Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques

Magnetic resonance (MR) imaging is almost never performed as the initial imaging test in cardiac valvular disease; that role is dominated by echocardiography. Nevertheless, MR imaging has much to offer in selected patients. Quantitative information regarding the severity of regurgitant or stenotic lesions can be obtained by using a combination of cine gradient-echo or steady-state free precession and cine phase-contrast sequences. In addition to providing measurements of peak velocity and flow, MR imaging is the standard of reference for evaluation of ventricular function, which can be a critical factor in determining when surgical intervention is indicated. Improvements in cardiac MR imaging technology have been particularly striking in the past few years, and these developments can easily be applied to the examination of cardiac valves. The authors briefly describe the pathophysiology of valvular disease, discuss standard MR techniques for qualitative and quantitative evaluation of valvular lesions, and illustrate these concepts with several case studies.