Key result
CMR delivers comprehensive anatomical and functional assessment in pediatric congenital heart disease without radiation.
Why the study?
Non-invasive imaging is essential to guide management in congenital heart diseases, and this review aims to elucidate the application, role, limitations, and challenges of CMR during pediatric age.
CMR is a crucial non-invasive imaging modality for the comprehensive assessment and longitudinal follow-up of pediatric patients with congenital heart diseases, offering detailed anatomical and functional data without ionizing radiation.
Supports CMR for radiation-free pediatric CHD assessment; leaves open prospective outcome studies across subtypes.
Congenital heart diseases (CHDs) represent a heterogeneous group of congenital defects, with high prevalence worldwide. Non-invasive imaging is essential to guide medical and surgical planning, to follow the patient over time in the evolution of the disease, and to reveal potential complications of the chosen treatment. The application of cardiac magnetic resonance imaging (CMRI) in this population allows for obtaining detailed information on the defects without the necessity of ionizing radiations. This review emphasizes the central role of CMR in the overall assessment of CHDs, considering also the limitations and challenges of this imaging technique. CMR, with the application of two-dimensional (2D) and tri-dimensional (3D) steady-state free precession (SSFP), permits the obtaining of very detailed and accurate images about the cardiac anatomy, global function, and volumes' chambers, giving essential information in the intervention planning and optimal awareness of the postoperative anatomy. Nevertheless, CMR supplies tissue characterization, identifying the presence of fat, fibrosis, or oedema in the myocardial tissue. Using a contrast agent for angiography sequences or 2D/four-dimensional (4D) flows offers information about the vascular, valvular blood flow, and, in general, the cardiovascular system hemodynamics. Furthermore, 3D SSFP CMR acquisitions allow the identification of coronary artery abnormalities as an alternative to invasive angiography and cardiovascular computed tomography (CCT). However, CMR requires expertise in CHDs, and it can be contraindicated in patients with non-conditional devices. Furthermore, its relatively longer acquisition time and the necessity of breath-holding may limit its use, particularly in children under eight years old, sometimes requiring anesthesia. The purpose of this review is to elucidate the application of CMR during the pediatric age.
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Moscatelli et al. (2024) conducted a review in Congenital Heart Diseases (CHDs). Cardiac Magnetic Resonance (CMR) was evaluated. Cardiac magnetic resonance provides essential, detailed anatomical and functional assessment of congenital heart diseases in pediatric patients without the use of ionizing radiation.
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