Matthias Friedrich

Departments of Cardiology and Diagnostic Radiology, McGill University Department of Cardiology, Heidelberg University

Adjunct Professor, Department of Radiology, Université de Montréal Adjunct Professor, Dept. of Cardiac Sciences and Radiology, University of Calgary

Was kann Kardio-MRT (nicht)?

Magnetic Resonance Imaging

Budinger and Lauterbur. Science 1984

Performance of imaging modalities

Friedrich. J Am Coll Cardiol: CV Img 2008

ADVANTAGES OF CMRSafe

- non-invasive, no radioactivity, well tolerated contrast agents

High spatial resolution

Consistent image quality

Accuracy of quantitative data

Excellent reproducibility

Small observer dependence

Excellent tissue contrast

Access to molecular level

Comprehensive multi-target approach- Morphology, function, flow, vessel lumen, tissue composition, metabolism

CHALLENGES OF CLINICAL CMR

Heart motion: ECG trigger required Breathing motion: Breath-holds required Individual identification of the anatomical heart axis Required modification protocols in certain cases (Pacemakers and defibrillators) (problems of heart failure patients to lie flat)

The Turf War between cardiology and radiology

CMR IMAGE QUALITY

Luu et al. Int J Cardiol 2013

n = 6463

1%17%

82%

good/very goodmoderate, but diagnosticpoor

MRT

kann

Funktion

VOLUMINA, FUNKTION, MASSE, MORPHOLOGIE

Gold Standard

CINE FOR LV FUNCTION

VOLUMINA, FUNKTION, MASSE, MORPHOLOGIE

LONG AXIS LV FUNCTION

VOLUMINA, FUNKTION, MASSE, MORPHOLOGIE

QUANTITATIVE ANALYSIS

Le Ven et al. Eur Heart J: CV Img 2016

MRT

kann

Fluss

FLOW QUANTIFICATION

Opening of a partially blocked heart valve

CMR IN VALVULAR DISEASE

MRT

kann nicht

kleine bewegliche Ziele

VALVULAR HEART DISEASE

MRT

kann nicht

kleine Koronaräste

VALVULAR HEART DISEASE

MRT

kann

dynamische Tests

DYNAMIC CMR OF MYOCARDIAL TISSUE

Perfusion

AdenosineBaseline

Function LGE

FIRST-PASS CMR PERFUSION: CLINICAL EXAMPLE

MRT

kann nicht (gut)

Koronarplaques

Noguchi et al. J Am Coll Cardiol 2013

CMR Coronary Plaque Analysis

MRT

kann

Gewebe

MRI

MRI OF MOLECULAR MIXES (TISSUE)

MRIQUESTIONS.com

EDEMA-SENSITIVE CMR

Tissue Characterization

Friedrich, Nature Rev Cardiol 2010

*

*

SCAR IMAGING

Myocardial scars

Infarction Myocarditis

MRT

kann

molekular

MYOCARDIAL IRON IMAGING

T2*-WEIGHTED IMAGES IN IRON OVERLOAD

Anderson et al. Lancet 2002

MYOCARDIAL IRON IMAGING

T2* MAPPING FOR IRON OVERLOAD

Carpenter et al. Circulation 2011

Anderson et al. Eur Heart J 2001

MYOCARDIAL IRON IMAGING

T1 MAPPING FOR IRON OVERLOAD

Sado et al. JMRI 2015

Healthy

Iron Overload

MAPPING

MEASURING MAGNETIC RELAXATION TIMES (T1, T2)

Raymond Damadian, Science 1971

CARDIAC MAPPING

Messroghli et al., JCMR 2003

0100200

300400500

600700800900

remote infarct

849721

Pre-contrast

p<0.05

FIRST CLINICAL PAPER ON MAPPING

CARDIAC MAPPING

NATIVE T1 MAPPING FOR CARDIAC AMYLOIDOSIS

Karamitsos et al. J Am Coll Cardiol CV Img 2013

CARDIAC MAPPING

MAPPING OF ACUTE MYOCARDIAL INJURY

Guensch et al. PLOS ONE, in press

T1 mapbaseline

T1 map5h post defibrillation

Pig model

CARDIAC MAPPING

MAPPING - NORMAL VS. DISEASE

Healthy

DCM

Athlete

EDD 56mm EF 58% 51.6ms 925ms

EDD 67mm EF 48% 59.8ms 1018ms

EDD 63mm EF 54% 50.4ms 931ms

male, 52

male, 58

male, 54

[Normal: 952±31ms]

[Normal:52.9±3.3 ms]

T2 T1Mordi et al. Eur Heart J: CV Img 2015

OXYGENATION-SENSITIVE CMR

OXYGENATION-SENSITIVE CMR

OS-CMR OF THE MYOCARDIAL OXYGENATION RESERVE

Friedrich et al. Circulation 2003

ASSESSING OXYGENATION IN THE HEART OXYGENATION-SENSITIVE CMR

B-MORE IN HEALTHY PEOPLE

Hyperventilation Breath-hold

OXYGENATION-SENSITIVE CMR

B-MORE IN CORONARY ARTERY STENOSIS

Fischer et. al., PLOS ONE, in press

MRT

kann nicht

Strahlung

Radiation-Induced Hair Loss in Angiographers

Wiper et al., Heart 2005

Risk of cancer after exposure to radiation

Mathews et al. BMJ 2013

n = 680,211

WAS KARDIO-MRT (NICHT) KANN

KARDIO-MRT KANN

▸ (fast) alles gut:▸ Volumina, Masse, Funktion, Morphologie▸ Fluss▸ Angio▸ Perfusion▸ Gewebe

▸ nicht (gut)▸ kleine, sich schnell und unregelmäßig bewegende Strukturen▸ kleine Koronaräste▸ Koronarplaques