SCMR expert consensus statement for cardiovascular magnetic resonance of acquired and non-structural pediatric heart disease

Abstract

Cardiovascular magnetic resonance (CMR) is widely used for diagnostic imaging in the pediatric population. In addition to structural congenital heart disease (CHD), for which published guidelines are available, CMR is also performed for non-structural pediatric heart disease, for which guidelines are not available. This article provides guidelines for the performance and reporting of CMR in the pediatric population for non-structural (“non-congenital”) heart disease, including cardiomyopathies, myocarditis, Kawasaki disease and systemic vasculitides, cardiac tumors, pericardial disease, pulmonary hypertension, heart transplant, and aortopathies. Given important differences in disease pathophysiology and clinical manifestations as well as unique technical challenges related to body size, heart rate, and sedation needs, these guidelines focus on optimization of the CMR examination in infants and children compared to adults. Disease states are discussed, including the goals of CMR examination, disease-specific protocols, and limitations and pitfalls, as well as newer techniques that remain under development.

Marfan Syndrome beyond Aortic Root—Phenotyping Using Cardiovascular Magnetic Resonance Imaging and Clinical Implications

“…With the use of ECG-gated non-contrast, respiratory, or self-navigated 3D imaging sequences, optimal delineation of the aortic wall [ 13 ] covering the entire length of aorta can be successful allowing for measurements at end-diastole in the same way as in echocardiography. For evaluation of the aortic root, the use of ECG-gated 2D cine b-SSFP imaging is preferred [ 14 ]. The measurement of the sinuses of Valsalva planes is planned from both the oblique sagittal and oblique coronal left ventricular outflow tract (LVOT) and axial planes.…”

Cardiac MRI in Fabry disease

“…Society for cardiovascular magnetic resonance (SCMR) guidelines do not provide FD-specific recommendations for CMR evaluation in the pediatric population ( 42 ). In young athletes, CMR is the preferred imaging modality to differentiate LVH from physiological remodeling by assessing hypertrophy regression with deconditioning ( 43 ).…”

Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease

“…However, if imaging is not multiphasic, the systolic (largest) aortic dimensions may not be captured. Children pose additional challenges to imaging the aorta in terms of increased scan times (with prolonged exposure to anesthesia) to achieve the necessary spatial resolution, accurate ECG-gating at faster heart rates, and repeated scans over a lifetime [ 52 ]. While CTA is considerably faster than CMR/MRA, exposure to ionizing radiation in a condition requiring lifelong follow up may not be appropriate.…”