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(Radiographics. 2002;22:905-906.)
© RSNA, 2002


EDUCATION EXHIBIT

Invited Commentary

Robert M. Steiner, MD

Department of Radiology, University of Pennsylvania Health System and Pennsylvania Hospital, Philadelphia, Pennsylvania


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A vast literature published during the past two decades addresses the effectiveness of MR imaging in the diagnosis of CHD.

The early articles understandably focused on the demonstration of cardiac anatomy and disease with use of spin-echo "black blood" pulse sequences. This "static" approach yields important information about cardiac masses and pericardial disease, and use of cine techniques permits analysis of important functional cardiac parameters such as valvular dysfunction and wall motion abnormalities. Spin-echo techniques remain the mainstay for many cardiac imaging indications despite the many advances that have taken place during the past decade (1).

The development of VEC MR imaging has made it possible to quantitatively analyze arterial and venous blood flow velocities, collateral blood flow, and pressure gradients with a high degree of accuracy, yielding results comparable to those possible with color Doppler flow echocardiography and cardiac catheterization.

In their thoughtful, focused review of the use of VEC MR imaging in the diagnosis of CHD, Varaprasathan et al (2), internationally recognized authorities on cardiac imaging, describe the value of this imaging technique in the diagnosis and characterization of a variety of frequently occurring congenital abnormalities of the heart and great vessels (3).

The authors also emphasize the efficacy of VEC MR imaging in postsurgical assessment of cardiac function and surgical complications including anastomotic stenosis and alterations in flow velocities.

The limitations of VEC MR imaging are also addressed and include underestimation of blood flow velocities and pressure gradients due to inadequate imaging planes, imaging at off-peak flow velocities, and the limited temporal resolution of the technique.

Certainly, this article fulfills the expectations created by its title, but perhaps it could have been enhanced by a comparison of VEC MR imaging with other current approaches for quantitation of cardiac function.

Many diagnostic radiologists are skittish about their personal involvement in cardiac radiology in general and cardiac MR imaging in particular. Perhaps this fear stems from inadequate training and exposure to the principles of cardiac imaging during their residency years. For many, cardiac radiology is an esoteric subspecialty understood by only a few aficionados and remains a mystery to the majority of diagnostic radiologists. The unsuccessful turf battles over coronary arteriography, nuclear cardiology, and echocardiography have led many to view involvement by radiologists as a losing battle (4,5).

During the past several years, organized radiology has gone to great lengths to raise the profile of cardiac radiology among practicing radiologists and trainees by means of well-constructed and widely advertised stand-alone symposia, new opportunities for hands-on training, and focused sessions at national meetings. The result of all this effort has been a growing recognition that cardiac imaging is important to radiologists and their practices. An important "critical mass" of interested CT and MR imagers have the potential and the equipment to take the lead in their respective institutions in developing cardiac imaging as a radiology department responsibility.

Articles such as this one by Varaprasathan et al clearly demonstrate the value of widely available techniques that are competitive with other accepted cardiac imaging modalities and help demystify cardiac radiology for the rest of us.


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  1. Haramati LB, Glickstein JS, Issenberg HJ, Haramati N, Crooke GA. MR imaging and CT of vascular anomalies and connections in patients with congenital heart disease: significance in surgical planning. RadioGraphics 2002; 22:337-349.[Abstract/Free Full Text]
  2. Varaprasathan GA, Araoz PA, Higgins CB, Reddy GP. Quantification of flow dynamics in congenital heart disease: applications of velocity-encoded cine MR imaging. RadioGraphics 2002; 22:895-906.[Abstract/Free Full Text]
  3. Steiner RM, Reddy GP, Flicker S. Congenital cardiovascular disease in the adult patient: imaging update. Thorac Imaging 2002; 17:1-17.
  4. Greenberg SB. Invited commentary. RadioGraphics 2002; 22:348-349.[Free Full Text]
  5. Lipton MJ, Boxt LM, Hijazi ZM. Role of the radiologist in cardiac imaging. AJR Am J Roentgenol 2000; 175:1495-1506.[Free Full Text]

Related Article

Quantification of Flow Dynamics in Congenital Heart Disease: Applications of Velocity-encoded Cine MR Imaging
Gita A. Varaprasathan, Philip A. Araoz, Charles B. Higgins, and Gautham P. Reddy
RadioGraphics 2002 22: 895-905. [Abstract] [Full Text] [PDF]




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