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Today we're going to review cardiac MRI cases

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as commonly seen in clinical practice. I have

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about 12 cases and each case has two

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to three questions, but we'll see how many we can

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get through. They're very

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in complexity some fairly simple and others

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are a slightly more complex. But all of these cases are

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what one would expect and a routine County

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MRI practice now, we'll start with case

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number one.

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So I see there's a question.

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Okay questions, please. Please feel

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free to to drop your questions into

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the box and we'll answer

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all the questions sometime maybe in a Bunches

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of two or three questions towards the end or

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some in between in between the cases. Okay. Let's start

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with the case. Number one. I'm going to use a

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separate.

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The cases on a separate folder which I'm going to toggle toggle.

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On the screen. This is case. Number one.

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The history of the case is provided. It's

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a 35 year old male who

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presents with the cardiacom are examination and the calculated volumes

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are in lb index and diastolic volume

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of 90. Ml per square meter

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LV ejection fraction of 58% The right ventricular

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and diastolic volume was 85 and the rvjection fraction

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with 56%

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This is a case number one.

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And this is figure a and this is figure B.

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This case also has cine Clips. I'm going to play.

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Can everyone see the cine clip?

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Yeah, this an eclip is a short axis View and notice

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the right ventricularly and they

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left ventricle slightly more towards the towards the

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back of the patient. So that's

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a short axis view pertaining to figure one

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and pertaining to figure 1B.

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There are two long

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access views.

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As shown on this image, I'm going to let these

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images play while we while we answer

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the questions. So which of the following is true regarding this cardiac

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Mr. Examination. I'm going to go fairly quickly through

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the questions and we'll discuss some of the key key points

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per turning to this case. So the index and diastolic volumes

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for the right and left ventricles are given

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for the left. It's 90 and for the right, it's 85 and

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the ejection fractions of 58 and 56 people can

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answer their question and

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So that's figure figure B.

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And this is figure a so two

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figures figure a and figure B. So the correct answer

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for number one is e

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and this this question emphasizes that

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quantification of right and left ventricular size

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should be performed on shot axis image. These are the short

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axis images and and shot access. We

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Contour The ventricle in endeastily and

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an systole and we get ejection fractions using

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what's known as The Simpsons rule.

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Can everyone see the screen again?

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So the correct answer to question a is quantification

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of right and left ventricular sides. It's performed using image using

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the images in a which is a short axis image. This

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is a gradient Echo technique called a

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steady state free procession technique. They do

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not require contrast intravenous scheduling and based

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contrast. There's inherent contrast in the blood and gradient

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actor provides a bright blood effect steady state

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free procession sequences are used for evaluation of

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cardiac Anatomy morphology and function with cardiacomar and

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a short axis images the key acquisition for evaluation

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of left and right ventricular cystolic function

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and ejection fractions. These are

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normal numbers. They left ventricular and right ventricular

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ejection fractions are within normal limits, which should be about 55%

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And the index and diastolic volumes

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for both ventricles should be approximately above 90 ventricle

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over 110 is

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Miley dilated, but between the 90 to 110 what

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approximately 105 range just as

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a ballpark figure the ventricles are within normal

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limits indexed the body surface area.

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Question two pertains to the advantages of cardiac Mr.

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And it asks but

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it has five choices. I won't

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read each of the choices. But if if the

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audience could take a

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Take time to review. These will will discuss

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the answer.

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And the true and false questions. We're probably about five

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minutes per case. Hoping to get through about 10 to 12 cases. Yes. Okay.

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Good. Let's see. There's a very educated audience here.

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Yes. It's not the test of choice all if all

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the four are advantages of cardiac Mr. It has

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a higher spatial and contrast solution compared to

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Echo geography Imaging is not affected by Body habits. It

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allows quantification of rest of

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flow and large vessels and it's Superior to Echo car

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geography for evaluation of ventricular size and function. However for diastolic

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function Echo car geography is a

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test of choice. So that's really function requires a much higher temporalization

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evaluation of inflow characters through the valves. And

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for that Echo should be

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used for diagnosis of diastolic function as such though

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for evaluation of the etiology

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of the dinosaur dysfunction, Mr. Can be used all the other

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points or advances of cardiacomar.

