What are the indications for Cardiac Magnetic Resonance Imaging (Cardiac MRI)?

From the Guidelines

Cardiac MRI is indicated for various heart conditions, including assessment of complex congenital heart disease, evaluation of coronary arteries in patients with new onset heart failure, characterization of native and prosthetic cardiac valves, and evaluation of cardiac mass, pericardial conditions, and pulmonary vein anatomy. The primary indications for Cardiac MRI can be broken down into several key areas:

• Assessment of complex congenital heart disease, including anomalies of coronary circulation, great vessels, and cardiac chambers and valves, with a high appropriateness score of 7 1
• Evaluation of cardiac mass, suspected tumor or thrombus, with a high appropriateness score of 8 1
• Evaluation of pericardial conditions, including pericardial mass, constrictive pericarditis, or complications of cardiac surgery, with a high appropriateness score of 8 1
• Evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation, with a high appropriateness score of 8 1
• Noninvasive coronary vein mapping prior to placement of biventricular pacemaker, with a high appropriateness score of 8 1
• Noninvasive coronary arterial mapping, including internal mammary artery prior to repeat cardiac surgical revascularization, with a high appropriateness score of 8 1
• Evaluation of suspected aortic dissection or thoracic aortic aneurysm, with a high appropriateness score of 9 1
• Evaluation of suspected pulmonary embolism, with a high appropriateness score of 9 1

According to the 2014 ESC guidelines for the diagnosis and management of hypertrophic cardiomyopathy, Cardiac MRI with late gadolinium enhancement is recommended in patients with suspected hypertrophic cardiomyopathy who have inadequate echocardiographic windows 1. Additionally, the 2012 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure highlight the value of Cardiac MRI in identifying inflammatory and infiltrative conditions, and in predicting prognosis in patients with these conditions 1.

The procedure typically takes 30-60 minutes and requires patients to hold their breath briefly during image acquisition for optimal quality. However, patients with certain metallic implants, severe claustrophobia, or significant kidney dysfunction may not be suitable candidates due to safety concerns or contraindications to contrast agents.

In terms of specific patient populations, Cardiac MRI is particularly valuable in patients with suspected cardiomyopathy, arrhythmias, suspected cardiac tumors, or pericardial diseases, and is the imaging method of choice in patients with complex congenital heart disease 1. Overall, Cardiac MRI provides excellent soft tissue contrast without radiation exposure, making it a superior imaging modality for tissue characterization in a variety of cardiac conditions.

From the Research

Indications for Cardiac Magnetic Resonance Imaging (Cardiac MRI)

The indications for Cardiac MRI include:

• Evaluation of coronary artery disease (CAD) 2, 3
• Diagnosis and management of cardiomyopathies, such as:
  • Dilated cardiomyopathy 4, 5
  • Hypertrophic cardiomyopathy 4, 5
  • Restrictive cardiomyopathy 4
  • Arrhythmogenic right ventricular disease 4
  • Myocarditis 4
• Assessment of myocardial function, volumes, and scarring 6
• Evaluation of congenital heart disease 6
• Evaluation of heart failure 3, 6
• Evaluation of cardiac masses 6
• Evaluation of pericardial disease 6
• Tissue characterization, including assessment of:
  • Myocardial edema 6
  • Myocardial siderosis 6
  • Myocardial perfusion 6
  • Diffuse myocardial fibrosis 6