41 - MRI of the Heart and Chest

Summary

CLINICAL INDICATIONS

The development and maturation of MRI has revolutionized the clinician's ability to noninvasively assess pathology with incredible detail and accuracy. Unfortunately, the limited availability and cost are major prohibitive factors in the prevalence of MRI as a first-line imaging modality in emergency medicine. A growing body of research and technological advancement suggests that MRI of the chest and heart will play a prominent role in future screening and monitoring of appropriate patients. As an example, even though MRI of the heart has matured to accurately assess cardiac structure, function, perfusion, and myocardial viability with a capacity unmatched by any other imaging modality, it comprises only 0.1% of all noninvasive cardiac studies ordered (1). Although current clinical guidelines limit the use of MRI of the chest and heart, it should be used more frequently in acute care as logistical concerns regarding the technology are overcome.

A careful history, physical exam, and relevant diagnostic studies are fundamental to the assessment of a patient before choosing the appropriate imaging modality. It is important to document a patient's presenting complaint and symptoms, along with results from prior investigations, when requesting the study. The stability of the patient's condition will steer the physician's management of the patient.