Cardiovascular Imaging The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging Bernd J. Wintersperger, MD,*† Fabian Bamberg, MD, MPH,‡ and Carlo N. De Cecco, MD§|| Abstract: Today’s noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CTapplications. Within the past 10–15 years, MR and CT technologies have pushed each other in cardiac applications; and without the “rival” modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today. Key Words: magnetic resonance imaging, computed tomography, heart, vessels, coronary arteries, myocardial viability, myocardial infarction, late gadolinium enhancement, delayed enhancement, myocardial perfusion (Invest Radiol 2015;50: 557–570)
maging of the cardiovascular system by means of computed tomography (CT) and magnetic resonance imaging (MRI) has come a long way. Five decades ago, neither technique was on the horizon, and only very limited imaging approaches (eg, chest x-ray and angiography) were available in cardiovascular medicine.1,2 This review takes the journey from “ancient” cardiovascular imaging to the modern era of cardiovascular CT and MRI approaches. Whereas technical developments as well as the development of contrast agents, especially for MRI, had a huge impact on the success of both modalities in cardiovascular imaging, further details of these aspects are covered elsewhere.3–5
CARDIOVASCULAR MAGNETIC RESONANCE IMAGING After key developments by Nobel laureates Paul Lauterbur and Sir Peter Mansfield to pursue imaging using nuclear magnetic resonance methods, enthusiastic researchers, entrepreneurs, and physicians together pushed the envelope of cardiovascular MRI. Whereas early cardiac applications of nuclear magnetic resonance focused on the exploration of cardiac metabolism using phosphorus spectroscopy, initial reports on cardiac imaging were published in the early 1980s.6 Almost 40 years of continued innovation and exploration of pathologies Received for publication March 11, 2015; and accepted for publication, after revision, March 24, 2015. From the *Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Toronto; †Department of Medical Imaging, University of Toronto, Ontario, Canada; ‡Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany; §Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC; and ||Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome, Italy. The authors report no conflicts of interest. Correspondence to: Bernd J. Wintersperger, MD, Department of Medical Imaging, Toronto General Hospital, 585 University Ave, Toronto, ON, M5G 2N2. E-mail: [email protected]
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0020-9996/15/5009–0557 DOI: 10.1097/RLI.0000000000000164
Investigative Radiology • Volume 50, Number 9, September 2015
resulted in today’s applicable techniques with enormous impact on modern medicine including specific cardiovascular diseases.
Cardiac Anatomy and Function Exploration of cardiac anatomy and assessment of cardiac function have been at the forefront of cardiac MRI from its very beginning and remain key elements of today’s practice. Early after initial reports of cardiac applications, its potential in cardiac diagnosis was postulated.6,7 While the combination of low field strength (