Cardiovascular Magnetic Resonance PDF
Preview Cardiovascular Magnetic Resonance
OXFORD MEDICAL PUBLICATIONS Cardiovascular Magnetic Resonance Oxford Specialist Handbooks published and forthcoming General Oxford Specialist Oxford Specialist Handbooks in Handbooks Neurology A Resuscitation Room Guide Epilepsy Addiction Medicine Parkinson’s Disease and Other Movement Hypertension Disorders Perioperative Medicine, Stroke Medicine Second Edition Oxford Specialist Handbooks in Post-Operative Complications, Paediatrics Second Edition Paediatric Dermatology Pulmonary Hypertension Paediatric Endocrinology and Diabetes Renal Transplantation Paediatric Gastroenterology, Hepatology, Oxford Specialist Handbooks in and Nutrition Anaesthesia Paediatric Haematology and Oncology Cardiac Anaesthesia Paediatric Intensive Care Day Case Surgery Paediatric Nephrology General Thoracic Anaesthesia Paediatric Neurology Neuroanaethesia Paediatric Palliative Care Obstetric Anaesthesia Paediatric Radiology Paediatric Anaesthesia Paediatric Respiratory Medicine Regional Anaesthesia, Stimulation and Oxford Specialist Handbooks in Ultrasound Techniques Psychiatry Oxford Specialist Handbooks in Child and Adolescent Psychiatry Cardiology Old Age Psychiatry Adult Congenital Heart Disease Oxford Specialist Handbooks in Cardiac Catheterization and Coronary Radiology Intervention Interventional Radiology Cardiac Electrophysiology Musculoskeletal Imaging Cardiovascular Magnetic Resonance Pulmonary Imaging Echocardiography Fetal Cardiology Oxford Specialist Handbooks in Heart Failure Surgery Nuclear Cardiology Cardiothoracic Surgery Pacemakers and ICDs Colorectal Surgery Valvular Heart Disease Hand Surgery Liver and Pancreatobiliary Surgery Oxford Specialist Handbooks in Operative Surgery, Second Edition Critical Care Oral Maxillofacial Surgery Advanced Respiratory Critical Care Otolaryngology and Head and Neck Oxford Specialist Handbooks Surgery in End of Life Care Paediatric Surgery End of Life Care in Dementia Plastic and Reconstructive Surgery End of Life Care in Nephrology Surgical Oncology End of Life in the Intensive Urological Surgery Care Unit Vascular Surgery Oxford Specialist Handbooks in Cardiology Cardiovascular Magnetic Resonance Edited by Saul G. Myerson Consultant Cardiologist, Honorary Senior Clinical Lecturer, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK Jane Francis Chief Technologist, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK and Stefan Neubauer Professor of Cardiovascular Medicine, Clinical Director, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2010 The moral rights of the author have been asserted Database right Oxford University Press (maker) First edition published 2010 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Glyph International, Ltd., Bangalore, India Printed in China on acid-free paper through Asia Pacifi c Offset ISBN 978–0–19–954957–3 10 9 8 7 6 5 4 3 2 1 Disclaimer The scan/analysis techniques described in this book are intended as a guide only, and Oxford University Press and the authors make no representation, express or implied, that these are universally applicable. Oxford University Press also make no representa- tion that the drug dosages in this book are correct. Readers must therefore always rely on their own good clinical practice, check with the MR system and software man- ufacturers that the techniques applied are safe and appropriate, and check the drug product information with the most up-to-date published product information and data sheets provided by the manufacturers, and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. v Foreword Cardiovascular magnetic resonance (CMR) is fast becoming the gold standard for visualizing the heart and large arteries. This book, one of a series published by Oxford University Press, is written by established experts in the fi eld, from internationally renowned CMR centres, and will appeal both to those who want to learn more about this technique and those who are already expert. Cardiologists have had excellent diagnostic imaging tools at their disposal for decades, though in recent years CMR has provided a much more accurate and refi ned look at the anatomy, func- tion, and in particular, the tissue characteristics of the myocardium, such as fi brosis and oedema – aspects which have previously been inaccessible. As a result, this relatively new imaging modality has rapidly become an impor- tant part of diagnostic cardiac imaging. There is still, however, a shortfall in training opportunities, and this handbook should play an important role, particularly with its focus on the practical aspects of acquiring and inter- preting images. Established practitioners will also fi nd its quick reference and practical format an invaluable aide-mémoire. Chapters that particularly caught my eye, refl ecting my own interests, included the fi rst chapter explaining the concept of CMR with clarity and skill; the chapters on ventricular function, and in ischaemic heart disease including myocardial viability, and a challenging fi nal chapter on ‘new hori- zons’ for CMR. There are many areas where the book makes timely con- tributions. For example, an exact assessment of myocardial infarct size is rapidly becoming more and more important as the new therapeutic