Ressonância magnética cardíaca
Cardiac MRI Scan
What is Cardiac MRI?
Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions.
MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI does not use ionizing radiation (x-rays).
Detailed MR images allow physicians to evaluate various parts of the body and determine the presence of certain diseases. The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD or uploaded to a digital cloud server.
What are some common uses of the procedure?
1. Cardiac MRI imaging is performed to help your physician detect or monitor cardiac disease by:
evaluating the anatomy and function of the heart chambers, valves, size and blood flow through major vessels, and surrounding structures such as the pericardium (the fluid filled sac that surrounds the heart)
2.Diagnosing a variety of cardiovascular (heart and/or blood vessel) disorders such as tumors, infections, and inflammatory conditions.
3. Evaluating the effects of coronary artery disease such as limited blood flow to the heart muscle and scarring within the heart muscle after a heart attack.
4. Planning a patient's treatment for cardiovascular disorders.
5. Monitoring the progression of certain disorders over time.
6. Evaluating the effects of surgical changes, especially in patients with congenital heart disease.
7. Evaluating the anatomy of the heart and blood vessels in children and adults with congenital heart disease.
How should you prepare?
You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.
Guidelines about eating and drinking before an MRI exam vary with the specific exam and with the imaging facility. Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual.
Some MRI examinations may require you to receive an injection of contrast material into the bloodstream. The radiologist, technologist or a nurse may ask if you have allergies of any kind, such as an allergy to iodine or x-ray contrast material, drugs, food, or the environment, or if you have asthma. The contrast material most commonly used for an MRI exam contains a metal called gadolinium. Gadolinium can be used in patients with iodine contrast allergy. It is far less common for a patient to have an allergy to a gadolinium-based contrast agent used for MRI than the iodine-containing contrast for CT.
However, even if it is known that the patient has an allergy to the gadolinium contrast, it may still be possible to use it after appropriate pre-medication. Patient consent will be requested in this instance. For more information on adverse reactions to gadolinium-based contrast agents, please consult the ACR Manual on Contrast Media.
You should also let the radiologist know if you have any serious health problems, or if you have had any recent surgeries. Some conditions, such as severe kidney disease, may prevent you from being given gadolinium contrast for an MRI. If you have a history of kidney disease or liver transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately.
Women should always inform their physician or technologist if there is any possibility that they are pregnant. MRI has been used for scanning patients since the 1980s with no reports of any ill effects on pregnant women or their unborn babies. However, because the unborn baby will be in a strong magnetic field, pregnant women should not have this exam in the first three to four months of pregnancy unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of gadolinium contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more information about pregnancy and MRI.
If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician for a prescription for a mild sedative prior to your scheduled examination.
Jewelry and other accessories should be left at home, if possible, or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. In addition to affecting the MRI images, these objects can become projectiles within the MRI scanner room and may cause you and/or others nearby harm. These items include:
jewelry, watches, credit cards and hearing aids, all of which can be damaged
pins, hairpins, metal zippers and similar metallic items, which can distort MRI images removable dental work pens, pocket knives and eyeglasses body piercings.
In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area:
1. Cochlear (ear) implant
2. Some types of clips used for brain aneurysms
3. Some types of metal coils placed within blood vessels
4. Nearly all cardiac defibrillators and pacemakers
You should tell the technologist if you have medical or electronic devices in your body. These objects may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will have a pamphlet explaining the MRI risks for that particular device. If you have the pamphlet, it is useful to bring that to the attention of the scheduler before the exam and bring it to your exam in case the radiologist or technologist has any questions. Some implanted devices require a short period of time after placement (usually six weeks) before being safe for MRI examinations.
Examples include but are not limited to:
artificial heart valves
implanted drug infusion ports
artificial limbs or metallic joint prostheses
implanted nerve stimulators
metal pins, screws, plates, stents or surgical staples
If there is any question of their presence, an x-ray may be taken to detect and identify any metal objects. In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure.
Patients who might have metal objects in certain parts of their bodies may also require an x-ray prior to an MRI. You should notify the technologist or radiologist of any shrapnel, bullets, or other pieces of metal that may be present in your body due to prior accidents. Foreign bodies near and especially lodged in the eyes are particularly important because they may move during the scan, possibly causing blindness. Dyes used in tattoos may contain iron and could heat up during an MRI scan, but this is rare. Tooth fillings and braces usually are not affected by the magnetic field, but they may distort images of the facial area or brain, so you should let the radiologist know about them.
Parents or family members who accompany patients into the scanning room also need to remove metal objects and notify the technologist of any medical or electronic devices they may have.
What does the equipment look like?
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet.
