MRI should be first line of defense for congenital heart disease

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This weekend at the Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, D.C., Jeffrey Hellinger, MD, director of cardiovascular imaging and director of the 3D Laboratory at The Children’s Hospital of Philadelphia, presented a lecture on why MRI should be the first line of defense for congenital heart disease (CHD) during a lecture series “Cardiac CT Didactic Sessions.”

During his presentation, Hellinger covered the spectrum of imaging goals for CHD, including situs (abdominal, thoracic); pericardium; cardiac chambers; valves; pulmonary arteries; pulmonary veins; and coronary arteries.

For a patient with potential CHD, echo and catheters are the most common approaches.  From those options, a cardiologist can then image the patient through MRI or cardiac CT angriogram. Hellinger favored the MRI for obtaining morphology and flow.

Hellinger stressed that MR should be the first line consideration because there it does not use radiation or iodinated contrast, and it produces dynamic acquisitions.

Hellinger conceded that CT scans should be used when the MRI was contraindicated (i.e. pacemakers or other devices that preclude MR); non-Dx MRI, or high-probability of non-Dx MRI; in patients with a high anesthesia or sedation risk; assess for non-CV structures; and finally, there is an emerging need for imaging and no MR is available.

Hellinger concluded that barring these considerations, MRI should be the first consideration for advanced non-invasive CHD imaging.