Cardiac MR

Cardiac MRI is a very effective diagnostic method that provides detailed information about the type and characteristics of heart diseases without the need for interventional procedures, allowing rapid diagnosis and accurate treatment planning. While providing high quality images, it is among the preferred safe methods because it does not cause radiation exposure.

WHAT IS CARDIAC MRI?

Cardiac MRI is an advanced cardiovascular imaging method that enables detailed images of the heart using radio waves, magnetic fields and computers.

IN WHICH DISEASES IS CARDIAC MR USED?

One of the most commonly used areas is heart failure. The degree of heart failure, the changes it causes in the chambers and valves provides advanced information on whether heart failure is reversible. Apart from this, as mentioned above, pericardium (pericardium), congenital heart diseases, valvular diseases, aortic diseases, the degree of involvement of the heart muscle in coronary artery disease and whether there is an oxygenation disorder are the areas where cardiac MRI can easily provide guidance.

Cardiac MR is also used in patients with palpitations, fainting, dizziness, and rhythm disturbances to investigate whether there is a focal or anatomical hemodynamic cause that may cause this. In congenital heart diseases and aortic diseases, it provides a painless diagnosis without radiation, painlessness, and helps in the follow-up and treatment process in patients with poor image quality and undiagnosed by echocardiography.

HOW IS CARDIAC MR PERFORMED? / HOW IS IT APPLIED? WHAT KIND OF A PROCESS AWAITS THE PATIENT?

First of all, a detailed medical history is taken from the patients and detailed information is obtained about the patient's kidney functions, allergic conditions, pacemaker, whether there is any metal in the body and about pregnancy status. Since the capture and image quality are very important for the correct interpretation of the examination, shooting is a part of the process that needs to be studied very meticulously and requires extra care. Vascular access is opened so that contrast material and other drugs that may be required can be administered to the patient first. After the vascular access is established, the patient is taken to the comfortable and wide cardiac MR machine. Cardiac MRI is a magnet-like device, in the middle of which is a tunnel through which the patient bed enters. Electrodes that record the heart rate are attached to the patient's chest. From the outside, the patient is told to breathe with voice commands. Each breath holding time can usually last up to 10 or 20 seconds. In this process, the patient's compliance with breathing commands and not moving at all is very important in terms of image quality. Make trials with the patient beforehand and make sure that this part is done correctly. Imaging takes about 50-60 minutes and there is no pain. Afterwards, the images are analyzed in detail and the reports are delivered to the patients quickly.

FREQUENTLY ASKED QUESTIONS ABOUT CARDIAC MRI

Cardiac should not applied to which patients?

Imaging is not performed for patients with severe claustrophobia, that is, fear of closed spaces and those who refuse to enter the device. In addition, if urea and creatinine values are above a certain level in the blood tests of patients with kidney failure, these patients should be evaluated by their physicians beforehand. General MR rules are also valid in cardiac MR. It is not recommended if the patient has a metal prosthesis or a battery that is incompatible with MRI in any part of the body. If available, pacemakers or metal caps should be compatible with MRI. Before deciding on the procedure, the patient should be asked whether there is a prosthetic valve, battery, or any other metal prosthesis in the body. Also, metals such as piercings need to be removed.

Is there a preparation process for cardiac MR?

Although there is no special preparation process, it is important for the success of the examination that the patient shaves the hairs on the chest, if any, due to the electrodes attached to the chest and recording the heart rhythm in cardiac MRI. In addition, if an allergic condition occurs while using drugs before the procedure, 4-5 hours of fasting is required to minimize the risk of nausea-vomiting and aspirating. In addition, the drugs used can continue to be used until the day of the examination, unless otherwise stated. Bringing all previous examination results and reports about the heart before the procedure will be beneficial in terms of a more holistic examination of the patient.

What should be considered after a cardiac MR?

After the procedure, there is nothing that needs special attention. The patient may resume daily life immediately after the procedure.

What are the advantages of cardiac MR?

As different from other cardiac imaging methods, echocardiography and cardiac tomography, the most important feature of this method is that gives detailed information at the tissue level. There is no other diagnostic method that can evaluate the tissue of the heart muscle in this way. For example, when echocardiography is performed on a patient with heart failure, only the presence and degree of heart failure is detected. However, when cardiac MRI is performed, very important information is obtained about the cause of heart failure. Cardiac imaging method that can best answer the question of whether heart failure is caused by coronary artery disease, a genetic type of heart failure or an inflammatory process due to infection in the heart is cardiac MRI. In this way, the diagnosis and treatment process of the patients is accelerated and a great contribution is made to the treatment of the disease.

