THIEME NEW YORK
• All You Really Need to Know about MRI Physics Moriel NessAiver, ISBN-13: 9780966098204, ISBN-10: 096609820X Publisher: SIMPLY PHYSICS

2. CMR introduction and textbooks

SMALL BOOKS

• Cardiovascular Magnetic Resonance Made Easy (Paperback) by Anitha Varghese and Dudley J. Pennell. This is due out October 2007.
• Pocket Atlas of Cardiac MRI (Radiology Pocket Atlas) by Pamela K Woodard, Jeffrey J. Brown, and Charles B. Higgins (Paperback - 1 Sep 2004)
• An Introduction to Cardiovascular Magnetic Resonance by Raad H. Mohiadin (Paperback - Aug 2002)

BIG TEXTBOOKS

• Cardiovascular Magnetic Resonance Imaging: A Guide for Fellows in Training (Contemporary Cardiology) by Peter G. Danias (Hardcover - April 2008)
• Cardiac Computed Tomography and Magnetic Resonance by John R. Lesser and Robert S. Schwartz (Hardcover - 15 Dec 2007)
• Cardiovascular MR Imaging: Physical Principles to Practical Protocols by Vivian S. Lee (Hardcover - 1 Dec 2005)
• Clinical Cardiac MRI (Medical Radiology / Diagnostic Imaging) by Jan Bogaert, S. Dymarkowski, and A.M. Taylor (Paperback - Aug 2005)
• Atlas of Practical Applications of Cardiovascular Magnetic Resonance (Developments in Cardiovascular Medicine) by Guillem Pons-Llado and Francesc Carreras (Hardcover - April 2005)
• Cardiovascular Magnetic Resonance by E Nagel, A.C Van Rossum, and E. Fleck (Hardcover - April 2004)
• Cardiovascular MRI and MRA by Charles B. Higgins, Albert de Roos, and Albert De Roos (Hardcover - Sep 2002)
  Manning, Warren J., Pennell Dudley J., Cardiovascular Magnetic Resonance, ISBN 0-443-07519-0 Churchill Livingstone Publishers, 2002

3. CMR official documents

Training and credentialing:

• Training in Advanced Cardiovascular Imaging (Cardiovascular Magnetic Resonance [CMR]).
• Indications for CMR
• SCMR Standardized protocols
• ACR guidelines
• Appropriateness Criteria for CCT and CMR

Part 2: CMR standard techniques and protocols

See SCMR Standardized protocols first

CMR general techniques

• 1. Stress and safety equipment

  "How I Do" CMR Scanning Safely   (SCMR members Only)
  
  GOOD REFERENCES:
  - Shellock FG, et al. Cardiac pacemakers and implantable cardioverter defibrillators: in vitro MRI evaluation at 1.5-tesla .
  J Cardiovasc Magn Reson. 2007;9(1):21-31.
  - Shellock F. G ., Prosthetic heart valves and annuloplasty rings: assessment of magnetic field interactions, heating, and artifacts at 1.5 Tesla .
  J Cardiovasc Magn Reson. 2001;3(4):317-24
  
  Also see the list available on MRI Safety Web site (You must register first)
  
  

• 2. LV structure and function module

  See "How I Do" a CMR Volume Study    (SCMR members Only)
  And Cardiac Views    (SCMR members Only)
  And Cardiac MRI Morphology    (SCMR members Only)
  
  GOOD REFERENCES (there are others):
  - Maceira AM et al: Normalized left ventricular systolic and diastolic function by steady state free precession CMR .
  J Cardiovasc Magn Reson. 2006;8(3):417-26.
  - Hudsmith LE et al. Determination of cardiac volumes and mass with FLASH and SSFP cine sequences at 1.5 vs. 3 Tesla: a validation study .
  J Cardiovasc Magn Reson. 2007;9(4):673-9.
  - Bellenger NG et al . Comparison of LV ejection fraction and volumes in heart failure by twodimensional echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance: are they interchangeable.
  Eur Heart J 2000;21:1387–96.
  
  

• 3. Gadolinium dosing module

  See Gd warnings FDA warning - MHRA warning (UK) - Omniscan statement - Clinical Radiology article - JAMA article UK/European advice (27/6/2007)
  
  

• 4. First pass perfusion module

  2 presentations to compare:
  - "How I Do" Myocardial Perfusion    (SCMR members Only)
  - "How we do Perfusion CMR"    (SCMR members Only)
  
  

• 5. Late gadolinium enhancement module

  See a late enhancement imaging quiz here: questions, Answers
  How We Perform Delayed Enhancement Imaging here

Disease specific protocols - Ischemic heart disease

• 6. Acute MI

  GOOD REFERENCES:
  - Wu KC, et al: Prognostic significance of microvascular obstruction by CMR in patients with acute myocardial infarction .
  Circulation. 1998;97:765-72.
  - Gerber BL, et al: Microvascular obstruction and left ventricular remodeling early after acute MI .
  Circulation. 2000;101:2734-41
  - Choi KM, et al: Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function .
  Circulation 2001;104:1101–7.
  - Kwong RY et.al .Detecting acute coronary syndrome in emergency department with CMR.
  Circulation. 2003;107:531-537
  
  CASES: Microvascular Obstruction by CMR  and Tako-tsubo or Infarction
  
  

