The target audience are clinicians involved in pediatric cardiac imaging and scientists involved in development and optimization of cardiac MR for use in children At the end of this session the participants should have a better understanding of the use and power of cardiac MR in the assessment of paediatric and congenital cardiac disease.In addition, they should be made aware of the problems associated with pediatric cardiac MRI and current and possible future solutions.

The uses of cardiac MR in children will be reviewed. In particular, conventional techniques for assessment of ventricular volumes, blood flow and anatomy will be addressed. Benefits of these techniques over other imaging modalities (such as echocardiography and x-ray angiography) will be discussed.

The main problem associated with performing cardiac MRI in children; namely poor patient compliance will be addressed. Specifically, children often have difficulty complying with breath hold instructions and dislike being in the scanner environment. Further problems are: a) complex disease requiring comprehensive anatomic and hemodynamic assessment, b) high heart rates requiring high temporal resolution imaging and c) small cardiovascular structures requiring high spatial resolution imaging. Currently, the conventional solution to these problems is general anesthesia, which is associated with some risks to the child and is a costly procedure for the institution. Thus, new approaches are required.

These problems can be solved by removing the need for breath holds and by reducing total acquisition time. One method by which breath-holds can be eliminated is to use real-time imaging. However, due to the nature of the pediatric cardiovascular system it is necessary to acquire data at high spatial and temporal resolution. This limits the use of conventional real-time imaging. Recently new fast imaging techniques have revolutionized real-time imaging, allowing high spatial and temporal resolution acquisitions. This is particularly true of methods that utilize k-t techniques and compressed sensing. In this session, the development of accelerated real-time cardiac imaging will be reviewed. Specific time will be spent on reviewing methodologies for ventricular function and flow quantification as well as time resolved angiography. Another method of removing the need for breath-holds is to use motion correction. The use of conventional navigators will be addressed with the use of self-navigation being highlighted. This will include a discussion of the different methods of measuring respiratory motion form the raw MR data itself. In addition, the benefits of motion correction will be described and the utility of such techniques for 3D and 4D imaging. Finally, simple methods of improving the patient experience will be described to aid current practice.There will be a wide discussion of studies that have utilized accelerated techniques in children. In particular, techniques that have resulted in a shift in types of children that can undergo cardiac MRI will be described. This will include case studies where new MR techniques have changed clinical practice, for instance in pediatric pulmonary hypertension. Cost benefit analysis of these new accelerated techniques will also be discussed and compared with other conventional imaging techniques such as echocardiography. Finally, new techniques that may have an important role in pediatric cardiac imaging will be discussed. This will include a discussion of 4D flow acquisitions, their benefits, problems and possible uses. The future of pediatric cardiac imaging will be discussed with specific consideration given to the costs related to this imaging technique within shrinking health care budgets. The development of disruptive new technologies and their capacity to reduce costs and improve patient experience will be described. To conclude, cardiac MR has an important role to play in the diagnosis and management of pediatric and congenital heart disease. Conventional imaging provides a reference standard method of assessing cardiac function, blood flow three dimensional anatomy. However, in children new accelerated techniques are important to improve patient compliance and reduce costs. With these new technique it may be possible to perform rapid throughput low cost MR that may replace older and less comprehensive imaging modalities.