Summary:
Cardiac MRA can be used to detect vascular abnormalities, and CMR allows for the assessment of cardiac motion and structure. Additionally, delayed enhancement can be used to evaluate myocardial damage. Although it cannot detect arrhythmias, I believe it is highly effective as a diagnostic tool for identifying the cause of syncope.
I have been conducting cardiac MRI for about 10 years. Recently, I have been interpreting cardiac MRI and coronary MRA images for health checkups.
(For reference, I have also been performing coronary CT since the 16-slice era.)
Currently, cardiac MRI is often used for evaluating secondary cardiomyopathy, assessing ischemic areas, and determining myocardial viability.
Regarding coronary MRA, even without contrast, it can effectively evaluate whether the major vessels (approximately 2.5 mm or larger) have no stenosis, stenosis that can be left untreated, or stenosis that might warrant coronary CTA.
In this context, I find that cardiac MRI is particularly useful for young patients with syncope.
Firstly, since these patients are young, it allows us to assess whether the coronary arteries, including their course, are normal. While it doesn’t detect spasms, it provides a significant amount of information.
Furthermore, with cardiac MRI, although it goes without saying that echocardiography should be done first, MRI does not typically suffer from the poor visibility that can affect echocardiograms. This makes it possible to evaluate the right heart, atria, and any adjacent extracardiac abnormalities.
In cases of sarcoidosis, for example, where there might be a ventricular aneurysm in an area difficult to visualize, MRI might be the first tool to reveal it.
By including the chest in the imaging, we can also assess abnormalities in the aorta.
Additionally, when combined with delayed enhancement imaging, if there was transient ischemia, there might be a faint delayed enhancement consistent with the coronary artery territory. This could also reveal unusual cardiomyopathies.
Importantly, since this imaging method does not involve radiation exposure, it can be ordered without hesitation, even for young women.
In cases of young patients with syncope, I often ordered a full cardiac MRI course, including delayed enhancement.
