Contrast media in cardiovascular magnetic resonance

Among the available imaging techniques, Magnetic Resonance Imaging (MRI) is gaining an increasing role in the cardiologic setting because its specific properties such as the use of non ionising energies, the natural strong contrast between different tissues, the absence of spatial limitations, the good spatial and temporal resolution, the reduced operator dependency. To further improve the images quality and the histopathologic characterisation of tissues the use of contrast media (molecules containing gadolinium, manganese, iron, dysprosium ions) has been proposed both in the experimental and in the clinical settings. Among these ions gadolinium, which having 7 odd electrons in the external orbit has a strong magnetic momentum, is the most used. Gadolinium by itself is extremely toxic but once it is linked with a chelanting agent such as DTPA (Dietilen-Triamin-Penta-Acetic acid) the resulting complex shows a very low toxicity. The number of Gadolinium based compound is growing together with the use of contrast agents in MRI. These contrast agents are routinely used to perform Magnetic Resonance Angiography (MRA) and to a better definition of several cardiac diseases such as the presence of a intra- or paracardiac mass, the evaluation of myocardial perfusion and the evaluation of viability. Both the latter applications have relevant clinical implications. In fact the assessment of myocardial perfusion is one of the most used approach for detecting inducible myocardial ischemia due to major coronary artery disease or to assess the presence of a microvascular disease. The presence and the extent of viable myocardium is deeply modifying the clinical decision making as this viable tissue can recruit a normal function spontaneously or after revascularisation. Furthermore, the extent of viable myocardium has a strong correlation with negative prognosis. Clinical events are also time related to the detection of viable tissue. These evidences imply that the diagnostic procedure needs the highest level of accuracy. Either in the case of myocardial perfusion and in that of myocardial viability the advantages of MRI with respect to the others techniques are the use of non ionising radiations, the superior spatial resolution, an overall cost/benefit favourable ratio which explains the growing interest among cardiologists toward this new diagnostic tool.