concept of postconditioning takes hold. Current therapy is moving towards a situation where prompt myocardial reperfusion is no longer suffi cient. Rather, lethal reperfusion-induced cell necrosis must also be limited. To meet these requirements, CMR will certainly be used, and its potential and practical application is well explained here. When combined with myo- cardial perfusion imaging, a comprehensive assessment in ischaemic heart disease can be obtained – CMR acquires a dynamic sequence of images during the passage of the contrast medium through the heart, with excel- lent sensitivity and good specifi city for detecting myocardial ischaemia. Its diagnostic potential is at least equal to that of nuclear perfusion imaging and is likely to become an important mainstream clinical test. In the future, using the blood oxygenation level-dependent (BOLD) effect, CMR may even potentially assess myocardial tissue oxygenation without the need for a contrast agent. Although CMR is already the most versatile of all cardiovascular imaging techniques, it is likely to see further major developments and the authors conclude that ‘In future, targeted molecular imaging may accelerate and re-defi ne diagnosis, provide more precise disease characterization, enable specifi c treatments to be targeted in individual patients, enable drug delivery to the site of pathology and monitor responses to treatment’. vi FOREWORD What more can we wish for? There has probably never been a more interesting time to become a cardiac imager nor for those who want to learn about CMR! Professor Lionel H Opie, MD, DPhil (Oxon), DSc, FRCP Director, Hatter Cardiovascular Research Institute, Department of Medicine, University of Cape Town Honorary Professor, Department of Medicine, University College London vii Preface Cardiovascular Magnetic Resonance (CMR) has become an important imaging modality in clinical cardiology. Recent developments in magnet and coil design, imaging sequences and image post-processing now allow imaging of cardiac anatomy, function, perfusion and viability with superb resolution, providing clinicians with unprecedented detail for the evalua- tion of cardiovascular disease. The rapidly growing interest from cardi- ology and radiology centres around the world is testimony to this. CMR is a complex imaging modality however, with many aspects to master: MR theory, image acquisition and analysis, interpretation and reporting. A number of outstanding text books on CMR have been published in recent years, but while these books provide scholarly and comprehensive infor- mation on the state of the fi eld, no previous book has focused on the practical aspects of CMR scanning in daily practice. Cardiovascular Magnetic Resonance (Oxford Specialist Handbook) is designed as a practical guide on performing, analysing and interpreting CMR scans. It is not meant as a comprehensive text book, but covers all major disease areas in suffi cient detail. It is aimed at all CMR users, par- ticularly those new to CMR, though we hope that even the advanced user will fi nd useful tips and tricks. The format is designed to be easily acces- sible and is laid out in easy to navigate sections, as with other handbooks. It is meant as a quick-reference guide to live near the MR console and case viewing station, or on the offi ce shelf. The book has three main sections: understanding CMR (the physics and technical aspects), practical aspects of scan acquisition (including patient safety and preparation, scan protocols, optimal image acquisi- tion and standard views), and integrated pathology (what imaging to use for each major cardiology diagnoses, and how to interpret the images). Each chapter is focussed on the clinical context, and examples of typical CMR reports are presented for the most common CMR indications. The book is kept as generally applicable as possible, including all MR scanner manufacturers, though where technical aspects are specifi c to individual vendors, this has been noted. We hope that you will fi nd Cardiovascular Magnetic Resonance an enjoy- able and valuable tool for your CMR practice, and provide you with as much satisfaction as we have enjoyed! Saul G. Myerson Jane Francis Stefan Neubauer Editors viii Acknowledgement The editors are most grateful to Dr Carmel Hayes, Siemens Healthcare, for her detailed, competent and excellent advice on all chapters of the book, which has provided an MR system manufacturer perspective. The book is not vendor-specifi c however, and is applicable to all MR system manufacturers. ix Contents Detailed contents xi Contributors xvii Symbols and abbreviations xix 1 Understanding cardiovascular magnetic resonance 1 2 Scan set-up and optimization 35 3 Image acquisition and standard views 71 4 Image processing 127 5 Ventricular function assessment 145 6 Ischaemic heart disease 155 7 Inheritable cardiomyopathies 177 8 Myocardial infl ammation and infi ltration 193 9 Tumours and masses 213 10 Valve disease 235 11 Pericardial disease 293 12 Congenital heart disease 309 13 Aortic disease 355 14 Peripheral arteries 383 15 Coronary magnetic resonance imaging 399 16 Systemic and pulmonary veins 409 17 Extracardiac fi ndings 425 18 New horizons for CMR 459 Index 467
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