Nuclear medicine and radiology go together Cardiac MRI

Nowadays cardiac magnetic resonance (CMR) plays a significant role in the clinical setting of many cardiac pathological conditions. The use of CMR is well established in the identification of the cardiomyopathies, cardiac tumors and thrombus as well as pericardial disease and congenital cardiomyopathies. More recently the possibilities of combining morpho-functional information and perfusion studies has proven to be of growing interest in ischemic disease. Ischemia is considered as an anemia of the heart in which there is a mismatch between oxygen supply and oxygen need The clinical presentations of myocardial ischemia are 1. chronic stable angina, 2. unstable angina, 3. variant angina, myocardial infarct. In all these conditions Myocardial oxygen supply is inadequate compared to myocardial oxygen needs. In chronic stable angina, the symptoms appear during stress and MRI is adequate to evaluate perfusion or function before the angina and similarly left ventricular dysfunction and perfusion defects appear before the increase of cardiac enzymes in infarction. CMR is able in fact to delineate regional and functional dysfunction better than any other techniques. Echocardiography is limited in the evaluation of epicardial borders and apical region. Moreover with MRI, it is possible perform perfusion studies able to analyze the status of the micro circulation at rest and during stress by means of rapid sequences susceptible to gadolinium. Perfusion can be analyzed at first passage but also the persistence of the gadolinium in to the myocardium 15-20 minutes later that means necrotic or fibrotic evolution at this region