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Cardiac Imaging

E3234. Pitfalls in Cardiac MRI: Causes and Solutions

Saxena D,  Quadri R,  Saboo S,  Abbara S,  Rajiah P. University of Texas Southwestern Medical Center, Dallas, TX

Address correspondence to P. Rajiah (radprabhakar@gmail.com)

Background Information: Cardiac MRI has become an important imaging modality in the evaluation of a variety of cardiovascular abnormalities. A high-quality cardiac MRI is essential for accurate diagnosis and characterization. However, a wide spectrum of pitfalls can be encountered which impair the diagnostic confidence and result in false-positive or -negative diagnosis. The purpose of this exhibit is to review the appearances and causes of several pitfalls in cardiac MRI and possible solutions.

Educational Goals/Teaching Points: We aim to illustrate the appearance of common and uncommon pitfalls in cardiac MRI and review the causes of these cardiac MRI pitfalls. We explain how these pitfalls may mimic lesions or lead to misinterpretation and propose effective approaches to eliminate these pitfalls.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: This exhibit presents a review of cardiac MRI sequences, along with acceleration strategies and a list of all cardiac MRI pitfalls. We review causes, imaging appearances, and solutions to the following cardiac MRI pitfalls: cine imaging, anatomic variants mimicking tumor (Crista terminalis, Chiari network, warfarin ridge); caseous mitral annular calcification; hypertrophied papillary muscle and moderator band mimicking mass; left apical thinning mimicking aneurysm and diverticulum; trabeculations of dilated left ventricle (LV) mimicking noncompaction; LV outflow tract in nontrue four-chamber mimicking aneurysm; partial volume averaging of right ventricle (RV) on LV in two-chamber view; black blood, high signal in black blood images due to slow flow; signal drop in myocardium due to coil sensitivity; vessel wall thickening due to chemical shift; fat in RV wall mimicking arrhythmogenic right ventricular dysplasia; dynamic first pass perfusion, subendocardial dark band due to Gibbs artifact; delayed enhancement, incorrect inversion time due to amyloidosis; fat versus fibrosis; partial volume averaging at RV insertion points, recesses; septal branch mimicking late gadolinium enhancement; pseudoenhancement due to pooling of blood in dilated ventricle; MR angiography, dense contrast in subclavian vein mimicking stenosis; and ringing (Maki) artifact.

Conclusion: Several pitfalls are encountered in cardiac MRI due to various causes. A knowledge of the various pitfalls, their causes, and corrective measures can reduce diagnostic misinterpretations and reduce redundant reporting times.