Top

Published in:

21-02-2024 | Cardiomyopathy | Invited review

ESR Essentials: ten steps to cardiac MR—practice recommendations by ESCR

Authors: Tilman Emrich, Bernd J. Wintersperger, Fabio Domenico Greco, Dominika Suchá, Luigi Natale, Maja Hrabak Paar, Marco Francone

Published in: European Radiology | Issue 4/2024

Abstract

Cardiovascular MR imaging has become an indispensable noninvasive tool in diagnosing and monitoring a broad range of cardiovascular diseases. Key to its clinical success and efficiency are appropriate clinical indication triage, technical expertise, patient safety, standardized preparation and execution, quality assurance, efficient post-processing, structured reporting, and communication and clinical integration of findings. Technological advancements are driving faster, more accessible, and cost-effective approaches. This ESR Essentials article presents a ten-step guide for implementing a cardiovascular MR program, covering indication assessments, optimized imaging, post-processing, and detailed reporting. Future goals include streamlined protocols, improved tissue characterization, and automation for greater standardization and efficiency.

Clinical relevance statement

The growing clinical role of cardiovascular MR in risk assessment, diagnosis, and treatment planning highlights the necessity for radiologists to achieve expertise in this modality, advancing precision medicine and healthcare efficiency.

Key Points

• Cardiovascular MR is essential in diagnosing and monitoring many acute and chronic cardiovascular pathologies.

• Features such as technical expertise, quality assurance, patient safety, and optimized tailored imaging protocols, among others, are essential for a successful cardiovascular MR program.

• Ongoing technological advances will push rapid multi-parametric cardiovascular MR, thus improving accessibility, patient comfort, and cost-effectiveness.

Key Recommendations

• Cardiovascular MR is essential in diagnosing and monitoring a wide array of cardiovascular pathologies (Level of Evidence: High).

• A successful cardiovascular MR program depends on standardization (Level of Evidence: Low).

• Future developments will increase the efficiency and accessibility of cardiovascular MR (Level of Evidence: Low).

Esposito A, Gallone G, Palmisano A et al (2020) The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precision medicine. Radiol Med 125:1013–1023. https://doi.org/10.1007/s11547-020-01286-9CrossRefPubMedPubMedCentral

Emrich T, Halfmann M, Schoepf UJ, Kreitner K-F (2021) CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments. Eur Radiol Exp 5:14. https://doi.org/10.1186/s41747-021-00208-2CrossRefPubMedPubMedCentral

Leiner T, Bogaert J, Friedrich MG et al (2020) SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 22:76. https://doi.org/10.1186/s12968-020-00682-4CrossRefPubMedPubMedCentral

Ferreira VM, Schulz-Menger J, Holmvang G et al (2018) Cardiovascular Magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol 72:3158–3176. https://doi.org/10.1016/j.jacc.2018.09.072CrossRefPubMed

Caobelli F, Cabrero JB, Galea N et al (2023) Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy : a review paper with practical recommendations on behalf of the European Society of Cardiovascular Radiology (ESCR). Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-023-02927-6CrossRefPubMedPubMedCentral

Fogel MA, Anwar S, Broberg C et al (2022) Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease: Endorsed by The American Heart Association. J Cardiovasc Magn Reson 24:1–78. https://doi.org/10.1186/s12968-022-00843-7CrossRef

Francone M, Budde RPJ, Bremerich J et al (2020) CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 30:2627–2650. https://doi.org/10.1007/s00330-019-06357-8CrossRefPubMed

Esposito A, Gatti M, Trivieri MG et al (2023) Imaging for the assessment of the arrhythmogenic potential of mitral valve prolapse. Eur Radiol. https://doi.org/10.1007/s00330-023-10413-9

Isselbacher EM, Preventza O, Hamilton Black J 3rd et al (2023) 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 166:e182–e331. https://doi.org/10.1016/j.jtcvs.2023.04.023

10.

Uhlig J, Al-Bourini O, Salgado R et al (2020) Gadolinium-based contrast agents for cardiac MRI: use of linear and macrocyclic agents with associated safety profile from 154 779 European Patients. Radiol Cardiothorac Imaging 2:e200102. https://doi.org/10.1148/ryct.2020200102CrossRefPubMedPubMedCentral

11.

Kodzwa R (2019) ACR manual on contrast media: 2018 updates. Radiol Technol 91:97–100PubMed

12.

MacIntyre S (2021) Regulating MR safety standards. Radiol Technol 93:75–89PubMed

13.

Kramer CM, Barkhausen J, Bucciarelli-Ducci C et al (2020) Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson 22:17. https://doi.org/10.1186/s12968-020-00607-1CrossRefPubMedPubMedCentral

14.

Tsai LL, Grant AK, Mortele KJ et al (2015) A practical guide to MR Imaging safety: what radiologists need to know. Radiographics 35:1722–1737. https://doi.org/10.1148/rg.2015150108CrossRefPubMed

15.

Raman SV, Markl M, Patel AR et al (2022) 30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper. J Cardiovasc Magn Reson 24:13. https://doi.org/10.1186/s12968-022-00844-6CrossRefPubMedPubMedCentral

16.

