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Year : 2007  |  Volume : 17  |  Issue : 2  |  Page : 84-85
Guest Editorial: Cardiac magnetic resonance: From protons to the pulsating heart

Department of Cardiac Radiology, Cardiothoracic Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India

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How to cite this article:
Gulati GS. Guest Editorial: Cardiac magnetic resonance: From protons to the pulsating heart. Indian J Radiol Imaging 2007;17:84-5

How to cite this URL:
Gulati GS. Guest Editorial: Cardiac magnetic resonance: From protons to the pulsating heart. Indian J Radiol Imaging [serial online] 2007 [cited 2021 Mar 1];17:84-5. Available from:
Magnetic resonance has certainly come a long way since its discovery as a phenomenon by Bloch and Purcell in 1946 and its first application for imaging by Ernst in 1975. The potential for clinical cardiac magnetic resonance (CMR) was recognized in the mid-1980s and by the mid-1990s, it had captured the imagination of many in the cardiology and radiology world as a virtual "one stop shop" for cardiac imaging. CMR was thought to be capable of imaging cardiac structure, function, coronary artery morphology (including plaque characteristics) and myocardial perfusion and viability, all as a part of a comprehensive single examination. This initial period of enthusiasm was however, marred by a period of slow growth in the clinical usage of CMR and development was largely restricted to the realm of research in cardiovascular medicine.

The last decade has, however, seen a remarkable upsurge in the utilization of CMR for clinical applications. This has primarily been due to a proliferation of cardiac-capable MRI systems, development of improved pulse sequences (including parallel imaging, respiratory compensation and three-dimensional imaging), better and quicker post-processing tools and a gradually increasing acceptance of the technique among referring physicians. Today, the entire gamut of cardiac diseases can be imaged adequately with CMR. These include congenital, pericardial, myocardial, valvular and coronary artery disease. Compared to other cardiac imaging tests, CMR has certain well-recognized advantages. These include high contrast and spatial resolution, ability for tissue characterization, accurate assessment of functional alterations, measurement of contrast kinetics and myocardial blood flow, simultaneous evaluation of pulmonary and systemic vasculature, use of a non-nephrotoxic contrast agent and freedom from use of radiation. CMR assessment complements and often obviates the need for, traditional imaging modalities such as echocardiography, radionuclide imaging and catheter angiography. Perhaps most significantly, for the quantification of ventricular function and myocardial mass, CMR is a highly reproducible technique and has the least inter- and intra-observer variability. It has therefore, made its place as a standard imaging technique for assessing outcomes of drug and stem cell therapeutic trials.

Future applications of CMR include coronary angiography, interventional MR, stem cell tracking and molecular imaging. It seems certain that, as of now, cardiac CT (CCT) has taken over CMR for coronary artery imaging by virtue of its superior spatial resolution and constantly improving temporal resolution. Diehard fans of CMR however, claim that technological advancements should allow CMR to catch up with CCT in another ten years. Ultra-fast MR imaging techniques may become a possible real-time imaging alternative to conventional fluoroscopy for interventional cardiology procedures (particularly electrophysiological studies and ablation procedures). [1] Various stem cells hold promise for the treatment of cardiovascular disease. Currently reported studies in animals have demonstrated the ability of CMR to track the presence and viability of injected stem cells in the myocardium over both short and long- term periods. [2] This would avoid the need for repeated biopsy to detect homing of stem cells to the target tissue and allow assessment of differentiation and proliferation of the stem cells in vivo . For molecular imaging, work is underway to utilize gadolinium bound antibodies or peptides to image and identify specific components of the plaque, such as adhesion molecules, macrophages, lipid core and fibrous plaque, as well as image angiogenesis, apoptosis or cell trafficking. [3] This should usher in an era of molecular imaging during which much progress in the diagnosis and management of cardiovascular diseases is expected.

CMR is very safe and no long-term ill effects have been demonstrated. Claustrophobia may hinder completion of a successful examination in 2% of the patients. Hip prostheses, prosthetic heart valves, coronary stents and sternal sutures usually present no hazard since the materials used are non-ferromagnetic (although local artifacts may be created). Care is however required in patients with ferromagnetic intracranial aneurysm clips. It is best to avoid scanning patients with pacemakers, implanted cardioverter defibrillators (ICDs), retained permanent pacemaker leads and other electronic implants, although some reports suggesting evidence of successful procedures do exist. [4],[5] CMR-compatible devices are currently being developed.

Certainly, the heart has a lot to thank the magnet for. The overall utilization of CMR in our country will likely continue to increase as techniques and other advances detailed in the ensuing articles of this issue are disseminated on a larger scale. I would like to sincerely thank all the authors and congratulate them for the superlative quality of their contributions to this special issue of the journal. I hope that the readers, both the initiated as well as the uninitiated, will take back messages to our colleagues in cardiology practice so as to open up new areas of collaborative work in CMR. More and more Indian radiologists need to enter dedicated cardiovascular imaging programs which impart focused training both in the clinical and imaging aspects of cardiac disease. One also hopes that our colleagues from the industry invest greater into efforts designed to make image acquisition and post-processing with CMR a more user friendly and less technologist dependant activity. Having lesser buttons to push to get to the required information would certainly allow the users to learn faster, reduce imaging time, improve patient cooperation and encourage wider acceptance of the modality overall.

   References Top

1.Rhode KS, Sermesant M, Brogan D, Hegde S, Hipwell J, Lambiase P, et al . A system for real-time XMR guided cardiovascular intervention. IEEE Trans Med Imaging 2005;24:1428-40.   Back to cited text no. 1  [PUBMED]  
2.Kim D, Hong KS, Song J. The present status of cell tracking methods in animal models using magnetic resonance imaging technology. Mol Cells 2007;23:132-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Fuster V, Kim RJ. Frontiers in cardiovascular magnetic resonance. Circulation 2005;112:135-44.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Martin ET, Coman JA, Shellock FG, Pulling CC, Fair R, Jenkins K. Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla. J Am Coll Cardiol 2004;43:1315-24.  Back to cited text no. 4    
5.Heatlie G, Pennell DJ. Cardiovascular magnetic resonance at 0.5T in five patients with permanent pacemakers. J Cardiovasc Mag Res 2007;9:15-9.  Back to cited text no. 5    

Correspondence Address:
Gurpreet S Gulati
Cardiac Radiology, All India Institute of Medical Sciences, Ansari Nagar. New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.33617

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