Some MRI units, called short-bore systems, are designed so that the magnet does not completely surround you. Some newer MRI machines have a larger diameter bore which can be more comfortable for larger size patients or patients with claustrophobia. Other MRI machines are open on the sides (open MRI).
Open units are especially helpful for examining larger patients or those with claustrophobia. Newer open MRI units provide very high quality images for many types of exams. Older open MRI units may not provide this same image quality. Certain types of exams cannot be performed using open MRI. For more information, consult your radiologist.
The computer workstation that processes the imaging information is located in a separate room from the scanner.
How does the procedure work?
Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not utilize ionizing radiation. Instead, radiofrequency pulses re-align hydrogen atoms that naturally exist within the body while you are in the scanner without causing any chemical changes in the tissues. As the hydrogen atoms return to their usual alignment, they emit different amounts of energy that vary according to the type of body tissue from which they come. The MR scanner captures this energy and creates a picture of the tissues scanned based on this information.
The magnetic field is produced by passing an electric current through wire coils in most MRI units. Other coils, located in the machine and in some cases, placed around the part of the body being imaged, send and receive radio waves, producing signals that are detected by the coils. The electric current does not come in contact with the patient.
A computer then processes the signals and generates a series of images, each of which shows a thin slice of the body. The images can then be studied from different angles by the interpreting radiologist.
Frequently, the differentiation of abnormal (diseased) tissue from normal tissues is better with MRI than with other imaging modalities such as x-ray, CT and ultrasound.
How is the procedure performed?
MRI examinations may be performed on outpatients or inpatients.
You will be positioned on the moveable examination table. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging.
Devices that contain coils capable of sending and receiving radio waves may be placed around or adjacent to the area of the body being studied.
Electrocardiogram (ECG) leads (small sticky patches) will likely be placed on your chest to help the machine synchronize the image acquisition with the beating of your heart. Men may require a small area of hair to be shaved from the chest in order to ensure that the small ECG patches will stick well. A respiratory gating belt, a device that helps the computer know how you are breathing at any given time, may be placed around your upper abdomen. Additionally, a small pulse monitor may be placed on your finger.
You will be given breathing instructions and will be asked to hold your breath numerous times during the examinations.
If a contrast material will be used in the MRI exam, a physician, nurse or technologist will insert an intravenous (IV)catheter, also known as an IV line, into a vein in your hand or arm. A saline solution may be used to inject the contrast material. The solution will drip through the IV to prevent blockage of the IV catheter until the contrast material is injected.
You will be placed into the magnet of the MRI unit and the radiologist and technologist will perform the examination while working at a computer outside of the room.
If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection.
When the examination is complete, you may be asked to wait until the technologist or radiologist checks the images in case additional images are needed.
Your intravenous line will be removed.
MRI exams generally include multiple runs (sequences), some of which may last several minutes.
The entire examination is usually completed in less than 90 minutes once imaging has started, but may be shorter or longer depending on what the initial image shows.
If a child has been sedated or anesthetized for an MRI exam, recovery time ranges from approximately 30 minutes to two hours after the exam is completed.
What will I experience during and after the procedure?
Most MRI exams are painless. However, some patients find it uncomfortable to remain still during MR imaging. Others experience a sense of being closed-in (claustrophobia) while in the MRI scanner. Therefore, sedation can be arranged for those patients who anticipate anxiety, but fewer than one in 20 require medication.
During cardiac MRI, your heart beat will be monitored and you will be asked to hold your breath for short periods of time while images are recorded.
It is normal for the area of your body being imaged to feel slightly warm, but if it bothers you, notify the radiologist or technologist. It is important that you remain perfectly still while the images are being obtained, which is typically only a few seconds to a few minutes at a time. You will know when images are being recorded because you will hear and feel loud tapping or thumping sounds when the coils that generate the radiofrequency pulses are activated. Some centers provide earplugs, while others use headphones to reduce the intensity of the sounds made by the MRI machine. You may be able to relax between imaging sequences, but will be asked to maintain your position without movement as much as possible.
You will usually be alone in the exam room during the MRI procedure. However, the technologist will be able to see, hear and speak with you at all times using a two-way intercom. Many MRI centers allow a friend or parent to stay in the room as long as they are also screened for safety in the magnetic environment.
Risks:
The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed.
If sedation is used, there are risks of excessive sedation. However, the technologist or nurse will monitor your vital signs to minimize this risk.
Although the strong magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam.
Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of gadolinium-based contrast material in patients with very poor kidney function. Careful assessment of kidney function before considering a contrast injection minimizes the risk of this very rare complication.
Reference:
1. www.radiologyinfo.org