MRI Of The Heart And Vessels

by Lombardi, Massimo; Bartolozzi, Carlo; Donato, Luigi

• ISBN13: 9788847003064
• ISBN10: 8847003067
• Format: Hardcover
• Copyright: 2005-06-20
• Publisher: Springer Verlag

Summary

In recent years magnetic resonance imaging (MRI) has enriched the technological potential available for the characterization of cardiovascular pathologies, adding substantial advantages to other non-invasive techniques. This technique, which is intrinsically digital and has reduced operator dependency, allows the performance of image analysis in a quantitative and reproducible manner. The use of non-ionizing energy with the consequent absence of an environmental impact and of operator and patient biohazards makes MRI a winning technique when evaluating the risk a?? benefit ratio in comparison to other imaging methods. In virtue of its added diagnostic value and inherent refinements that allow construction of two- and three-dimensional images, MRI is gaining a primary role in the histopathological and physiopathological understanding of a large number of pathologies concerning the heart and vessels. This text is addressed both to MRI operators seeking specific technical information and to clinicians who wish to have a better understanding of the diagnostic and management advantages that MRI can offer.

Table of Contents

1 Physical principles of imaging with magnetic resonance	1	(30)
Maria Filomena Santarelli
1.1 Introduction	1	(1)
1.2 The phenomenon of magnetic resonance	1	(2)
1.2.1 The nucleus	2	(1)
1.3 Interaction with an external magnetic field	3	(4)
1.3.1 Radio Frequency (RF) pulses	4	(1)
1.3.2 Free Induction Decay (FID)	5	(2)
1.4 Magnetic Resonance interaction with tissues	7	(9)
1.4.1 Proton density	7	(1)
1.4.2 Relaxation	7	(2)
1.4.3 RF pulse sequences	9	(4)
1.4.4 MR signal parameters	13	(3)
1.5 MR imaging	16	(7)
1.5.1 Magnetic field gradients	17	(4)
1.5.2 K-space	21	(2)
1.6 From K-space to the MR image: the Fourier Transform	23	(1)
1.7 MRI hardware	23	(5)
1.7.1 The magnet	24	(2)
1.7.2 Radio frequency coils	26	(1)
1.7.3 Field gradient	27	(1)
1.7.4 Computer	28	(1)
References	28	(3)
2 Techniques of fast MR imaging for studying the cardiovascular system	31	(26)
Maria Filomena Santarelli
2.1 Introduction	31	(1)
2.2 Methods for optimizing K-space covering	31	(11)
2.2.1 Scanning time	31	(2)
2.2.2 Cardiac Gating	33	(2)
2.2.3 Partial filling of K-space	35	(2)
2.2.4 Segmentation	37	(1)
2.2.5 Single pulse	38	(1)
2.2.6 Echo Planar Imaging (EPI)	38	(2)
2.2.7 Interleaved image acquisition	40	(1)
2.2.8 Spiral	41	(1)
2.3 Fast sequences in GRE	42	(2)
2.3.1 Low Angle GRE	42	(2)
2.3.2 Spoiled Gradient Echo (SPGR)	44	(1)
2.3.3 Steady State Free Precession (SSFP)	44	(1)
2.4 Fast sequences in SE	44	(2)
2.4.1 Fast Spin Echo (FSE)	45	(1)
2.5 Rapid images with parallel imaging techniques	46	(1)
2.6 Vascular imaging sequences	47	(7)
2.6.1 Time Of Flight (TOF)	48	(2)
2.6.2 Phase Contrast Images	50	(2)
2.6.3 Contrast Enhanced Magnetic Resonance Angiography (CEMRA)	52	(2)
2.7 Conclusions	54	(1)
References	55	(2)
3 Post-processing	57	(18)
Vincenzo Positano
3.1 Introduction	57	(1)
3.2 Digital images	57	(6)
3.2.1 Proprietary formats and DICOM formats	59	(1)
3.2.2 Memory devices	60	(2)
3.2.3 Data transfer via network	62	(1)
3.2.4 Printing devices	63	(1)
3.3 Image visualization	63	(5)
3.3.1 Windowing	63	(1)
3.3.2 Visualizing in 3D	64	(1)
3.3.3 Image segmentation	64	(1)
3.3.4 MIP and RaySum algorithms	65	(2)
3.3.5 Approach to surfaces	67	(1)
3.4 Quantitative measures of mass and volume	68	(2)
3.5 Flow analysis	70	(1)
3.6 Measures of myocardial perfusion	71	(3)
References	74	(1)
4 Contrast agents in cardiovascular magnetic resonance	75	(14)
Massimo Lombardi, Virna Zampa
