Cardiovascular MR imaging includes the complete anatomical display of the heart with CINE imaging of all phases of the heartbeat. Ultrafast techniques make breath hold three-dimensional coverage of the heart in different cardiac axes feasible. Cardiac MRI provides reliable anatomical and functional assessment of the heart and evaluation of myocardial viability and coronary artery disease by a noninvasive diagnostic imaging technique.
Cardiovascular MRI offers potential advantages over radioisotopic techniques because it provides superior spatial resolution, does not use ionizing radiation, has no imaging orientations constraints and contrast resolution better than echocardiography. It also offers direct visualization and characterization of atherosclerotic plaques and diseased vessel walls and surrounding tissues in cardiovascular research.
MRI perfusion approaches measure the alteration of regional myocardial magnetic properties after the intravenous injection of contrast agents and assess the extent of injury after a myocardial infarction and the presence of myocardial viability with a technique based on late enhancement. Extracellular MRI contrast agents, like Gd-DTPA, accumulate only in irreversibly damaged myocardium after a time period of at least 10 minutes.
This type of patients may also have an implanted cardiac stent, bypass or a cardiac pacemaker and special caution should be observed on the MRI safety and the contraindications. While a number of coronary stents have been tested and reported to be MRI compatible, coronary stents must be assessed on an individual basis, with the medical team weighing the risks and benefits of the MRI procedure.

Cardiac MRI overview:

Cardiovascular MRI has become one of the most effective noninvasive imaging techniques for almost all groups of heart and vascular disease.

ABLAVAR™ (formerly named Vasovist™) is a blood pool agent for magnetic resonance angiography (MRA), which opens new medical imaging possibilities in the evaluation of aortoiliac occlusive disease (AIOD) in patients with suspected peripheral vascular disease.
ABLAVAR™ binds reversibly to blood albumin, providing imaging with high spatial resolution up to 1 hour after injection, due to its high relaxivity and to the long lasting increased signal intensity of blood.
As with other contrast media: the possibility of serious or life-threatening anaphylactic or anaphylactoid reactions, including cardiovascular, respiratory and/or cutaneous manifestations, should always be considered.

WARNING:
NEPHROGENIC SYSTEMIC FIBROSIS Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in patients with acute or chronic severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73m²), or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period.

See also Cardiovascular Imaging, Adverse Reaction, Molecular Imaging, and MRI Safety.

With this method irregular RR intervals in cardiac gating during cardiovascular imaging are rejected and then repeated to improve the image quality, whereby the cardiac frequency is used as a basis of the normal heart rate.
The RR interval window determines the percentage variation of the heart rate. Variations of the acquired data outside the window are rejected and not used in the image reconstruction. Also one interval after the arrhytmic beat will be rejected.
Arrhythmia rejection may be inappropriate for patients with certain pathologies, because if the RR interval is constant long, short, long, - all intervals would be rejected. Also a disadvantage is the time consume, but in some cases this function is mandatory, e.g. for diverse retrospective triggered sequences.

With this magnetic resonance angiography technique flowing blood appears dark.
MR black blood techniques have been developed for cardiovascular imaging to improve segmentation of myocardium from the blood pool. Black blood MRA techniques decrease the signal from blood with reference to the myocardium and make it easier to perform cardiac chamber segmentation.
ECG gated spin echo sequences with presaturation pulses for magnetization preparation will show strong intravascular signal loss due to flow effects when appropriate imaging conditions including spatial presaturation are used. The sequence use the flow void effect as blood passes rapidly through the selected slice.
For dark blood preparation, a pair of nonselective and selective 180° inversion pulses are used, followed by a long inversion time to null signal from inflowing blood. A second selective inversion pulse can also be applied with short inversion time to null the fat signal. These in cardiac imaging used black blood techniques are referred to as double inversion recovery T1 measurement turbo spin echo or fast spin echo, and double-inversion recovery STIR.

Blood pool agents (intravascular contrast agents) remain in the blood for a prolonged time compared with conventional contrast agents, which diffuse quickly into the interstitial space. Magnetic resonance angiography (MRA), cardiovascular imaging, or contrast enhanced MRIs are possible over an hour or more. This advantage over conventional MRI contrast media allows also higher resolution MRA of several territories using respiratory or cardiac gating techniques with a single contrast bolus.
Different types of blood pool contrast agents:
Blood pool MRI contrast agents with their longer intravascular circulation can be designed to be targeted to necrotic myocardium, to assess myocardial viability, or tumor directed to provide better diagnostic information for various tumors. A disadvantage of the use of blood pool agents for MRA is that the separation of arteries and veins is more difficult because they are present in both and the overlapping of those vessels is disturbing. This can be solved by e.g. different MIP segmentation algorithms.

See also Necrosis Avid Contrast Agent, Tumor Specific Agents, Feruglose, Gadofosveset Trisodium (Vasovist), Ultrasmall Superparamagnetic Iron Oxide and Contrast Medium.