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the last question pertaining to this case and we'll take some

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questions which of the following is not a contraindication now

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I'm looking for

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For one of these which is obviously not

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a contraindications for cardiacomana indications and

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contraindications do evolve but in

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general coronary stance are not a

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contraindication. Most coronary stands are made of non-ferromagnetic material

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in a label is Mr. Safe and Mr.

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Can be performed even within a week of insertion of coronary stance

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AI CDs and pacemakers are

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considered now a relative contraindication, even

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the Legacy pacemakers. There's increasing

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data to show that even with conventional pacemakers and

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icds which are considered unsafe Mr. Can

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be safely reform provided adequate precautions are

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taken.

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And there's EP support and the device is

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adequately programmed before and after Cochlear implants

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are contraindegration intracranial sharpenal particular for a

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magnetic or contraindication. But in general chronic stance after placement,

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for example for myocardial infarction and

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not under contraindication before discharge, if needed

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to evaluate ventricular function or to look for complications such

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as thrown by they cardiacomark can be safely performed.

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So just to summarize this case. This is a normal

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cardiac Mr. Examination. I wanted to start with a normal

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cardiac amount. These are short access views of

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the left and right ventricles and these are

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and here on these are long axis viewers. I'm

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just going to play the long access video long access for chamber and

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two chamber views quantification is done

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using the shot access images and these

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are non-contrast steady state free procession gradient echo

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images at the end of each question.

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In the handout, there are some top

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tips for each case. So because the city cardigan Mark

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examination performed using this special form of grading Echo

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sequence called steady state representation cardiacomar is

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a reference standard for right and left ventricular size.

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It's an systolic function calculated by

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planometry of short axis slices in clinical practice. The

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major indications for this is a normal cardiacom are examination. Once

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again, I want to stress the ventricular volumes normal. The size

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is normal. And the wall motion is normal obviously

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normal anatomy and normal segmental connections left and

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right ventricles the major indications for cardiacoma and

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clinical practice are evaluation of ischemic hard disease, particularly

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myocardial viability evaluation of cardiomyopathies with

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respect to etiology and prognosis.

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And in in places where there's a

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congenital heart center comprehensive valuation of congenital

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heart disease for intra cardiac and extraconic Anatomy also

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evaluation of cardiac masses particularly thrown by so there's a major

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indications where clinical my chemical disease cardiomyopathies.

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Congenital heart disease cardiac masses they are the indications as

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we shall see including very kind of disease but in

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general ischemic and non-ishchemic cardiomyopathies from

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the main bulk of cardiac of the cardiacoma practice.

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Okay, before we go to the next case, are there

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any questions for this case?

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So one of the attendees asks, I'm a cardio.

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I work with a cardiologist who stressing her needs regurgitant volume.

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How do we calculate? What is a significance we

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shall see this in further cases? I believe

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regurgit infractions calculator using what's known

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as face contrast Imaging it's a special technique where we

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calculate forward flow and backward flow. It's particularly useful

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for evaluation of aortic regurgitation and also

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be calculated indirectly indirectly for mitral

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regurgitation tracker speed regurgitation and also

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from harmonic regurgitation particularly for Egyptian files. It's very

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useful. It's in adult non congenital clinical practice

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typically used for aortic and sufficiency calculation forward

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flow and backward flow region fractions

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over 30% or 35% are considered severe

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particularly for associated with the dilated ventricle and they're

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useful for surgical decision making and for cereal

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for lump of the patient. So face contrast Imaging non contrast

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technique is used to calculate registered volumes. And

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yes it is. It is a very important

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Advantage of cardiacomar though. Not

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not one of the key indications.

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It hasn't yet.

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Become mainstream for for Cardiology practices,

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but it is a very very important application of cardigma evaluation

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of regurgits and fractions particularly your chicken

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sufficiency in non cajal hard disease and

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harmonic and sufficiency in congenital heart disease.

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Any more questions on this case if there's

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no more questions, we're going to go to the next case.