Right ventricular cardiovascular magnetic resonance imaging: normal anatomy and spectrum of pathological findings

Abstract

BackgroundThe right ventricle (RV) has been defined as the “forgotten chamber”, as its role in cardiac physiopathology has long been underestimated. Nevertheless, the RV is involved in a wide range of pathological conditions and its altered function may significantly affect the patient’s clinical status.MethodsA selection of the most common cardiovascular magnetic resonance (CMR) features in a spectrum of pathological conditions is illustrated. Although its complex morphology, thin myocardium and trabeculated apex, RV can be accurately imaged by CMR, revealing its involvement in ischaemic and non-ischaemic heart disease. CMR has emerged as the pre-eminent modality in monitoring ventricular performance in congenital heart disease, pulmonary hypertension and cardiomyopathies. Arrhythmogenic right ventricular cardiomyopathy is a difficult diagnosis and the recently revised task force criteria confirmed a crucial role of CMR to increase diagnostic accuracy, by combining detection of RV dilation, regional wall motion and structural abnormalities. Moreover, a multiparametric approach of CMR is often necessary for delineation and characterisation of cardiac masses.ConclusionCMR, combining assessment of morphology, structure and function, has definitively emerged as the reference technique to evaluate a large variety of RV diseases.Teaching Points• CMR offers unique advantages for imaging of many RV congenital, ischaemic and non-ischaemic diseases.• Because of high reproducibility, CMR has a crucial role in decision-making for chronic RV pathology.• The use of CMR increases detection of RV disease as infarction or arrhythmogenic cardiomyopathy.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-013-0222-3) contains supplementary material, which is available to authorized users.

Morphometric and Clinical Analysis of Moderator Band in Humans

“…In a rare condition called arrythmogenic right ventricular dysplasia (ARVD), the moderator band is visualized as a highly thick echogenic band and hence helps in differentiating ARVD from RV ischaemia [8]. The same is also useful in distinguishing RV from LV in congenital anomalies as there is no muscular or trabecular attachment on the LV [9].…”

Inherited cardiomyopathies

“…It may determine tissue characteristics, such as myocardial fibrosis, and uncover subtle right ventricular abnormalities in ACM 24. It may also differentiate specific causes such as amyloidosis and Fabry disease25 and different forms of disease that affect prognosis 26…”

Reverse double inversion‐recovery: Improving motion robustness of cardiac T2‐weighted dark‐blood turbo spin‐echo sequence

“…11 The sequence can be used to provide a morphological evaluation of the RV as well as an assessment of RV fat infiltration, which is a pathological finding but not yet a reliable imaging feature of ARVC. 12,13 The sequence provides a unique advantage in reducing the partial volume effects between myocardium and blood, which is critical for tissue characterization of all thin-walled chambers. However, there are a variety of challenges for RV dark-blood imaging, including a thinner wall, higher mobility, a shorter quiescent period, and slower blood flow.…”