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Future Innovations in CMR Techniques

The chapter discusses the evolution and future potential of cardiovascular magnetic resonance (CMR) imaging, highlighting its development from basic anatomical imaging to advanced techniques like cine imaging and late gadolinium enhancement. It emphasizes the unpredictability of future advancements due to disruptive technologies and innovation in the field. The authors aim to identify key areas likely to see significant innovation in CMR over the next 10-20 years.

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23 views4 pages

Future Innovations in CMR Techniques

The chapter discusses the evolution and future potential of cardiovascular magnetic resonance (CMR) imaging, highlighting its development from basic anatomical imaging to advanced techniques like cine imaging and late gadolinium enhancement. It emphasizes the unpredictability of future advancements due to disruptive technologies and innovation in the field. The authors aim to identify key areas likely to see significant innovation in CMR over the next 10-20 years.

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drbashi10
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The EACVI Textbook of Cardiovascular Magnetic Resonance

Massimo Lombardi (ed.) et al.

[Link]
Published: 01 September 2018 Online ISBN: 9780191824760 Print ISBN: 9780198779735

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CHAPTER

1 Introduction: general considerations on the future of CMR


Stefan Neubauer

[Link] Pages 613–614


Published: September 2018

Abstract
Cardiovascular magnetic resonance (CMR) has become one of the great pillars of cardiac imaging. Modern
CMR, as we now practise it, is the result of an enormous method and application development effort that
occurred over the past 25 years and has taken CMR from its humble beginnings of anatomical T1- and T2-
weighted imaging to the extremely versatile, accurate, and robust technique it is now. The main
developments over this time, building on the anatomical imaging, were the establishment of cine imaging
for assessment of cardiac function, rst-pass perfusion imaging for measurement of perfusion reserve, as
well as myocardial blood ow (in millilitre per minute and gram), late gadolinium enhancement for
imaging of scar and patchy brosis, and two-dimensional ow velocity imaging for the assessment of
valve and shunt lesions. This chapter aims to address the question of what the game changers for CMR are
in the next 10-20 years.

Keywords: Cardiovascular magnetic resonance, CMR, method, application, anatomical T1 and T2, cardiac
function
Collection: ESC Publications, Oxford Medicine Online

Contents

General considerations on the future of CMR 613


References 614
General considerations on the future of CMR

CMR has become one of the great pillars of cardiac imaging. Modern CMR, as we now practise it, is the result of
an enormous method and application development effort that occurred over the past 25 years and has taken
CMR from its humble beginnings of anatomical T1- and T2-weighted imaging to the extremely versatile,
accurate, and robust technique it is now [1, 2]. The main developments over this time, building on the
anatomical imaging, were the establishment of cine imaging for the assessment of cardiac function, rst-pass
perfusion imaging for the measurement of perfusion reserve, as well as myocardial blood ow (in millilitres
per minute and gram), LGE for imaging of scar and patchy brosis, and 2D ow velocity imaging for the
assessment of valve and shunt lesions. The question this section aims to address is what the game changers for
CMR are in the next 10–20 years.

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As a matter of principle, trying to predict the future may be exciting—an exercise in creative imagination—but
at the same time it is a dif cult business. The quotes shown in Fig. 13.1.1 illustrate this. The main reason why
it is so hard to predict future progress in CMR, or for that matter in any other area of medicine, is the
phenomenon of disruptive technology and innovation. Fig. 13.1.2 shows examples of such innovation that
have changed the course of technical development dramatically and forever—electricity, the jet engine, or the
Internet being striking examples from the past two centuries. These developments can appear at any time, and
then the carefully predicted course of technical development is disrupted and the eld is taken in a direction no
one was able to expect or forecast. While the authors of this section are also facing this dilemma and cannot
know with certainty where the next big wave of disruptive innovation will come to CMR, we are making the
best possible educated guess, describing the areas that we believe to be the most likely ones to see such
innovation (see Fig. 13.1.3). It will be interesting to come back to this section in a decade and judge whether
our predictions have materialized. As a disclaimer, when selecting the areas covered, we had to select a shortlist
from a large number of meritable and promising contenders, and such areas of promise not covered in this
section include BOLD imaging for oxygenation assessment, atrial wall imaging, PET-MR hybrid imaging, MR
elastography, automated image analysis based on machine learning, and others. Furthermore, three of the
biggest developments in CMR that are bound to change its future in coming years, i.e. parametric mapping of
relaxation times, accelerated imaging, and large-scale CMR registries/multi-centre studies, are covered
elsewhere in this book and are therefore not included in this section.

Fig. 13.1.1 Famous quotes on predicting the future.


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Fig. 13.1.2 Predicting the future of CMR.

Fig. 13.1.3 New horizons for CMR.


References
1. Pennell DJ. Cardiovascular magnetic resonance. Circulation. 2010;121:692–705.
Google Scholar WorldCat PubMed

2. Myerson SG, Francis JM, Neubauer S. Cardiovascular Magnetic Resonance. Oxford Specialist Handbooks in Cardiology.
Oxford: Oxford University Press; 2010.
Google Scholar Google Preview WorldCat COPAC

© European Society of Cardiology

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Common questions

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Significant developments in CMR over the past 25 years include the implementation of cine imaging for assessing cardiac function, first-pass perfusion imaging for measuring perfusion reserve, late gadolinium enhancement (LGE) for imaging scars and patchy fibrosis, and two-dimensional flow velocity imaging for evaluating valve and shunt lesions .

Innovators face challenges in predicting the future of CMR due to the inherent unpredictability of disruptive technologies, which can emerge unexpectedly and completely alter the current understanding and direction of technological advancements, irrespective of prior educated guesses .

First-pass perfusion imaging impacts the assessment of cardiac function within CMR by providing valuable data on myocardial blood flow and perfusion reserve, thereby enhancing the detection and characterization of ischemic heart disease and aiding in the evaluation of therapy efficacy .

Machine learning is anticipated to play a significant role in the future advancements of CMR by enabling automated image analysis, which could enhance diagnostic efficiency and accuracy by processing complex imaging data more swiftly and consistently .

Large-scale CMR registries are significant for the future of CMR because they facilitate multi-center studies that can provide robust data for understanding diverse cardiovascular conditions, leading to improved standardization, and helping in the validation of new imaging techniques .

Advanced imaging techniques for CMR developed after the initial anatomical imaging include cine imaging for cardiac function assessment, first-pass perfusion imaging for perfusion reserve, LGE for scar and fibrosis imaging, and two-dimensional flow velocity imaging for valve and shunt lesion assessment .

Disruptive innovations can dramatically alter the predicted course of technical development in CMR by introducing unexpected advancements that redirect the field in unforeseen directions. Such innovations can appear unpredictably, making it difficult to forecast their impacts accurately .

Predicted areas of innovation in CMR include BOLD imaging for oxygenation assessment, atrial wall imaging, PET-MR hybrid imaging, MR elastography, and automated image analysis based on machine learning .

It is challenging to forecast future developments in CMR because of the phenomenon of disruptive technology, which can unpredictably change the course of technical progression, as historic examples like electricity and the Internet demonstrate .

Late gadolinium enhancement (LGE) contributes to the evaluation of cardiovascular conditions by allowing the visualization of scar tissue and patchy fibrosis, which are critical for assessing the extent and severity of myocardial infarction or cardiomyopathy .

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