4.1 General characteristics	75	(4)
4.2 Behavior of extra-vascular contrast agents at myocardial level	79	(1)
4.3 Distinctive behavior of intravascular contrast agents at myocardial level	80	(3)
4.4 Intracellular or organ-specific contrast agents	83	(1)
4.5 Guide to the use of contrast agents in cardiovascular magnetic resonance	83	(1)
4.6 Toxicity of contrast agents in magnetic resonance	84	(1)
4.7 Way of administration	85	(1)
References	85	(4)
5 Intracranial vascular district	89	(32)
Raffaello Canapicchi, Francesco Lombardo, Fabio Scazzeri, Domenico Montanaro
5.1 Introduction	89	(1)
5.2 Arterial compartment	89	(22)
5.2.1 Anatomical variants and persistence of fetal anastomoses	89	(1)
5.2.2 Arterial lumen abnormalities: steno-occlusion and ectasia	90	(8)
5.2.3 Vascular malformations	98	(7)
5.2.4 Aneurysms	105	(5)
5.2.5 Neurovascular conflict	110	(1)
5.2.6 Expansive lesions (dislocations and neoformed vascularizations)	111	(1)
5.3 Venous compartment	111	(5)
5.3.1 Occlusive pathology	111	(4)
5.3.2 Venous angiomas	115	(1)
5.3.3 Tumors (relationship with main venous structures: surgical planning)	115	(1)
References	116	(5)
6 Vessels of the neck	121	(24)
Mirco Cosottini, Maria Chiara Michelassi, Guido Lazzarotti
6.1 Introduction	121	(1)
6.2 Imaging techniques	121	(1)
6.3 Evaluation of epi-aortic vessels	122	(1)
6.4 Subclavian arteries	123	(4)
6.5 Carotid and vertebral arteries	127	(14)
6.5.1 Atherosclerotic steno-occlusive disease	127	(9)
6.5.2 Non-atherosclerotic pathology	136	(5)
References	141	(4)
7 Heart	145	(158)
7.1 Heart morphology	145	(9)
Massimo Lombardi, Anna Maria Sironi, Lorenzo Monti, Mariolina Deiana, Piero Ghedin
7.1.1 Introduction	145	(1)
7.1.2 Study of heart morphology	145	(1)
7.1.3 Scanning and segment planes of the heart	146	(3)
7.1.4 Strategy of image acquisition	149	(3)
7.1.5 Techniques for measuring wall thickness and cardiac diameters	152	(1)
7.1.6 Advantages and limitations	153	(1)
References	154	(1)
7.2 Study of heart function	154	(15)
Anna Maria Sironi, Massimo Lombardi, Alessia Pepe, Daniele De Marchi
7.2.1 Main issues	154	(1)
7.2.2 MRI: a complementary response to Echocardiography	155	(1)
7.2.3 Imaging strategies	156	(3)
7.2.4 Sequences used for evaluation of cardiac function	159	(1)
7.2.5 Evaluation of the cardiac function with MR and postprocessing	159	(3)
7.2.6 MRI quantification of left and right ventricular dimensions: accuracy and reproducibility	162	(2)
7.2.7 Evaluation of diastolic function	164	(2)
7.2.8 Evaluation of cardiac function by tagging images	166	(2)
References	168	(1)
7.3 Study of myocardium	169	(67)
7.3.1 Stress MRI	169	(14)
Alessandro Pingitore, Brunella Favilli, Petra Keilberg, Giovanni Aquaro, Elisabetta Strata
References	182	(1)
7.3.2 Myocardial perfusion	183	(10)
Massimo Lombardi, Piero Ghedin
References	192	(1)
7.3.3 Myocardial viability	193	(16)
Alessandro Pingitore, Brunella Favilli, Vincenzo Positano, Massimo Lombardi
References	205	(4)
7.3.4 Cardiomyopathies	209	(27)
Massimo Lombardi, Claudia Raineri, Alessia Pepe
References	231	(5)
7.4 Valvular disease	236	(8)
Massimo Lombardi
7.4.1 Introduction	236	(1)
7.4.2 Indications for MRI in valve disease	237	(4)
7.4.3 Study of prosthetic valves	241	(1)
7.4.4 Current limitations	241	(1)
7.4.5 Imaging procedure	242	(1)
References	243	(1)
7.5 Coronary arteries	244	(16)
Alessandro Pingitore, Massimo Lombardi, Paolo Marcheschi, Piero Ghedin
7.5.1 Introduction	244	(1)
7.5.2 Magnetic Resonance of coronaries: angiographic approach	244	(4)
7.5.3 How to improve SNR and CNR	248	(1)
7.5.4 Feasibility of coronary angiography by MR	249	(1)
7.5.5 Study of the coronary wall by MRI	250	(1)
7.5.6 Study of coronary reserve	251	(2)
7.5.7 Scanning planes for coronaries (in 2D or 3D small slab)	253	(1)
