Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review.

Cardiovascular Magnetic Resonance is increasingly used to differentiate the aetiology of cardiomyopathies. Late Gadolinium Enhancement (LGE) is the reference standard for non-invasive imaging of myocardial scar and focal fibrosis and is valuable in the differential diagnosis of ischaemic versus non-ischaemic cardiomyopathy. Diffuse fibrosis may go undetected on LGE imaging. Tissue characterisation with parametric mapping methods has the potential to detect and quantify both focal and diffuse alterations in myocardial structure not assessable by LGE. Native and post-contrast T1 mapping in particular has shown promise as a novel biomarker to support diagnostic, therapeutic and prognostic decision making in ischaemic and non-ischaemic cardiomyopathies as well as in patients with acute chest pain syndromes. Furthermore, changes in the myocardium over time may be assessed longitudinally with this non-invasive tissue characterisation method

Myocardial Inflammation—Are We There Yet?

Several exogenous or endogenous factors can lead to inflammatory heart disease. Beside infectious myocarditis, other systemic inflammatory disorders such as sarcoidosis, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Churg-Strauss syndrome, and rheumatoid arthritis can affect the myocardium. Myocardial inflammation may have a major impact on the outcome of these patients, resulting in sudden cardiac death, severe arrhythmias, or end-stage heart failure. The current gold standard for definite confirmation of inflammatory heart disease is endomyocardial biopsy (EMB), but is invasive and suffers low sensitivity and specificity due to sampling errors. Thus, non-invasive methods for detecting the extent and changes over time of the inflammatory myocardial disease are needed. Cardiac magnetic resonance (CMR) is such a non-invasive method. We will describe and discuss different approaches for CMR assessment of inflammatory myocardial disease including early gadolinium enhancement (EGE), T2-weighted imaging, late gadolinium enhancement (LGE), the newer mapping proton relaxation techniques (T1 pre-contrast, T1 post-contrast, T2 mapping), and the hybrid PET/MRI technique

Update Curriculum Kardiale Magnetresonanztomographie [Update on the cardiac magnetic resonance imaging curriculum]

The aim of this cardiac magnetic resonance imaging (C-MRI) curriculum is a description of the further education process for cardiologists in order to be able to achieve expert certification in C‑MRI. The further education C‑MRI curriculum should provide the basis according to three different C‑MRI levels for a cardiologist to assess the indications, perform and interpret C‑MRI examinations correctly in a large cohort of patients with a broad range of cardiovascular diseases. In addition, on a higher level, the cardiologists should be able to lead a C-MRI laboratory and to perform scientific C‑MRI examinations at a defined high level. The curriculum itself is intended to be carried out in a defined process certified by the German Cardiac Society. To guarantee the quality of certification, this publication covers not only the education process itself but also the approval criteria for further education centers and knowledge assessment of candidates by written examination. The C‑MRI certification process is in accordance with the recommendations of the European Society of Cardiovascular Imaging (EACVI) and the Society for Cardiovascular Magnetic Resonance (SCMR) to harmonize education and facilitate clinical and scientific exchange in Europe