State of the Art:
Pediatric Cardiac MRI
Neil Mardis, DO
Assistant Professor Radiology
Children’s Mercy Hospital
University of Missouri, Kansas City
Pediatric cMRI
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When to order
What does it involve
Where and when we offer study
What you get
Who is not a candidate
When to order?
PEDIATRIC CMRI
Pediatric cMRI
• When?
– When patient has complex congenital heart disease
which requires more information than
echocardiography
• Best to discuss case with Cardiologist who manages patient
• Coordinated and scheduled through Cardiology
– When patient has risk for coarctation or other aortic
anomaly
• Turners
• Noonans
• Marfans
Pediatric cMRI
• When?
– When there is concern for ARVD
• Typically referred from Cardiology
What does it involve?
PEDIATRIC CMRI
Pediatric cMRI
• What does it involve?
– 1-2 hours of scanning time
Pediatric cMRI
• What does it involve?
– Possibly sedation/anesthesia
• Always administered and
supervised by Anesthesia
Department
• Older children can often go
without sedation
Pediatric cMRI
• What does it involve?
– Multiple breath holds by patient
– Often times IV gadolinium
Where and when is it offered?
PEDIATRIC CMRI
Pediatric cMRI
• Where is it offered?
– Main campus
• Always supervised and directed by a Radiologist
• Access to Sedation team
Pediatric cMRI
• When is it offered?
– Tuesday for all
complex congenital
disease
– Monday through
Friday for limited
aortic cases
What do you get?
PEDIATRIC CMRI
Pediatric cMRI
• What do you get?
– High resolution anatomic images
Pediatric cMRI
• What do you get?
– Real-time assessment of wall motion and blood
flow
Pediatric cMRI
• What do you get?
– Functional data
• Ventricle
– Stroke volume
– Cardiac output
– Ejection fraction
Pediatric cMRI
• What do you get?
– Functional data
• Great vessels/valves
– Flow velocity
– Flow direction
Pediatric cMRI
• What do you get?
– Functional data
• Great vessels/valves
– Flow velocity
– Flow direction
Who is not a candidate for cMRI?
PEDIATRIC CMRI
Pediatric cMRI
• Who is not a candidate?
– Pacer dependant patients
– Any patient with a typical contraindication to MRI
• Surgical/orthopedic implant of unknown type
• VNS
• What is okay for MRI?
– Sternal wires
– Vascular stents/coils of known brand
– Any implant we have adequate safety data on
Summary
PEDIATRIC CMRI
Pediatric cMRI
• Summary
– Great modality for assessing anatomic and
functional aspects of congenital heart disease
– Available downtown
– When in doubt consult cardiology