The ischemic cascade represents the order of events in a patient with ischemic heart disease. In the course of these events, multiple imaging modalities are required for monitoring the progression of disease, and for determination of the stage of disease in the ischemic cascade (see center scheme). Cardiovascular MR (CMR) is capable of evaluation of most aspects of the ischemic cascade, such as: (1) perfusion, (2) metabolism, (3) diastolic function, and (4) systolic function. CMR has become possible on most clinical scanners, but there is...

Based on clinical examples, MR imaging of the ischemic cascade will cover evaluation of acute and chronic ischemic heart disease. Applied MR techniques will be explained, concerning 31P-MR spectroscopy for evaluation of myocardial high-energy phosphate metabolism, MR imaging for assessment of global and regional cardiac function, myocardial perfusion, and delayed enhancement for determination of viability and MR flow for diastolic heart function.Systolic dysfunction ECG-triggered dynamic MRI is the most accurate and reproducible imaging technique currently available to detect myocardial wall motion abnormalities. In this example,...

The interested observer will be educated on all above mentioned aspects, and the presented examples will form the basis for personal application in their own hospital. One of the general objectives of this educational presentation is to train radiologists to perform cardiac MR, thereby preserving this technique for the field of radiology in the future. Moreover, it is possible that interested observers contact us for later education ([email protected]) and help to stimulate the field of CMR.

The most clinically relevant part of the ischemic cascade can be imaged by cardiovascular MR. After participation of the current educational session, the interested technician or radiologist should have a clear feeling of the possibilities of cardiovascular MR. Further help to implement the techniques at home is offered.

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T.A.M. Kaandorp, H.J. Lamb, J.J. Bax, J. Doornbos, R.J. van der Geest, A. de RoosDepartments of Radiology and Cardiology, Leiden University Medical Center, The Netherlands