Low-Field Cardiac Magnetic Resonance ImagingResponse to Simonetti and Ahmad
A Compelling Case for Cardiac Magnetic Resonance’s Future
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Cardiac magnetic resonance (CMR) is arguably unmatched in its ability to evaluate cardiovascular structure and function, to characterize myocardial tissue by a wide variety of mechanisms, and to quantitatively assess blood flow and perfusion without the use of radiation or the need for invasive catheterization. CMR research and development continues at a rapid pace both in academia and by commercial vendors, and every year, new techniques are put forth that improve on existing applications and provide new capabilities that further expand the clinical utility of this powerful modality. Real-time and single-shot techniques have made CMR feasible in patients with rhythm irregularities and inability to breath-hold. Ongoing development and regulatory approval of magnetic resonance imaging (MRI) conditional pacemakers and implanted cardioverter defibrillators continues to grow the patient population amenable to CMR. Larger clinical trials are coming out that support the clinical value of CMR.1–3 Despite the advances in CMR technology over the past decades, the growing data supporting its effectiveness, and the increasing availability of both CMR-capable scanners and practitioners, the penetration of CMR into routine diagnostic cardiovascular imaging remains limited. It is clear that those involved in CMR research must not only engage in developing new and exciting applications made feasible by technological advances, but must also ask whether their technology will promote the routine clinical utilization of CMR beyond academic and isolated private centers. There are many factors at play in answering this question, but important considerations must be affordability and ease of use.
A CMR system is one of the most expensive devices in the hospital, and the cost of the system scales with field strength. Prior to 2001, the highest field strength available for clinical MRI was 1.5T; however, recent years have witnessed an expanded utilization of 3T MRI that has been driven mainly …