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Review
. 2010 Jun 8;55(23):2614-62.
doi: 10.1016/j.jacc.2009.11.011.

ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents

American College of Cardiology Foundation Task Force on Expert Consensus Documents; W Gregory Hundley, David A Bluemke, J Paul Finn, Scott D Flamm, Mark A Fogel, Matthias G Friedrich, Vincent B Ho, Michael Jerosch-Herold, Christopher M Kramer, Warren J Manning, Manesh Patel, Gerald M Pohost, Arthur E Stillman, Richard D White, Pamela K Woodard
Collaborators
Review

ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents

American College of Cardiology Foundation Task Force on Expert Consensus Documents et al. J Am Coll Cardiol. .
No abstract available

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Figures

Figure 1
Figure 1. Cardiovascular Magnetic Resonance of Acute Myocarditis
Panel A: T2-weighted image of LV myocardial edema showing global bright signal intensity (ratio 2.2) of the left ventricle relative to the myocardium. Panel B: Early enhancement (T1-weighted spin echo) before (left) and after (right) Gd administration; enhancement ratio 5.4. Panel C: Arrows indicating late enhancement (T1-weighted gradient echo sequence with myocardial nulling) 10 minutes after Gd. Gd indicates gadolinium; and LV, left ventricular.
Figure 2
Figure 2. Cardiovascular Magnetic Resonance of a Coronary Artery Anomaly
An oblique axial reconstruction is presented from a “whole-heart coronary MRA” sequence. The white arrow notes the normally arising left main coronary artery from the left sinus of Valsalva. The black arrowhead highlights the right coronary artery arising anomalously from the anterior aspect of the left sinus of Valsalva superior to the left main origin and then coursing between the aortic root and the outflow tract of the right ventricle. MRA indicates magnetic resonance angiography.
Figure 3
Figure 3. Cardiovascular Magnetic Resonance of a Single Coronary Artery
A 3-dimensional volume-rendered reconstruction from a “whole-heart coronary MRA” sequence in a patient with single ventricle and a single coronary artery. The white arrow denotes the proximal right coronary artery, whereas the black arrow highlights the elongated left main coronary artery arising from a common origin with the right coronary artery. MRA indicates magnetic resonance angiography.
Figure 4
Figure 4. Cardiovascular Magnetic Resonance of a Proximal Aneurysm
Transverse targeted 3-dimensional T2 prepulse coronary MRA of a subject with a proximal right coronary artery aneurysm. Ao indicates aorta; L, left coronary artery; and MRA, magnetic resonance angiography.
Figure 5
Figure 5. Myocardial Perfusion Imaging
First-pass contrast-enhanced perfusion images from a 73-year-old diabetic man using a hybrid gradient echo–echo planar pulse sequence with parallel imaging during infusion of 0.075 mM/kg of gadolinium chelate at 4 cc/s. The top panel of short-axis images was obtained during adenosine stress, a 4-minute infusion at 0.14 mg/kg, and the bottom panel obtained in the same short-axis slices 10 minutes later at rest. The base of the left ventricle on the left demonstrates an inferior wall perfusion abnormality seen at both stress and rest, consistent with myocardial infarction. The mid left ventricle demonstrates a large perfusion defect only at stress in the anterolateral and inferior walls. The apical left ventricle shows an inferolateral perfusion defect at stress but is normal at rest. cc indicates cubic centimeter; and mM, millimolar.
Figure 6
Figure 6. Infarct Imaging
Images from the same patient as in Figure 5. The panel of images demonstrates phase-sensitive inversion recovery gradient echo images in the same 3 short-axis locations obtained 10 minutes after 0.15 mM/kg of gadolinium was infused intravenously. The basal left ventricle shows a 50% transmural inferior infarction while the mid and apical left ventricle show a 25% to 50% transmural inferior infarction. Putting this data together with Figure 5, the findings are consistent with an inferior infarction with peri-infarct ischemia in the mid and apical inferior walls as well as mid anterolateral ischemia, consistent with multivessel coronary artery disease. mM indicates millimolar.
Figure 7
Figure 7. Microvascular Obstruction of a Patient After Anteroseptal Myocardial Infarction
This figure is a short-axis late gadolinium-enhanced inversion recovery gradient echo axis image obtained 10 minutes after gadolinium infusion in a patient on Day 3 after reperfused anteroseptal myocardial infarction. Note the transmural late gadolinium enhancement in the anteroseptum. The arrow points to a region of microvascular obstruction in the core of the infarction that represents a region of capillary damage to the extent that contrast is unable to fill this region even 10 minutes after contrast. MO is generally only seen in the first 7 to 10 days postmyocardial infarction and signifies an infarction and patient with poorer prognosis than those without MO. MO indicates microvascular obstruction.
Figure 8
Figure 8. Late Gadolinium Enhancement in ARVC in a Patient With Family History of ARVC
Upper panel: irregular silhouette of the free RV wall with microaneurysm. Lower panel: evidence for LGE of the RV wall (arrowheads), but also focal fibrosis of the interventricular septum (arrow). ARVC indicates arrhythmogenic right ventricular cardiomyopathy; LGE, late gadolinium enhancement; and RV, right ventricular.
