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The Evolution of Cardiovascular Magnetic Resonance: A 50-Year Journey

24 Jun 2024
cardiovascular magnetic resonance

Cardiovascular magnetic resonance (CMR) has developed over the past 50 years as an advantageous noninvasive imaging modality. Recently published in Circulation, Gregory Hundley reviews CMR’s evolution and its current pivotal role in cardiovascular care.

Three Developmental Stages

The development of CMR can be divided into three stages: the origins of clinical use of magnetic resonance in imaging, the development of CMR-specific methods and techniques, and the integration of CMR into cardiovascular care pathways. The first stage began with the description of nuclear magnetic resonance (NMR) by Bloch and Purcell in 1946 and progressed with the application of Fourier transformation by Ernst and colleagues in 1966. These foundational advancements set the stage for Lauterbur and Mansfield’s work in the 1970s, which integrated proton-resonant frequency differences to produce images reflective of tissue characteristics.

Integration and Advancements

In the second stage, spanning the 1980s to 2010, significant progress was made in using magnetic resonance technology to capture various cardiovascular images. These advancements included identifying cardiac anatomy, measuring myocardial mass and chamber sizes, quantifying blood flow, and characterizing tissue properties using different relaxation times and gadolinium contrast.

The third stage, beginning in 2010 and continuing today, emphasized the widespread clinical use of CMR. Hundley describes that CMR has become a “one-stop shop” for evaluating cardiovascular morphology, perfusion, function, and tissue characterization in a single examination. This comprehensive approach allows for precise differentiation between various cardiomyopathies, myocarditis, and myocardial infarction.

Future Directions

Looking toward the future, Hundley mentions that four specific areas are anticipated to drive the next stage of CMR evolution:

1. Non-Gadolinium Imaging: Recent research shows that noncontrasted images combined with computer analytics can provide information comparable to gadolinium-enhanced images.

2. Comprehensive Examinations: Integrating heart images with those of other organs, like the kidneys, liver, and brain, to assess the brain-heart axis interaction.

3. Clinical Trials: Synchronizing protocols among different scanners to enhance the reliability of CMR measures in clinical trials.

4. Artificial Intelligence: Incorporating AI to improve image acquisition, facilitate advanced diagnoses, and predict cardiovascular risk using deep learning.

Finally, Hundley explains that the Society for Cardiovascular Magnetic Resonance (SCMR), founded in 1988, has played a crucial role in guiding CMR development and implementation. This global collaboration of experts provides a platform for innovation, technical development, and dissemination of research findings. This will be pivotal in shaping the future of CMR in clinical practice.

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