• 7. Chronic Ischemic heart disease and Viability

  GOOD REFERENCES: 
  - Kim RJ et al, The Use of Contrast Enhanced MRI to Identify Reversible Myocardial Dysfunction.
  N Engl J Med 2000;343: 1445-53
  - Kim RJ et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age and contractile function.
  Circulation 1999;100:1992-02.
  - A. Wagner et al H. Contrast-enhanced MRI and routine SPECT perfusion imaging for detection of subendocardial MIs: an imaging study. 2003:361:374-379
  
  CASES:   Acquired VSD by CMR   and Troponin +ve Chest pain, normal coronaries
  
  
  

• 8. Dobutamine stress

  See " How we do Dobutamine Stress CMR " (SCMR members Only)
  
  GOOD REFERENCES:
  - Jahnke C et al. Prognostic value of CMR stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging.
  Circulation. 2007;115:1769-76
  - Wahl A et al. Safety and feasibility of high-dose dobutamine-atropine stress CMR for diagnosis of myocardial ischaemia: experience in 1000 consecutive cases.
  - Hundley WG et al. Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography.
  Circulation. 1999;100:1697-702.
  
  
  

• 9. Adenosine stress perfusion

  "How I Do" Myocardial Perfusion    (SCMR members Only)
  "How we do Perfusion CMR"  (SCMR members Only)
  
  GOOD REFERENCES:
  - Gebker R et al. How we perform myocardial perfusion with cardiovascular magnetic resonance.
  J Cardiovasc Magn Reson. 2007;9(3):539-47.
  - Schwitter J et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography.
  Circulation 2001;103:2230–5.

Disease specific protocols - Angiography:

• 10. Peripheral MRA 

  GOOD REFERENCES:
  - Yuan C et al . Identification of fibrous cap rupture with MRI is highly associated with recent transient ischemic attack or stroke .
  Circulation 2002;105:181–5.
  
  

• 11. Thoracic MRA

  See "How I do CMR of the Aorta"  (SCMR members Only)
  
  GOOD REFERENCES:
  - Fayad ZA et al. In vivo MR evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with TOE.
  Circulation 2000;101:2503–9.
  - Wentz KU et al. High-resolution MR resonance angiography of hands with timed arterial compression (tac-MRA).
  Lancet 2003;361:49–50.
  
  CASE : Great vessel pathology
  
  

• 12. Anomalous Coronary arteries

  GOOD REFERENCES: 
  - Kim WY et al. Coronary magnetic resonance angiography for the detection of coronary stenoses.
  N Engl J Med 2001;345:1909
  - Bunce NH et al . Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography.
  Radiology. 2003;227:201-8.
  
  CASE: What course the RCA?
  
  

• 13. Pulmonary Vein Evaluation

  - Dill T et al. Pulmonary vein diameter reduction after radiofrequency catheter ablation for PAF evaluated by contrast-enhanced 3D MRI.
  Circulation 2003;107:845–50.

Disease specific protocols - Others

• 14. Non-ischemic cardiomyopathy

  "How I do" CMR in DCM    (SCMR members Only)  
  
  GOOD REFERENCES: DCM:
  - McCrohon JA et al Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced CMR .
  Circulation. 2003;108:54-9. 
  
  "How I do" CMR in HCM (SCMR members Only)
  
  GOOD REFERENCES: HCM
  - Moon JC et al. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance .
  J Am Coll Cardiol. 2003;41:1561-7.
  
  CASES: High Risk HCM and HCM with multi-level obstruction and  HCM with LVOT obstruction by CMR
  
  GOOD REFERENCES: SARCOID
  - Smedema JP et al. Evaluation of the accuracy of gadolinium-enhanced CMR in the diagnosis of cardiac sarcoidosis .
   J Am Coll Cardiol. 2005;45:1683-90.
  
  GOOD REFERENCES: AMYLOID
  - Maceira AM et al. CMR in cardiac amyloidosis.
  Circulation. 2005;111:186-93.
  
  GOOD REFERENCES: MYOCARDITIS
  - Mahrholdt H et al. CMR assessment of human myocarditis: a comparison to histology and molecular pathology.
  Circulation. 2004;109:1250-8.
  
  CASE: Myocarditis
  
  

• 15. ARVC

  "How I Do" CMR of ARVC/D (SCMR members Only)
  
  GOOD REFERENCES:
  - Sen-Chowdhry S et al CMR in arrhythmogenic right ventricular cardiomyopathy revisited: comparison with task force criteria and genotype .
  J Am Coll Cardiol. 2006;48:2132-40.
  
  CASES: ARVC with LV involvement and Delayed enhancement-targeted biopsy
  
  

• 16. Congenital heart disease

  How I do" CMR of repaired Tetralogy of Fallot  (SCMR members Only)
  
  CASES: Coarctation, MS and bicuspid AoV and  Double chambered Right Ventricle
  
  

• 17. Valvular heart disease

  "How I do CMR of valvular heart disease" (SCMR members Only)
  
  CASE: Valvular disease by CMR
  
  

• 18. Pericardial disease

  "How I Do" CMR in Pericardial Disease    (SCMR members Only)
  
  GOOD REFERENCE: 
  - Francone M et al. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy .
  Eur Radiol. 2006;16:944-51.
  
  CASE: Pericardial constriction
  
  
  

• 19. Masses

  CASES: Left Atrial Myxoma  and Thrombus or tumor?  (1) and Tumor or Thrombus?  (2)

Special thanks to SCMR and especially to James Moon (James.moon@uclh.nhs.uk )
*.pdf and *.doc placed on www.scmr.org )