State of the Art:Pediatric Cardiac MRI

Neil Mardis, DOAssistant Professor Radiology

Children’s Mercy HospitalUniversity of Missouri, Kansas City

Pediatric cMRI• When to order• What does it involve• Where and when we offer study• What you get• Who is not a candidate

PEDIATRIC CMRIWhen to order?

Pediatric cMRI• When?

– When patient has complex congenital heart disease which requires more information than echocardiography• Best to discuss case with Cardiologist who manages patient• Coordinated and scheduled through Cardiology

– When patient has risk for coarctation or other aortic anomaly• Turners• Noonans• Marfans

Pediatric cMRI• When?

– When there is concern for ARVD• Typically referred from Cardiology

PEDIATRIC CMRIWhat does it involve?

Pediatric cMRI• What does it involve?

– 1-2 hours of scanning time

Pediatric cMRI• What does it involve?

– Possibly sedation/anesthesia• Always administered and

supervised by Anesthesia Department

• Older children can often go without sedation

Pediatric cMRI• What does it involve?

– Multiple breath holds by patient– Often times IV gadolinium

PEDIATRIC CMRIWhere and when is it offered?

Pediatric cMRI• Where is it offered?

– Main campus• Always supervised and directed by a Radiologist• Access to Sedation team

Pediatric cMRI• When is it offered?

– Tuesday for all complex congenital disease

– Monday through Friday for limited aortic cases

PEDIATRIC CMRIWhat do you get?

Pediatric cMRI• What do you get?

– High resolution anatomic images

Pediatric cMRI• What do you get?

– Real-time assessment of wall motion and blood flow

Pediatric cMRI• What do you get?

– Functional data• Ventricle

– Stroke volume– Cardiac output– Ejection fraction

Pediatric cMRI• What do you get?

– Functional data• Great vessels/valves

– Flow velocity– Flow direction

Pediatric cMRI• What do you get?

– Functional data• Great vessels/valves

– Flow velocity– Flow direction

PEDIATRIC CMRIWho is not a candidate for cMRI?

Pediatric cMRI• Who is not a candidate?

– Pacer dependant patients– Any patient with a typical contraindication to MRI

• Surgical/orthopedic implant of unknown type• VNS

• What is okay for MRI?– Sternal wires– Vascular stents/coils of known brand– Any implant we have adequate safety data on

PEDIATRIC CMRISummary

Pediatric cMRI• Summary

– Great modality for assessing anatomic and functional aspects of congenital heart disease

– Available downtown– When in doubt consult cardiology