Figure 9
Figure 9. Late Gadolinium Enhancement in Left Ventricular Noncompaction
Upper panels: systolic long-axis (left) and short-axis (right) still frames. Lower panels: left: short-axis late Gd enhancement image showing several areas of fibrosis. Right: late Gd enhancement study using a short inversion time (fibrosis appears with low SI). Confirmation of lesions in the myocardium (arrows) and in the trabecular tissue (arrowhead) are shown. Gd indicates gadolinium; LGE, late gadolinium enhancement; and SI, signal intensities.
Figure 10
Figure 10. Cardiovascular Magnetic Resonance Tissue Characterization in a Patient With Acute Myocarditis
Images obtained by different sequences in the same 2-chamber view are shown. Panels A (diastolic) and B (systolic) indicate a basal-anterior and apical-inferior wall motion abnormality. Panel C shows increased signal intensity in a T2-weighted image, indicating edema as a feature of acute injury (arrowheads). Note the increased signal of the apical blood due to slow blood flow (thin arrow). Panel D visualizes a delayed gadolinium washout indicating irreversible injury (arrowheads).
Figure 11
Figure 11. Late Gadolinium Enhancement in Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient With Cardiac Sarcoidosis
Left panel: long-axis view of a late gadolinium enhancement study showing a transmural lesion in the basal lateral wall (arrow). Right panel: cross-referenced short-axis view with the same lesion (arrow).
Figure 12
Figure 12. Late Gadolinium Enhancement in Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient With Cardiac Amyloidosis
Left panel: long-axis view of a late Gd enhancement study (10 min post Gd administration) showing extensive, diffuse myocardial Gd uptake (arrows) with early clearance from blood pool (low signal intensity of the ventricular lumen). Right panel: confirmative short-axis view showing the mainly subendocardial distribution of the Gd (arrow). Gd indicates gadolinium.
Figure 13
Figure 13. Cardiovascular Magnetic Resonance Findings Associated With Pericardial Disease
Panel A: a short-axis, cine-tagged imaging is provided. Along the posterior wall of the left ventricle (white arrow), tag deformation is absent, indicating pericardial adhesions. Panel B: dark blood T1-weighted spin echo images are provided, indicating thickened pericardium along the anterior surface of the right ventricle and corresponding tubular deformity of the ventricles. Advanced lung disease is also noted.
Figure 14
Figure 14. Examples of Cardiovascular Magnetic Resonance in Congenital Heart Disease
The upper left panel is a cine CMR of a patient with double outlet right ventricle demonstrating semilunar valve morphology. The PV is trileaflet, whereas the AoV is bicuspid. The lower left panel is a 3-dimensional reconstruction of a single-ventricle patient after aortic to pulmonary anastamosis (arrow on leftward image, which is an anteroposterior view) and a bilateral bidirectional cavopulmonary connection where the LSVC and RSVC are connected to the LPAs and RPAs (best visualized on the rightward image, which is a posterior view). The rightward panels are from a patient with tetralogy of Fallot after repair with pulmonary regurgitation using through-plane phase-contrast imaging of the MPA. This technique encodes flow into and out of the imaging plane with directionality encoded as white or black; the top image demonstrates antegrade flow (white), and the bottom image demonstrates retrograde or regurgitant flow (black). The frames were acquired at peak systole and diastole. AoV indicates aortic valve; CMR, cardiovascular magnetic resonance; LPA, left pulmonary artery; LSVC, left superior vena cava; MPA, main pulmonary artery; PV, pulmonary valve; RPA, right pulmonary artery; and RSVC, right superior vena cava.
Figure 15
Figure 15. Bolus Chase Contrast-Enhanced Magnetic Resonance Angiography
Bolus chase CE-MRA of the aorta and lower extremity arteries obtained with a 3–stage table-stepping protocol during infusion of 0.2 mM/kg of gadolinium chelate in a patient with peripheral arterial disease. There is evidence of sequential moderate stenoses in the left superficial femoral artery (upper arrow), as well as runoff disease in the left calf (lower arrow). CE-MRA indicates contrast-enhanced magnetic resonance angiography; and mM, millimolar.
Figure 16
Figure 16. Atherosclerotic Plaques in Cardiovascular Magnetic Resonance
Multispectral atherosclerotic plaque imaging of the SFA in the same patient as Figure 10 with a T1-W image on the left, PDW image in the middle, and T2-W image on the right. The lumen is preserved (long white arrows), yet there is significant atherosclerotic plaque in the wall. The black arrows on the T1-W image point to areas of low signal consistent with calcification (seen on all 3 image weightings). The large white arrowheads point to areas of low signal on the PDW and T2-W images that are consistent with lipid-rich necrotic core. The brighter areas around the lumen on PDW and T2-W images represent fibrous tissue. PDW indicates proton density–weighted; SFA, superficial femoral artery; T1-W, T1-weighted; and T2-W, T2-weighted.
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