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Principles and Practice of Cardiac Magnetic Resonance in Congenital Heart Disease: Form, Function and Flow



Principles and Practice of Cardiac Magnetic Resonance in Congenital Heart Disease: Form, Function and Flow

Mark A. Fogel (Editor)

ISBN: 978-1-405-16236-4 May 2010 Wiley-Blackwell 480 Pages


CMR is a powerful tool in the armamentarium of pediatric cardiology and health care workers caring for patients with congenital heart disease (CHD), but a successful study still presents major technical and clinical challenges. This text was created to give trainees, practitioners, allied professionals, and researchers a repository of dependable information and images to base their use of CMR on.

Because CHD presents an intricate web of connections and associations that need to be deciphered, the imager performing CMR needs to understand not only anatomy, physiology, function, and surgery for CHD, but also the technical aspects of imaging. Written by experts from the world’s leading institutions, many of whom pioneered the techniques and strategies described, the text is organized in a logical way to provide a complete understanding of the issues involved. It is divided into three main parts:

  • The Basics of CMR - familiarizes the reader with the minimum tools needed to understand the basics, such as evaluating morphology, ventricular function, and utilizing contrast agents
  • CMR of Congenital and Acquired Pediatric Heart Disease - discusses broad categories of CHD and the use of CMR in specific disease states
  • Special Topics in Pediatric Cardiac MR - covers other important areas such as the complementary role of CT scanning, interventional CMR, the role of the technologist in performing a CMR exam, and more

With the ever increasing sophistication of technology, more can be done with CMR in a high quality manner in a shorter period of time than had been imagined as recently as just a few years ago. Principles and Practice of Cardiac Magnetic Resonance in Congenital Heart Disease: Form, Function, and Flow makes a major contribution to applying these techniques to improved patient care. An ideal introduction for the novice or just the curious, this reference will be equally useful to the seasoned practitioner who wants to keep pace with developments in the field and would like a repository of information and images readily availalble.

List of contributors, vii

Foreword, x

Preface, xi

Part I: The basics of cardiac MR

1 Physics of cardiac MR and image formation, 3
Orlando P Simonetti and Georgeta Mihai

2 Technical aspects of pediatric cardiac MR, 17
Christopher Occleshaw

3 Assessment of morphology, 33
John C Wood

4 Assessment of ventricular function and blood fl ow, 51
Mark A Fogel

5 Contrast cardiac MR – anatomy, physiology, viability and perfusion, 75
Scott D Flamm

Part II: Cardiac MR of congenital and acquired pediatric heart disease

6 The normal cardiac magnetic resonance examination – ruling out congenital heart disease, 93
Matthew Harris and Mark A Fogel

7 Abnormalities of the atria and systemic veins, 110
Tiffanie R Johnson and Mark A Fogel

8 Abnormalities of the ventricles and pericardium, 124
Beth F Printz

9 MRI in conotruncal anomalies (except tetralogy of Fallot), 155
Willem A Helbing and Adriaan Moelker

10 Tetralogy of Fallot: morphology and function, 172
Arno AW Roest, Lucia JM Kroft and Albert de Roos

11 Aortic arch anomalies, 183
Paul M Weinberg and Kevin K Whitehead

12 MR assessment of pulmonary circulation, 209
Shi-Joon Yoo and Lars Grosse-Wortmann

13 Valvular heart disease, 236
Juha Koskenvuo, Karen G Ordovás and Charles B Higgins

14 Imaging coronary arteries in children, 250
Gerald F Greil, Rene M Botnar and Taylor Chung

15 Other complex congenital heart disease – heterotaxy, complex spatial relationships, conjoined twins and ectopia cordis, 265
Rajesh Krishnamurthy and Taylor Chung

Part III: Special topics in cardiac MR of pediatric and congenital heart disease

16 Cardiac magnetic resonance of single ventricles, 289
Mark A Fogel

17 Baffl es and conduits, 316
Philipp Beerbaum, Israel Valverde, Gerald F Greil and Sonya V Babu-Narayan

18 Cardiac tumors, 345
Ashwin Prakash

19 Considerations in the post-operative patient, 354
G Wesley Vick III

20 Interventional magnetic resonance imaging, 382
Gerald F Greil, Sanjeet Hegde, Kawal Rhode, Carsten Schirra, Philipp Beerbaum and Reza Razavi

