Establishing a cardiac MRI program: problems, pitfalls, expectations.

Magnetic resonance imaging (MRI) has been used to evaluate the cardiovascular system for almost 2 decades. Although vascular applications have been robust and steadily improving for many years, the utility of MRI for clinical cardiac imaging has been limited. However, recent advances in hardware technology and pulse sequence design have led to substantial improvements in image quality, while reducing scan times to clinically reasonable durations. Pulse sequences using electrocardiographic gating and k-space segmentation have made it possible to obtain high-contrast, high-resolution images of the beating heart within single breath-holds. These images in turn have provided unprecedented visualization of myocardial morphology and function. Because of these developments, cardiac MRI (CMR) has made rapid and dramatic inroads into the clinical arena. Currently, the primary limitations to routine clinical application are hardware availability, clinical acceptance, politics, examination cost, and not least of all physician education. As these limitations are overcome or made more manageable, the clinical use of CMR will grow, potentially without bound. Combined with steady hardware development and an ever-growing armamentarium of pulse sequences, MRI may ultimately become the modality of choice for cardiac imaging. Because cardiac imaging is relatively unknown territory for most radiologists and because the high-end equipment has until now been sparsely available, CMR has been largely limited to major medical centers. However, if sufficient interest is present and resources are appropriately allocated, CMR can be successfully implemented in community imaging practices.