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org
1832
| CARDIAC IMAGING

Quantification in Cardiovascu-
lar MRI: A Primer for Radiology
Residents
Kevin R. Kalisz, MD The full digital presentation is available online.
RADIOGRAPHICS FUNDAMENTALS

Kianoush Ansari-Gilani, MD
Cardiac MRI has become an increasingly used tool for noninvasive
Abbreviation: SSFP = steady-state free comprehensive assessment of the heart in a wide variety of cardio-
precession
vascular pathologic conditions. This is because of several factors,
RadioGraphics 2020; 40:1832–1833 including increased availability, improved data sampling strategies and
https://doi.org/10.1148/rg.2020200035 reconstruction techniques, and a growing body of literature regarding
Content Codes: its accuracy and prognostic impact. A critical component of cardiac
MRI and a principle strength over other imaging modalities is the abil-
From the Department of Radiology, North-
western University Feinberg School of Medi- ity to provide precise and reproducible quantitative information about
cine, Chicago, Ill (K.R.K.); and Department cardiac structure and function and myocardial tissue characteristics.
of Radiology, University Hospitals Cleveland
Medical Center, 11100 Euclid Ave, Cleveland, For example, at echocardiography, right ventricular assessment may
OH 44106 (K.A.G.). Presented as an education be limited as this chamber may not be well visualized because of poor
exhibit at the 2019 RSNA Annual Meeting. Re-
ceived March 13, 2020; revision requested May
acoustic windows. Echocardiography also cannot delineate the pres-
22 and received June 4; accepted June 13. All ence of myocardial edema or fibrosis. However, both features can be
authors have disclosed no relevant relationships. quantified at a single cardiac MRI examination. Quantitative informa-
Address correspondence to K.A.G. (e-mail:
[email protected]). tion obtained at cardiac MRI has a significant impact on the diagnosis,
©
treatment, and prognostication of many cardiovascular diseases.
RSNA, 2020
Quantification with cardiac MRI requires use of postprocessing
software, with many vendors now incorporating artificial intelligence
to provide increased automated postprocessing capabilities. User
input from the interpreting physician is still often mandatory to cor-
rect and troubleshoot software errors and inaccuracies. Therefore,
interpreters must have a thorough understanding of the underlying
concepts and steps involved in basic quantification techniques to
ensure accuracy and reliability.
This online presentation reviews the fundamental concepts of
several areas that may be used in cardiac MRI examinations. Essen-
tial to every cardiac MRI examination is calculation of ventricular
volumes, function, and mass, which is performed using short-axis
steady-state free-precession (SSFP) images. In this process, end-sys-
tolic and end-diastolic phases are selected, and ventricular endocar-
dial and epicardial contours are drawn. From this information, end-
systolic and end-diastolic volumes are subsequently calculated (Fig
1). Stroke volume, ejection fraction, and cardiac output can then be
calculated from this information. Myocardial volume is calculated
using similar steps, from which myocardial mass is derived.
Vascular velocity, flow, and volume information is obtained from
velocity-encoded phase-contrast images. Phase-contrast images can
be oriented in-plane parallel to the direction of blood flow or through-
plane oriented orthogonal to the direction of flow (Fig 2). Velocity
and, subsequently, peak gradient information can be obtained on ei-
ther in-plane or through-plane images. Flow and volume information

TEACHING POINTS
„ Describe the basic principles of sequences commonly used in quantitative cardiac MRI.
„ Explain the principles of parameter quantification in clinical scenarios.
„ Identify common pitfalls in cardiac MRI and learn appropriate troubleshooting techniques.
RG • Volume 40 Number 7 Kalisz and Ansari-Gilani 1833

Figure 1. Use of Simpson’s rule

technique with knowledge of the
section thickness (ST) and intersec-
tion gap to measure end-systolic
and end-diastolic volumes. Short-
axis SSFP images (left and right
images) and four-chamber refer-
ence SSFP image (middle image)
show epicardial and endocardial
contours and cross-sectional areas.
Green line = left ventricle epicardial
contour, yellow line = right ventri-
cle endocardial contour, yellow shading = right ventricle endocardial cross-sectional area, red line = left ventricle endocardial contour,
red shading = left ventricle endocardial cross-sectional area.

Figure 2. Vascular velocity, flow, and volume

information can be obtained from velocity-
encoded phase-contrast images. Phase-contrast
images can be orientated in-plane parallel to
the direction of blood flow or through-plane or-
thogonal to the direction of flow. In-plane left
ventricular outflow tract systolic phase (a) and
magnitude (b) phase-contrast images as well
as through-plane systolic phase (c) and magni-
tude (d) phase-contrast MR images at the level
of the aortic valve show how flow across the left
ventricular outflow tract and through the aortic
valve appears with low signal intensity on phase
images (arrow in a and c). The corresponding
anatomy is better delineated on magnitude
images.

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