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Review
. 2018 Sep 26;20(11):119.
doi: 10.1007/s11886-018-1057-9.

Role of Cardiac Magnetic Resonance Imaging in Valvular Heart Disease: Diagnosis, Assessment, and Management

Roshin C Mathew  1 , Adrián I Löffler  1 , Michael Salerno  2   3   4
Affiliations
Review

Role of Cardiac Magnetic Resonance Imaging in Valvular Heart Disease: Diagnosis, Assessment, and Management

Roshin C Mathew et al. Curr Cardiol Rep. .

Abstract

Purpose of review: This article will review the current techniques in cardiac magnetic resonance imaging (CMR) for diagnosing and assessing primary valvular heart disease.

Recent findings: The recent advancements in CMR have led to an increased role of this modality for qualifying and quantifying various native valve diseases. Phase-contrast velocity encoded imaging is a well-established technique that can be used to quantify aortic and pulmonic flow. This technique, combined with the improved ability for CMR to obtain accurate left and right ventricular volumetrics, has allowed for increased accuracy and reproducibility in assessing valvular dysfunction. Advancements in CMR technology also allows for improved spatial and temporal resolution imaging of various valves and their regurgitant or stenotic jets. Therefore, CMR can be a powerful tool in evaluation of native valvular heart disease. The role of CMR in assessing valvular heart disease is growing and being recognized in recent guidelines. CMR has the ability to assess valve morphology along with qualifying and quantifying valvular disease. In addition, the ability to obtain accurate volumetric measurements may improve more precise management strategies and may lead to improvements in mortality and morbidity.

Keywords: Aortic regurgitation; Cardiac magnetic resonance imaging; Cardiac valve disease; Mitral regurgitation; Phase-contrast imaging; Velocity encoded imaging.

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Conflict of interest statement

Conflict of Interest Roshin C. Mathew and Adrián I. Löffler declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Three-chamber steady-state free precession (SSFP) cine imaging of a bicuspid aortic valve. Note the bright signal (green arrow) indicating a turbulent jet through the stenotic valve. b LVOT SSFP imaging for the same stenotic bicuspid aortic valve. Low-signal void and dephasing is indicated by the yellow arrow. c Short-axis SSFP cine stacks with regions of interest drawn in the LV endocardium, LVepicardium, and RVendocardium. Post-processing analysis software can allow for calculation of ejection fraction and volumes. d Gradient echo (GRE) of an incompetent quadricuspid aortic valve (blue arrow) in the diastolic phase with a regurgitant jet. e GRE of the same quadricuspid valve in the systolic phase
Fig. 2
Fig. 2
a Steady-state free precession (SSFP) left ventricular outflow tract (LVOT) cine imaging of a quadricuspid aortic valve with severe aortic regurgitation (yellow arrow). b, c “In-plane” phase-contrast velocity encoded imaging. The in-plane image allows for perpendicular planning (red line) to obtain through-plane images above the aortic valve leaflets. d Phase-contrast velocity encoded through plane images with a region of interest drawn in the aorta. e Plotted graph of forward flow and regurgitant flow with calculated regurgitant fraction of 52.8% and regurgitant volume of 63.9 mL indicating severe aortic regurgitation
Fig. 3
Fig. 3
Four-chamber steady-state free precession (SSFP) cine image showing mitral regurgitation (red arrow) (a). Quantification was performed using volumetric analysis by obtaining short axis cine stacks (b) to obtain a stroke volume (c). Velocity encoded imaging of the aorta (d) above the level of the valve is obtained for forward-flow volume measurement (e). The regurgitant fraction can be obtained with a simple mathematical formula using the stroke volume and the forward flow volume (f). In this case, the regurgitant fraction of 62% indicates severe mitral regurgitation
Fig. 4
Fig. 4
a Steady-state free precession (SSFP) right ventricular outflow tract (RVOT) cine image showing severe pulmonic regurgitation. The regurgitation is so severe that there is no turbulent flow to cause dephasing and a low signal flow void. A through-plane phase-contrast velocity-encoded image (VENC) can be obtained at the cross-sectional plane (red line) of the pulmonary artery (green arrow). b Through-plane VENC image with a region of interest drawn in the pulmonary artery. c Graphic plot of forward and regurgitant flow through the pulmonary artery showing a regurgitant fraction of 42.5% indicating severe pulmonic regurgitation
See this image and copyright information in PMC

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