21 Adult congenital heart disease, 398
Victor A Ferrari and Alexander R Opotowsky

22 Cardiovascular computed tomographic angiography: complementary role to magnetic resonance imaging, 414
Jeffrey C Hellinger and Stephen C Cook

23 Radiation in cardiac imaging in congenital heart disease, 429
Mark A Fogel

24 Pediatric cardiovascular MRI in the outpatient private practice setting, 440
Nancy L Morris and Edward T Martin

25 The role of the technologist in performing a cardiac MRI (CMR) exam, 444
Christine Harris

Index, 450

"This book occupies a unique position in providing a comprehensive picture of the use of cardiac magnetic resonance imaging for pediatric and adult congenital heart disease. It is very technically driven, but remains useful for those of all levels of experience in this field." (Doody's, 30 September 2011)


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Any project of this magnitude can never be done by one individual alone. I would first like to thank Steve Korn of Blackwell-Futura, who was willing to give a project like this a shot. There are many people in Wiley Blackwell-Futura who contributed many long and hard hours and whose patience and persistence has paid off such as Kate Newell, Gina Almond, and Beckie Brand. This book would not be possible without the long list of my colleagues and contributors who did such wonderful and thorough work on their topics – I owe them a debt of gratitude. I had much help on the administrative side from Stacey Casper and I wanted to thank her for all their efforts.

I would also like to thank some of the people who inspired me and whom I worked with through the years:

  • Paul Weinberg, Alvin Chin, Gerald Barber, John Murphy and Henry Wagner have been my teachers in pediatric cardiology and have contributed much to my understanding of the field. Paul Weinberg started me along the long path of cardiac magnetic resonance in the early 90’s – he is both a wonderful mentor, friend and one of the best pediatric cardiologists in the world. Henry Wagner also stands out as a “true gentleman cardiologist” as well as being an outstanding clinician. Charlie Kleinman was the division chief of pediatric cardiology when I was a resident at Yale who was there for me when I needed someone the most; his successful fight against all odds to battle his failing health is a lesson to us all. My CMR comrades at my hospital – Kevin Whitehead, Matthew Harris and Marc Keller – are pretty wonderful people to work with. Finally, I couldn’t ask for better colleagues to practice pediatric cardiology with than at The Children’s Hospital of Philadelphia; the great friendship of people such as Paul Stephens, Dick Donner, Jack Rychik, Meryl Cohen, Stan Ewing and others make coming to work that much more enjoyable and fun.
  • The world of cardiac magnetic resonance is a small one, but ever growing one. I have been fortunate enough to have interacted with, learned from and become friends with giants who started the field such as Nathaniel Reichek, Leon Axel, Gerry Pohost and Charlie Higgins. It has also been an honor to work with the greatest colleagues in the world such as Victor Ferrari, Edward Martin, Tal Geva, Andrew Powell, Shi Joon Yu, Taylor Chung, Warren Manning, Christopher Kramer…..the list is exhaustive and can go on for many pages. Ajit Yoganathan has been a close research collaborator and friend; his keen mind, wit and drive has been goal for me to always strive for. One special thank you needs to be made to Eric Hoffman who gave me my start in CMR research many years ago – his intelligence, kindness and understanding will always be remembered fondly.
  • All pediatric cardiologists work closely with our cardiothoracic surgical colleagues and our symbiotic relationship always seems to lead to a better understanding of the field in which we work. Working with the likes of Bill Norwood, Marshall Jacobs and Tom Spray, I have learned not only to think through a problem but also the importance of "thinking outside the box."
  • I could not have had a better pediatric residency than I did at Yale and although I would like to thank the entire attending staff during my years there, Tom Dolan, Paul McCarthy and George Lister stand out as extraordinary physicians and teachers. I also owe a debt of gratitude to all my fellow pediatric residents who were there for me always, especially during some very hard times and whose friendship I will always treasure.
  • Finally, no medical student who has gone through the program at Upstate Medical Center in Syracuse, NY in the 80s can ever publish a scholarly textbook without the mention of Robert Rohner who not only was one of the best teachers ever but also instilled the love of medicine in us all and taught us to be proud of who we are.

Ultimately, however, I want to thank you, the reader, whose interest in reading or purchasing this textbook is the spark which gave this project its life in the first place.

This comprehensive guide is divided into three main sections:

  • The Basics of Cardiac MR
  • MR of Congenital and Acquired Pediatric Heart Disease
  • Special Topics in Pediatric Cardiac MR

Every cardiac imaging lab should keep a copy of this book available for reference.