The Role of Cardiovascular Magnetic Resonance in Pediatric Congenital Heart Disease

Abstract

Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.

Noninvasive Cardiovascular Imaging

“…There is anticipation that cardiac MRI could also be used for assessment of myocardial perfusion and ischemia, for atherosclerotic plaque imaging, and as a type of therapeutic imaging for electrophysiology and interventional procedures [11]. Some health care centers currently have hybrid suites that combine cardiac catheterization and cardiac MRI [12]; however, there have been no published clinical trials showing that using these modalities in combination yields a better clinical outcome than using them in tandem.…”

“…Cardiac MRI has become the gold standard for assessment of cardiac anatomy, interventricular volumes, and cardiac function; for the identification and diagnosis of different types of cardiac tumors; and for the evaluation of coronary vascular anomalies [11]. It has been shown to be helpful for the identification and management of coarctation of the aorta and interrupted aortic arch, and for evaluation of postoperative complications following surgery to correct transposition of the great arteries [12]. Cardiac MRI is also helpful in the follow-up of congenital heart defects in patients for whom imaging windows are insufficient due to scarring or body habitus.…”

Strengths and Pitfalls of Whole-Heart Atlas-Based Segmentation in Congenital Heart Disease Patients

“…It outlines anatomy and physiology, assists the intervention planning, helps to refine management, evaluates the consequences of interventions and facilitates prognosis [9]. At all stages of the CHD assessment pipeline, delineation and extraction of the whole heart, which includes the four chambers and eventually the great vessels, are crucial to achieve a successful outcome.…”

“…Cardiovascular magnetic resonance (CMR) has emerged as a major alternative to echocardiography (the by default modality of choice in paediatric patients) as an imaging tool within the CHD assessment pipeline [9,11], due to its non-invasiveness, lack of ionizing radiation, and its higher anatomical resolution and extra cardiac information. Moreover, the vast literature in CMR analysis tools [14] proposes a large set of semi-and fully-automated methods for adult whole-heart segmentation that could be adapted and applied to paediatric CMR images to ease and improve the delineation and extraction of the heart.…”

“…Imaging plays a key role in the diagnosis of CHD and it is required at all stages of patient care [9]. It outlines anatomy and physiology, assists the intervention planning, helps to refine management, evaluates the consequences of interventions and facilitates prognosis [9].…”