While providing all of these, it is a very important feature of this technique is that patients are not exposed to radiation.

In addition to the diagnosis and treatment of the patients, it is also important to follow the patients after the treatment process is initiated. For example, when a patient is evaluated with cardiac MRI before bypass surgery, the amount of tissue that can heal after surgery can be predicted. Cardiac MRI can be used to make detailed measurements and tissue-based evaluations during follow-up.

Some drugs can have toxic effects on the tissue of the heart in chemotherapy patients. Heart functions can be monitored in detail with MRI, especially in patient groups with poor echocardiographic image quality. In addition, since there is no radiation, it is also of great importance for cancer patients.

Cardiac MRI can also be used to investigate whether there is any permanent damage after heart muscle inflammation (myocarditis) treatment or after a heart attack.

Heart muscle may also be affected due to some rheumatological diseases. If there is heart involvement and if heart failure is thought to be due to these diseases, the treatment may change completely. Therefore, cardiac MRI is also very guiding in rheumatological diseases whether there is heart involvement or not.

Image quality of cardiac MR is much superior to echocardiography. Detailed analysis can be made regarding the volume, contraction force and the entire anatomy of the heart. Especially the right ventricle has a different, difficult, funnel-shaped anatomy, and detailed evaluation of the right ventricle is difficult with echocardiography, while detailed assessment of both volume and function can be easily performed with cardiac MR. Cardiac MR is one of the diagnostic criteria in the guidelines in heart disease, which is called arrhythmogenic right ventricular dysplasia (ARVD) and can lead to life-threatening rhythm disorders.

In some diseases of genetic origin, such as hypertrophic cardiomyopathy, which are caused by thickening of the heart muscle, the connective tissue change in the heart muscle provides advanced information about possible rhythm disturbances, so it must be done in these patients. In addition, since this disease has a genetic inheritance form that we call 'autosomal dominant', when family members are evaluated by echocardiography, if there is an interruption or suspicion of early stage disease, family members may be checked with cardiac MRI for detailed evaluation and tissue-based evaluation.

In the evaluation of the mass in the heart, it provides detailed information about what kind of mass the mass is and its spread.

It is used quite frequently in congenital heart diseases as it provides advanced information in terms of both anatomy, volume and hemodynamics. It is a preferred diagnostic method for the patients to decide on the operation type and to be free from radiation in the routine follow-up afterwards, to have hemodynamic evaluation and to take detailed images.

How long does a cardiac MR take?

It takes about 50-60 minutes.

Kardiyak MR’ın böbreklere zararı var mı?

If the patient's kidney functions are impaired, hydration (intravenous serum injection) is performed or some precautions are taken. If there is a serious kidney problem, the process is carried out with nephrology. Those with kidney problems should definitely inform the physician about this before cardiac MRI. Creatinine value is routinely checked before cardiac MRI. If the patient has a recent creatinine value, it is not requested again. However, if it is not available recently, creatinine is checked again in the blood.

Is there any side effect?

As mentioned above, there are no side effects of cardiac MRI except the possibility of allergy to the contrast agent to be given during the procedure and the progression of kidney disease if some kidney patients are not checked correctly if and precautions are not taken.

Is it taken in the check-up program routinely?

If there is no indication in the patient, there is no need for routine extraction. However, if the patient has a disease that requires follow-up such as heart failure, valvular disease, congenital heart disease, aortic enlargement, it may be recommended to follow-up and evaluate these patients with cardiac MRI. Especially in patients with aortic enlargement and some annual / 2-year close follow-ups, follow-up with cardiac MR instead of computed tomography will eliminate radiation exposure.

Is contrast material given in cardiac MR?

Contrast material is given in cardiac MR. There are conditions called late or early gadolinium involvement in cardiac MRI. In early involvement, it is checked whether there is any clot or problem called microvascular obstruction in the heart. In the late gadolinium phase, contrast is essential to see if there is a connective tissue change within the muscle tissue of the heart called myocardium. If no contrast agent is given, it is not possible to see the connective tissue change in the heart muscle, the localization or the amount of dead heart cells.

Prepared by Memorial Medical Editorial Board.