Imaging cardiac fat by cardiovascular magnetic resonance - A state-of-the art review
Franca Morselli1, Iain Pierce2, Matthew Webber2
1UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.
Insights
Myocardial fat infiltration increases arrhythmia and sudden cardiac death risk. Fat-water separation (FWS) magnetic resonance imaging visualizes and quantifies this fat, aiding diagnosis and risk assessment.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging Physics
- Cardiac Pathology
Background:
- Myocardial fat infiltration is linked to ventricular arrhythmias and sudden cardiac death in various cardiomyopathies.
- Epicardial and pericardial fat also correlate with adverse cardiovascular outcomes.
- Advanced imaging techniques are crucial for assessing cardiac fat.
Purpose of the Study:
- To review the physics, evolution, and clinical applications of fat-water separation (FWS) magnetic resonance imaging.
- To highlight FWS capabilities in quantifying myocardial lipid content.
- To discuss FWS in characterizing cardiac and extracardiac fat and pericardial disease.
Main Methods:
- Review of the underlying physics of fat-water separation techniques in MRI.
- Discussion of improvements in FWS methods for cardiac and extracardiac fat imaging.
- Analysis of sequence acquisition and artifact resolution in FWS.
Main Results:
- Fat-water separation (FWS) enables precise visualization and quantification of myocardial and surrounding fat.
- FWS can differentiate between normal fat, pathological fat infiltration, and fat-containing neoplasms.
- Optimized FWS methods improve image quality and reduce artifacts in cardiac MRI.
Conclusions:
- Fat-water separation is a valuable MRI technique for assessing myocardial and epicardial/pericardial fat.
- Accurate fat quantification via FWS aids in risk stratification for cardiovascular events.
- Continued advancements in FWS promise broader clinical applications in cardiology.
Abstract:
Myocardial fat infiltration may represent a substrate for ventricular arrhythmias, and its presence has been associated with increased risk for sudden cardiac death in both ischaemic and non-ischaemic cardiomyopathies. Epicardial and pericardial adiposity has also been linked with adverse cardiovascular outcomes. Fat-water separation (FWS) is an advanced magnetic resonance imaging technique enabling for visualisation and quantification of lipid content within the myocardium, and it can also identify fat-containing neoplasms, discriminate epicardial and pericardial fat, and characterise pericardial disease. Methods for FWS have improved significantly over the years, with resulting optimisation of cardiac and extracardiac fat imaging, and resolution of artifacts that may arise from the presence of fat. This review covers the physics underlying FWS imaging technique, its evolution, the practical aspects of sequence acquisition, clinical applications, and future directions.
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