Magnetic Resonance Imaging: A Wealth of Cardiovascular Information

Case: 16-year-old male with ascites being referred to Ochsner for liver transplant. Echocardiogram showed normal left ventricular size and function. Cardiac magnetic resonance imaging: Black blood images. Diagnosis: Pericardial thickening (arrow), resulting in constrictive pericardial disease and hepatic congestion.

Case: 72-year-old cachectic male with chronic obstructive pulmonary disease and shortness of breath. Echocardiogram was nondiagnostic secondary to poor acoustic window. Cardiac magnetic resonance imaging: Cine images created by steady state free precession. Diagnosis: Ejection fraction, 67.4%; stroke volume of 95.2 cc; end diastolic volume of 141.1 cc; end systolic volume, 45.9 cc; left ventricular mass, 196 g.

Case: 16-year-old female with dyspnea on exertion. Echocardiogram shows right ventricular enlargement with reduced function. Cardiac magnetic resonance imaging: Cine images, steady state free precession. Diagnosis: Precise measurement of right ventricular (arrow) end-diastolic volume (top image) and end-systolic (bottom image) show normal right ventricular (RV) volumes and function: RV ejection fraction, 52%; RV end diastolic volume, 133 cc; RV end systolic volume: 64 cc; stroke volume: 69 cc.

Case: 68-year-old male post left anterior descending infarct. Cardiac magnetic resonance imaging: Cine images, steady state free precession. Diagnosis: Akinesis and thinning of the mid-apical anterior wall and apical inferior wall and apical thrombus (arrow).

Case: 65-year-old male with history of recurrent lymphoma and coronary artery disease with newly depressed left ventricular function. Cardiac magnetic resonance imaging: Assessment of differential perfusion of the myocardium with gadolinium during adenosine stress. Diagnosis: Left ventricular ejection fraction, 41%. No evidence of ischemia.

Case: 56-year-old male with new onset weight loss. Echocardiogram showed intracardiac mass. Cardiac magnetic resonance imaging: Without (top) and with (bottom) gadolinium. Diagnosis: Highly vascular structure with gadolinium; cardiac sarcoma (arrow).

Case: 55-year-old female with echocardiogram ejection fraction of 45% and normal nuclear stress test. Cardiac magnetic resonance imaging: Delayed hyperenhancement. Diagnosis: Nontransmural infarct (arrow) of the mid inferolateral wall; superior spatial resolution magnetic resonance imaging defects >2 g necrosis; single photon emission computed tomography detects >10 g necrosis.

Case: 24-year-old male with chest pain, elevated troponin, and normal coronary arteries. Cardiac magnetic resonance imaging: delayed hyperenhancement (DHE). Diagnosis: Image on the left shows typical DHE (arrow) consistent with myocardial infarction (involving endocardium and sparing epicardium). Image on the right shows DHE (arrow) in this patient with myocarditis (involvement of epicardium only).

Case: 45-year-old female with rapidly progressing heart failure. Cardiac magnetic resonance imaging: Cine images, steady state free precession (top) and delayed hyperenhancement (bottom). Diagnosis: Amyloidosis—ventricular hypertrophy (top image, right arrow), thickened intra-atrial septum (top image, left arrow), and diffuse delayed hyperenhancement (bottom image).

Case: 75-year-old female with a bright mass seen in the intraventricular septal on echocardiogram. Cardiac magnetic resonance imaging: Black blood imaging (top) and fat suppression (bottom). Diagnosis: Benign cardiac lipoma (arrows); mass disappears with fat suppression.

Case: 19-year-old male with bicuspid aortic valve (AV). Cardiac magnetic resonance imaging: Cine image (top image with arrow on bicuspid AV) and velocity encoding contrast imaging (bottom). Graph depicts flow through the valve in systole and diastole. Diagnosis: Bicuspid AV with peak gradient of 40 mmHg and aortic insufficiency with regurgitation fraction of 21%.