Normal MRI of the heart

Normal MRI of the heart

Normal MRI of the heart


Introduction

This e-Anatomy module is dedicated to the anatomy of the heart, showing the normal MRI appearance of the myocardium, pericardium, ventricles, atria, and heart valves.

Cardiac MRI has become a key tool in radiology and cardiology because it provides excellent soft tissue characterization, functional assessment, and vascular imaging without ionizing radiation. Its indications are broad but they can be grouped into several main categories:

1. Ischemic heart disease

  • Assessment of myocardial viability (differentiating scar from hibernating myocardium prior revascularization).
  • Detection and characterization of myocardial infarction (size, location, transmurality).
  • Evaluation of microvascular obstruction and post–acute myocardial infarction complications.
  • Stress perfusion MRI for the diagnosis of ischemia and evaluation of coronary artery disease.
     

2. Cardiomyopathies

  • Hypertrophic cardiomyopathy (extent of hypertrophy, fibrosis with late gadolinium enhancement).
  • Dilated cardiomyopathy (ventricular volumes, function and fibrosis).
  • Arrhythmogenic right ventricular cardiomyopathy (structural and functional abnormalities).
  • Restrictive cardiomyopathies and infiltrative diseases (amyloidosis, sarcoidosis, and Fabry disease).
  • Myocarditis (tissue edema, hyperemia, and necrosis characterization).
     

3. Valvular and congenital heart disease

  • Quantification of valvular regurgitation and stenosis when echocardiography findings are inconclusive.
  • Comprehensive assessment of congenital heart disease, especially in complex anatomy or post-surgical follow-up.
  • Shunt quantification (Qp/Qs).
     

4. Masses and pericardial disease

  • Differentiation between tumor, thrombus, and other masses.
  • Pericardial disease (pericardial thickening, constriction, effusion).
  • Evaluation of post-surgical or post-radiotherapy complications.
     

5. Functional and quantitative assessment

  • Precise measurement of biventricular volumes, ejection fraction, and myocardial mass (gold standard).
  • Quantification of blood flow and pressure gradients.

 

Material and methods

This MRI of the heart (CMR) was performed on a healthy 40-year old male patient using a Siemens 1.5T MRI.

Cardiac MRI employs various sequences and planes to provide a comprehensive evaluation of cardiac structures. The primary sequences used include:

 

Cine imaging (SSFP / balanced-FFE)

  • Purpose: Gold standard for measuring biventricular volumes, function, and wall motion.
  • Use: Ejection fraction, stroke volume, wall motion abnormalities, valve motion.
  • Sequence type: Steady-state free precession cine in multiple planes (short-axis stack and long-axis views).
     

Late gadolinium enhancement (LGE)

  • Purpose: Detection of scar, fibrosis, or necrosis.
  • Use: Myocardial infarction (ischemic pattern), myocarditis (non-ischemic patchy pattern), cardiomyopathy fibrosis, viability assessment.
  • Sequence type: Inversion-recovery gradient echo 10 minutes after contrast injection; inversion time adjusted to null normal myocardium.

Images were acquired in standardized planes in cardiac MRI:

Short-Axis Plane

The short-axis plane is oriented perpendicular to the long axis of the left ventricle (LV), extending from the mitral valve annulus to the apex. A contiguous stack of cine images is acquired to cover the entire ventricle.

Clinical applications:

  • Quantification of left and right ventricular volumes and function (gold standard).
  • Evaluation of regional wall motion and wall thickness.
  • Assessment of myocardial infarction and fibrosis using late gadolinium enhancement (LGE).
     

Long-Axis Planes

Long-axis imaging is aligned with the longitudinal orientation of the LV. Three standard long-axis views are acquired:

  1. Two-chamber view (vertical long axis, VLA): Includes the LV and left atrium, suitable for evaluating apical thrombi and infarcts.
  2. Four-chamber view (horizontal long axis, HLA): Displays both ventricles and atria, enabling global functional and morphological analysis.
  3. Three-chamber view (LV outflow tract): Depicts the LV, left atrium, aortic valve, and proximal ascending aorta, useful for assessing LV outflow tract obstruction and aortic valve disease.

 

Left Ventricular Function of the patient of this module

ParameterAbbreviationAbsoluteNormalized
Ejection FractionEF57 % 
End Diastolic VolumeEDV218 ml112 ml/m2
End Systolic VolumeESV94 ml49 ml/m2
Stroke VolumeSV123 ml64 ml/m2
Cardiac OutputCO7.3 l/min3.8 l/min/m2
Average Heart RateHR59 bpm 
Average Myocardial MassLVM161.7 g83.4 g/m2
Std. Dev. Myocardial MassSD3.8 g2.0 g/m2
Myocardial Mass at EDLVM ED163.7 g84.4 g/m2
Patient HeightH1.84 m 
Patient WeightW72 kg 
Body Surface AreaBSA1.94 m2 

 

The anatomical structures were labeled by Antoine Micheau M.D. (Radiologist, Montpellier – France), following the Terminologia Anatomica 2.

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