R E V I E W www.nature.com/clinicalpractice/cardio Technology Insight: MRI of the myocardium Dipan J Shah, Robert M Judd and Raymond J Kim* This article offers the opportunity to earn one
category 1 credit toward the AMA physicians
recognition award. INTRODUCTION MRI is emerging as the method of choice for
the evaluation of a wide range of cardiovascular
disorders. Its advancing role is related largely to a
variety of innovations that are being rapidly trans-
lated from the bench to routine clinical practice.
As in other imaging modalities, such as CT, echo-
cardiography and radionuclide imaging, innova-
tions in MRI arise from technical improvements
in hardware, which allow increasingly rapid and
robust data acquisition. Unlike in other modali-
ties, however, many advances are purely a result
of changes in software programsMRI pulse
sequenceswithout any hardware modifications.
These different pulse sequences enable multiple
variant sets of raw data to be gathered from one
regiona feature unique to MRI, which provides
it with the potential to probe a vast number of
biological properties with the same machine (e.g.
blood perfusion, contractile function, presence of
fat, thrombus, infarction, etc.). Unfortunately, this
feature is also responsible for an increase in the
complexity of MRI, since the operator must first
determine the appropriate biological property or
properties to assess for each clinical scenario, and
then select the correct pulse sequence or sequences
to highlight these properties. In addition, for each
pulse sequence there are many sequence para-
meters that need to be set correctly in order to
achieve optimum image quality. The purpose of this article is to highlight the unique ability of MRI, via different pulse
sequences, to provide a multifaceted approach to
imaging the myocardium. We provide examples
of where this approach can have a direct effect
on clinical decision making. PULSE SEQUENCES Most imaging methods rely predominantly on a
single parameter to differentiate between tissues
in the body. For instance, ultrasound images MRI is emerging as the method of choice for the evaluation of a wide
variety of cardiovascular disorders. A major advantage of this technique
over the other cardiac imaging modalities is the fact that it allows the
operatorvia special software programs called pulse sequencesto probe
a vast array of biological properties while using the same machine. In this
review, we provide the reader with a brief overview of the pulse sequence
concept and how it enables MRI practitioners to pursue a multifaceted
approach to evaluating the myocardium. We discuss how MRI technology
makes this imaging method ideally suited to the assessment of cardiac
morphology, contractile function, myocardial perfusion and infarction.
In addition, we present clinical scenarios in which the performance of
multifaceted imaging by MRI can alter clinical decision making. KEYWORDS cardiac mass, MRI, perfusion, ventricular function, viability DJ Shah is Director of the Nashville Cardiovascular Magnetic Resonance
Institute, The Heart Group, PLLC, Brentwood, TN, USA. RM Judd and
RJ Kim are Co-Directors of the Duke Cardiovascular Magnetic Resonance
Center, Duke University Medical Center, Durham, NC, USA. Correspondence *Duke Clinic, Orange Zone, Room 4231, Trent Drive Durham, NC 27710, USA
raymond.kim@dcmrc.mc.duke.edu Received 30 March 2005 Accepted 16 August 2005 www.nature.com/clinicalpractice
doi:10.1038/ncpcardio0352 REVIEW CRITERIA
All articles were identified from our own database. All referenced articles were
full-text, English-language papers, published between the years 1980 and 2005. S U M M A R Y C M E NOVEMBER 2005 VOL 2 NO 11 NATURE CLINICAL PRACTICE CARDIOVASCULAR MEDICINE 597 Nature Publishing Group