7.5.8 Bypass and STENT	254	(2)
7.5.9 Anomalies in the coursing of coronaries	256	(1)
7.5.10 Conclusions	257	(1)
References	257	(3)
7.6 Tumors and masses of the heart and of the pericardium	260	(13)
Virna Zampa, Massimo Lombardi
7.6.1 Introduction	260	(1)
7.6.2 Benign atrial tumors	261	(5)
7.6.3 Benign ventricular tumors	266	(1)
7.6.4 Malignant tumors	266	(3)
7.6.5 Para-cardiac masses	269	(2)
7.6.6 Pitfall	271	(1)
References	272	(1)
7.7 Congenital heart disease	273	(30)
Pierluigi Festa
7.7.1 Introduction	273	(1)
7.7.2 Techniques	274	(1)
7.7.3 Cardiac MRI exam in congenital heart disease	275	(2)
7.7.4 Extracardial defects of the mediastinal vessels	277	(7)
7.7.5 Simple isolated cardiac defects	284	(4)
7.7.6 Defects of the atrio-ventricular connection	288	(2)
7.7.7 Tronco-conal defects	290	(3)
7.7.8 Defects of the ventricular-arterial connections (postsurgery)	293	(2)
7.7.9 Complex defects (presurgery and postsurgery)	295	(6)
References	301	(2)
8 Pericardium and mediastinum	303	(16)
Virna Zampa, Giulia Granai, Paola Vagli
8.1 Pericardium	303	(6)
8.1.1 Introduction	303	(1)
8.1.2 Normal anatomy	303	(1)
8.1.3 Congenital disease	304	(2)
8.1.4 Pericardial effusion	306	(1)
8.1.5 Constrictive pericarditis	306	(1)
8.1.6 Hematoma	307	(2)
8.2 Mediastinum	309	(9)
8.2.1 Introduction	309	(1)
8.2.2 Technological and methodological aspects	309	(1)
8.2.3 Clinical applications	310	(8)
References	318	(1)
9 Thoracic aorta	319	(20)
Massimo Lombardi
9.1 Introduction	319	(1)
9.2 Patient preparation	320	(1)
9.3 Imaging techniques	320	(5)
9.4 Data processing	325	(2)
9.5 Acquired pathologies of the thoracic aorta	327	(8)
9.5.1 Aneurysms of the aorta	327	(2)
9.5.2 Aortic dissection	329	(1)
9.5.3 Aortic intramural hematoma and ulcer of the aortic wall	330	(1)
9.5.4 Traumas of the aorta	331	(1)
9.5.5 Follow-up of aortic disease	331	(3)
9.5.6 Aortitis	334	(1)
9.6 Limits of the technique	335	(1)
9.7 Conclusions	335	(2)
References	337	(2)
10 Renal arteries	339	(1)
Mirco Cosottini, Maria Chiara Michelassi, Guido Lazzarotti
10.1 Introduction	339	(2)
10.2 MRA techniques	341	(5)
10.2.1 Time Of Flight MRA (TOF-MRA)	341	(1)
10.2.2 Phase Contrast MRA (PC-MRA)	341	(3)
10.2.3 Contrast Enhanced MRA (CEMRA)	344	(2)
10.3 Technical features	346	(1)
10.4 Clinical applications	346	(8)
10.4.1 Stenosing pathologies	346	(6)
10.4.2 Non-stenosing pathologies	352	(1)
10.4.3 Kidney transplant	353	(1)
References	354	(3)
11 Abdominal aorta	357	(1)
Virna Zampa, Marzio Perri, Simona Ortori
11.1 The technique	357	(4)
11.1.1 Ultrafast technique with contrast bolus	357	(3)
11.1.2 Phase Contrast MRA (PC-MRA)	360	(1)
11.2 Clinical applications	361	(13)
11.2.1 Atherosclerotic and inflammatory aneurysms	361	(5)
11.2.2 Dissection	366	(2)
11.2.3 Steno-occlusion	368	(2)
11.2.4 Control of vascular stents/prostheses	370	(3)
11.2.5 Retroperitoneal fibrosis	373	(1)
References	374	(3)
12 Peripheral arterial system	377	(1)
Virna Zampa, Irene Bargellini
12.1 Introduction	377	(1)
12.2 Technique	378	(7)
12.2.1 Patient preparation	378	(1)
12.2.2 Time Of Flight Angio-MR (TOF-MRA)	378	(2)
12.2.3 Contrast Enhanced MRA (CEMRA)	380	(5)
12.3 Clinical applications	385	(4)
12.3.1 Atherosclerosis	385	(2)
12.3.2 Surgical arterial bypass	387	(1)
12.3.3 Vascular lesions of the soft tissue and vascularization of tumoral lesions	387	(2)
12.3.4 Obstructive pathology due to external compression	389	(1)
12.4 Advantages	389	(1)
12.5 Limits	390	(3)
12.5.1 Timing	390	(1)
12.5.2 Artifacts	391	(1)
12.5.3 Visualizing the vascular lumen alone	391	(1)
12.5.4 Missed visualization of arteries not included in the volume of study	392	(1)
12.5.5 Missed dynamic visualization	392	(1)
12.5.6 Localizing a lesion	393	(1)
12.6 Conclusions	393	(1)
References	393