Synopsis

Keywords: Cardiovascular: Cardiac

Cardiac MRI can be challenging in patients for a variety of reasons. Heart rates may be undesirable to obtain information need for the images. Twenty second breath holds may be difficult for a patient to maintain. Body habitus can place the heart in an orientation that will need a larger field of view. Patients with implanted devices may need to be scanned on 1.5T or lower field strength scanners to reduce artifacts. Ideally, image reconstruction should keep pace with the images acquisition.

Syllabus

Cardiac MRI can be challenging in patients for a variety of reasons. A high heart rate associated with pediatrics or adults with disease have a small diastolic window for capturing data. Arrythmias may have a long quite time, but come in an irregular pattern. Patients with very low heart rates can have up to 600ms to acquire date, but probably don’t have the ability to for a 20 seconds breath hold. Following breath hold instructions can be difficult when there is a language barrier. Even with an interpreter, there is an inherent delay. A patient’s body habitus and orientation of the heart can pose an issue in regards to field of view (FOV). The heart is usually tipped down and pointed to the left giving the short axis slices a somewhat sagittal view moving right to left for base to apex. A tall thin person may have a heart that sits vertically. Therefore, base to apex will go head to foot in an axial plane. Images can also be in the coronal plane when the apex it pointed to the sternum. Function and delayed enhancement only studies were the bread and butter of cardiac MRI. Through the years, additions such as flow, pharmacological stress perfusion, quantitative mapping, and tissue characterization have turned it into a full meal. Obtaining the images needed to answer the question asked can trim down the time a patient is in the scanner. This will help with claustrophobic patients that will not be able to spend 60 minutes in the bore. Patients with MRI conditional implanted devices can be problematic due to artifacts. Having this information in advance of scheduling the patient will determine which field strength scanner the patient should occupy. Image reconstruction time also plays a part in the overall length of the study. Ideally images should be seen as they are acquired to assess for slice prescription and quality. This talk will define what makes a patient challenging based on my observations over the last 20 years of scanning cardiac MRI studies. Then, pose suggestions for the best way to deal with those challenges in an efficient manner.

Acknowledgements

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References

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