For cardiac imaging, special MRI sequences with and without contrast enhancement and cardiac and respiratory gating also provide soft-tissue characterization, accurate measurements of cardiac chamber ...size and global and regional function, valvular morphology, and physiologic parameters. Applications for cardiac PET/MRI The following are examples of potential clinical or research applications for PET/MR imaging of the heart 3,4,5,6,7: rest and/or stress myocardial perfusion, myocardial viability including rest and/or stress perfusion when indicated, inflammatory processes such as sarcoidosis and myocarditis, myocardial masses including non-neoplastic and neoplastic (both primary and metastatic), infiltrative processes such as amyloidosis, hereditary disorders such as hypertrophic cardiomyopathy and Anderson-Fabry disease, cardiac valvular disorders and emerging areas of research including tissue regeneration after stem cell therapy, coronary artery plaque imaging and assessment of sympathetic reinnervation after cardiac transplant. ...whether a physician comes from a radiology, nuclear medicine, or cardiology training background, gaps in experience may be present after formal training. For those with radiology or nuclear medicine as a primary specialty wishing to interpret cardiac PET/MRI in clinical practice, this writing committee recommends that in addition to the recommended initial training and continuing requirements, the radiologists or nuclear medicine specialist also holds and maintains certification by the American Board of Radiology or the American Board of Nuclear Medicine, respectively, or the equivalent in Canada.
Evaluation of acute coronary syndromes (ACS) in young women presents a clinical challenge. An unremarkable coronary angiogram may not exclude ACS, as spontaneous lesion revascularization, resolved ...coronary spams, or spontaneous coronary dissection (SCAD) can often be missed. Cardiac magnetic resonance imaging (CMR) can provide useful information in acute myocardial infarction (MI) by confirming and sizing acute infarction and delineating the etiology when angiography is inconclusive. Here, we report a case of a 39-year-old postpartum woman with a history of hyperlipidemia who presented with a one-day history of atypical angina. On presentation, she was found to have transient ST-segment elevation in high lateral leads and elevated troponin. Coronary angiography revealed a nonobstructive lesion in the first obtuse marginal branch (OM1) distribution. The patient subsequently underwent cardiac magnetic resonance imaging (MRI) for further delineation of etiology, which confirmed acute infarction in the OM1 distribution. Diagnosis of myocardial infarction with no obstructive coronary artery disease (MINOCA) secondary to acute coronary artery dissection type 2 (SCAD-2) was made. The patient was managed conservatively with medical therapy. CMR has emerged as a front-line diagnostic imaging modality in acute MI and can provide invaluable information in the confirmation and sizing of infarction, delineating tissue characteristics, establishing the etiology of infarction, and prognostication.
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