Natale L, Vliegenthart R, Salgado R et al (2023) Cardiac radiology in Europe: status and vision by the European Society of Cardiovascular Radiology (ESCR) and the European Society of Radiology (ESR). Eur Radiol 33:5489–5497. https://doi.org/10.1007/s00330-023-09533-zCrossRefPubMedPubMedCentral

17.

Ismail TF, Strugnell W, Coletti C et al (2022) Cardiac MR: from theory to practice. Front Cardiovasc Med 9:826283. https://doi.org/10.3389/fcvm.2022.826283CrossRefPubMedPubMedCentral

18.

Kellman P, Larson AC, Hsu L-Y et al (2005) Motion-corrected free-breathing delayed enhancement imaging of myocardial infarction. Magn Reson Med 53:194–200. https://doi.org/10.1002/mrm.20333CrossRefPubMedPubMedCentral

19.

Cross R, Olivieri L, O’Brien K et al (2016) Improved workflow for quantification of left ventricular volumes and mass using free-breathing motion corrected cine imaging. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson 18:10. https://doi.org/10.1186/s12968-016-0231-8CrossRef

20.

Schulz-Menger J, Bluemke DA, Bremerich J et al (2020) Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update. J Cardiovasc Magn Reson 22:19. https://doi.org/10.1186/s12968-020-00610-6CrossRefPubMedPubMedCentral

21.

Weikert T, Francone M, Abbara S et al (2021) Machine learning in cardiovascular radiology: ESCR position statement on design requirements, quality assessment, current applications, opportunities, and challenges. Eur Radiol 31:3909–3922. https://doi.org/10.1007/s00330-020-07417-0CrossRefPubMed

22.

Leiner T, Rueckert D, Suinesiaputra A et al (2019) Machine learning in cardiovascular magnetic resonance: basic concepts and applications. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson 21:61. https://doi.org/10.1186/s12968-019-0575-yCrossRef

23.

(2018) ESR paper on structured reporting in radiology. Insights Imaging 9:1–7. https://doi.org/10.1007/s13244-017-0588-8

24.

Kotter E, Pinto Dos Santos D (2021) Structured reporting in radiology : German and European radiology societies’ point of view. Radiologe 61:979–985. https://doi.org/10.1007/s00117-021-00921-4CrossRefPubMedPubMedCentral

25.

Saba L, Loewe C, Weikert T et al (2023) State-of-the-art CT and MR imaging and assessment of atherosclerotic carotid artery disease: standardization of scanning protocols and measurements-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 33:1063–1087. https://doi.org/10.1007/s00330-022-09024-7CrossRefPubMed

26.

Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B et al (2020) Reference ranges (“normal values”) for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 22:87. https://doi.org/10.1186/s12968-020-00683-3CrossRefPubMedPubMedCentral

27.

Prakken NH, Velthuis BK, Teske AJ et al (2010) Cardiac MRI reference values for athletes and nonathletes corrected for body surface area, training hours/week and sex. Eur J Cardiovasc Prev Rehabil 17:198–203. https://doi.org/10.1097/HJR.0b013e3283347fdbCrossRefPubMed

28.

Di Marco A, Brown PF, Bradley J et al (2021) Improved risk stratification for ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol 77:2890–2905. https://doi.org/10.1016/j.jacc.2021.04.030CrossRefPubMed

29.

Ommen SR, Mital S, Burke MA et al (2021) 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 162:e23–e106CrossRefPubMed

30.

Thavendiranathan P, Zhang L, Zafar A et al (2021) Myocardial T1 and T2 mapping by magnetic resonance in patients with immune checkpoint inhibitor-associated myocarditis. J Am Coll Cardiol 77:1503–1516. https://doi.org/10.1016/j.jacc.2021.01.050CrossRefPubMedPubMedCentral

31.

Francone M, Figliozzi S, Monti L et al (2023) Multiparametric cardiac magnetic resonance unveiling the mechanisms and early manifestations of anticancer drug cardiotoxicity. Eur Radiol. https://doi.org/10.1007/s00330-023-09948-8CrossRefPubMedPubMedCentral

Title: ESR Essentials: ten steps to cardiac MR—practice recommendations by ESCR
Authors: Tilman Emrich
Bernd J. Wintersperger
Fabio Domenico Greco
Dominika Suchá
Luigi Natale
Maja Hrabak Paar
Marco Francone
Publication date: 21-02-2024
Publisher: Springer Berlin Heidelberg
Keyword: Cardiomyopathy
Published in: European Radiology / Issue 4/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-024-10605-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ESR Essentials: ten steps to cardiac MR—practice recommendations by ESCR

Abstract

Clinical relevance statement

Key Points

Key Recommendations

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Clinical relevance statement

Key Points

Key Recommendations

Please log in to get access to this content

Other articles of this Issue 4/2024

Can absolute arterial phase hyperenhancement improve sensitivity of detection of hepatocellular carcinoma in indeterminate nodules on CT?

Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study

Letter to the Editor: “Effects of intravenous hydration in preventing post-contrast acute kidney injury in patients with eGFR < 30 mL/min/1.73 m2”

Low-dose liver CT: image quality and diagnostic accuracy of deep learning image reconstruction algorithm

Multi-parametric MRI-based machine learning model for prediction of WHO grading in patients with meningiomas

Comparison between CT volumetry, technetium99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients