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Novel functional imaging techniques

An interesting talk regarding new imaging techniques based around magnetic resonance (MR), was led by Dr Aghogho Odudu (University of Manchester). The use of MR in cardiac and renal imaging is clearly growing, and the use of gadolinium to enhance both blood and extracellular fluid is a testament to the effectiveness of functional MR imaging.

Blood-oxygen-level dependent imaging (BOLD) works off of the basis that both oxygenated and deoxygenated haemoglobin are both weakly magnetic. The spin of both molecules can alter the signal and this has been useful in renal imaging – particularly identifying the loss of capillary beds in renal artery stenosis. Arterial spin labelling takes this further with real-time perfusion images – for example, demonstrating differences in the perfusion of both renal cortex and medulla. This has the potential to demonstrate both areas damaged by acute tubular injury. From a cardiac perspective, it also has the potential to be an extremely sensitive functional assessment of perfusion damage in myocardial ischaemia.

Dr Aghogho Odudu (University of Manchester)

Dr Aghogho Odudu (University of Manchester)

In non-ischaemic cardiomyopathies, it is thought that myocardial fibrosis is the primary underlying cause. This change in extracellular matrix remodelling increases the risk of diastolic heart failure and arrhythmias.1 Areas of specific regional myocardial scarring seen in cardiac ischaemia have a far slower washout time with regards to gadolinium-enhancement and, as such, are seen as an increased signal intensity. Diffuse fibrosis is more difficult to establish, and post-contrast T1 cardiac MR mapping has a role in identifying this. Consequently, T1 mapping is far more effective in detecting pathologies, such as dilated cardiomyopathy. 2 This technique may soon be used also in renal imaging – in particular for characterising the scarring seen in (CKD) kidney disease and end-stage renal failure.

References

1. Ling LH, Kistler PM, Ellims AH et al. Diffuse ventricular fibrosis in atrial fibrillation: noninvasive evaluation and relationships with aging and systolic dysfunction. J Am Coll Cardiol 2012;60: 2402–08. http://dx.doi.org/10.1016/j.jacc.2012.07.065

2. Iles L, Pfluger H, Phrommintikul A et al. Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol 2008;52:1574–80. http://dx.doi.org/10.1016/j.jacc.2008.06.049

Published on: February 21, 2017

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