Advances in cardiac magnetic resonance imaging and computed tomography

Imaging evaluation of the heart encompasses structural evaluation of the chambers, valves and coronary arteries, and functional evaluation, including assessment of perfusion, wall motion and myocardial viability. Magnetic resonance imaging is well established for the structural and functional evaluation of the heart, and benefits from direct multiplanar image acquisition and a lack of ionizing radiation. Magnetic resonance imaging assessment of myocardial viability after myocardial infarction appears to be helpful in predicting benefit from revascularization procedures. Magnetic resonance imaging continues to hold promise as the least invasive method of coronary artery evaluation, and continuing developments are improving image quality and decreasing examination time. The development of cardiac-gating techniques for multidetector computed tomography has the potential to provide widespread availability of cardiac computed tomography. Short examination times and straightforward scanning procedures promise a convenient method for the examination of cardiac structure and function. However, this convenience must be balanced against radiation dose and contrast-media requirements when determining the appropriate use of cardiac computed tomography. Computed tomography coronary-calcium scoring can aid in the prediction of significant coronary events in all but the lowest-risk patients. The high negative-predictive value of computed tomography coronary angiography may allow some patients to avoid cardiac catheterization, but its role in the assessment of patients with moderate coronary atherosclerosis remains unclear. New software tools can assist in the complex and tedious analysis of the large volumes of data produced by these examinations.