Long-term hepatic arterial infusion of 5-fluorodeoxyuridine for liver metastases using an implantable infusion pump.

Twenty-one patients with liver metastases of various histologies (predominantly colorectal carcinoma) underwent Infusaid pump implantation for long-term hepatic arterial 5-fluorodeoxyuridine (5-FUdR) infusion. Patients received 5-FUdR infusion on a 2-wk cycle alternating with a 2-wk saline--heparin infusion. A dosage of 0.2-0.3 mg/kg/day (average 0.23 mg/kg/day) was infused for a cumulative 5-FUdR administration of 1940 days. Six patients (29%) responded to therapy (five colorectal, one carcinoid); median response duration was 6 mo. Median survival for the treated group was 17 mo from diagnosis of liver metastases and 13 mo from pump implantation. Median survival among the six responding patients was 15 mo from diagnosis of liver metastases and 11 mo from pump implantation. Comparison of survival from the diagnosis of liver metastases of the treated group to ten patients found ineligible for the study by virtue of extrahepatic metastases revealed no significant difference in median (18 mo for ineligible group) or overall survival. However, median survival for the treated group after pump implantation (13 mo) was significantly better than the median survival of the ineligible group after evaluation for this study (4 mo). Toxicities of therapy included fatigue, anorexia, nausea, vomiting, toxic hepatitis, epigastric pain, and diarrhea. No patients died of toxicity, but six patients required hospitalization for management of pain or vomiting. No serious technical complications developed in any patient except separation of the infusion catheter at its junction with the pump in one patient, necessitating pump replacement for continuation of therapy. These survival data suggest identification of new anticancer agents for hepatic arterial infusion.

Estimation of right ventricular mass in normal subjects and in patients with primary pulmonary hypertension by nuclear magnetic resonance imaging.

OBJECTIVES: This study was designed to test the accuracy of nuclear magnetic resonance (NMR) imaging as a noninvasive technique for estimating right ventricular mass in normal subjects and in patients with primary pulmonary hypertension. BACKGROUND: An accurate means of noninvasively estimating right ventricular mass may allow better characterization of the degree of right-sided pressure or volume overload caused by underlying cardiac or pulmonary diseases. METHODS: End-diastolic short-axis electrocardiogram (ECG)-gated spin echo NMR images of the heart were obtained in vivo in 13 patients with primary pulmonary hypertension and 10 normal adult volunteers. Both right and left ventricular mass were computed by summing the myocardial slice volumes over all slices spanning the myocardium and multiplying by myocardial density. This technique of myocardial mass determination was verified by imaging 10 calf hearts and comparing the NMR-determined right and left myocardial mass with the actual mass determined by weighing the right and left ventricles. RESULTS: In the calf heart study, an excellent correlation was obtained between the directly measured ventricular mass and the NMR-calculated mass, for both the right and the left ventricle. Patients with primary pulmonary hypertension had an elevated right ventricular mass index compared with that of normal subjects (62.69 +/- 8.72 g/m2 vs. 23.32 +/- 1.36 g/m2, p < 0.0005). There was no significant difference in left ventricular mass index between the two groups. Both mean intraobserver and inter-observer variability in myocardial mass determination were low. Linear regression analysis between right ventricular mass index and mean pulmonary artery pressure was significant (r = 0.75, p < 0.003). CONCLUSIONS: Electrocardiogram-gated spin echo NMR imaging of the heart may be used for quantitating right ventricular mass in normal subjects and in patients with primary pulmonary hypertension, in whom it may also provide an alternative noninvasive technique for estimating mean pulmonary artery pressure.

Direct quantitation of right and left ventricular volumes with nuclear magnetic resonance imaging in patients with primary pulmonary hypertension.

To test the utility of electrocardiographically gated spin echo nuclear magnetic resonance (NMR) imaging in quantitating right and left ventricular volumes and function in patients with primary pulmonary hypertension, right and left ventricular end-diastolic and end-systolic volumes, stroke volumes and ejection fractions were determined in 11 patients with primary pulmonary hypertension and in 10 subjects with normal echocardiographic findings. Ventricular chamber volumes were computed by summing the ventricular chamber volumes of each NMR slice at end-diastole and end-systole. This technique was verified by comparison of results obtained by this method and with the water displacement volumes of eight water-filled latex balloons and ventricular casts of eight excised bovine hearts. In the patients with primary pulmonary hypertension, right ventricular volume indexes were 121 +/- 45 ml/m2 at end-diastole and 70.1 +/- 41.6 ml/m2 at end-systole; both values were significantly greater than values in the normal subjects (67.9 +/- 13.4 and 27.9 +/- 7.5 ml/m2, respectively). Left ventricular end-diastolic volume index was significantly less in the patients (44.9 +/- 9.7 ml/m2) than in the normal subjects (68.9 +/- 13.1 ml/m2). There was no significant difference in left ventricular end-systolic volume between the two groups (24.4 +/- 8.6 and 27.1 +/- 7.8 ml/m2, respectively). Right and left ventricular ejection fractions in the patients with primary pulmonary hypertension (0.43 +/- 0.21 and 0.46 +/- 0.15, respectively) were significantly less than values in normal subjects (0.59 +/- 0.09 and 0.6 +/- 0.11, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of three-dimensional echocardiographic assessment of volume, mass, and function in children with functionally single left ventricles with two-dimensional echocardiography and magnetic resonance imaging.

Diminished systolic function or inappropriate hypertrophy are considered risk factors for outcome following the Fontan procedure. These parameters are difficult to assess in univentricular hearts that do not conform to the uniform shapes prescribed by conventional 2-dimensional imaging volume algorithms. Three-dimensional echocardiography requires no geometric assumptions and has been validated in both normal and distorted left ventricles. To assess the feasibility and accuracy of this technique in patients with univentricular hearts, we compared 2- and 3-dimensional echocardiographic estimates of ventricular volume, ejection fraction, and mass in patients with functionally single left ventricles with results obtained by magnetic resonance imaging (MRI). Twelve patients with functionally single left ventricles (6 months to 22 years) underwent examination by all 3 modalities. Correlation and agreement with MRI were calculated for volumes, ejection fraction, and mass. Three-dimensional echocardiographic comparison with MRI yielded a bias of 3.4 +/- 5.5 ml and 14.2 +/- 8.3 ml for systolic and diastolic volumes, respectively. Agreement analysis for mass showed a bias of 5.8 +/- 8.4 grams. Two-dimensional echocardiography showed less agreement for both volumes and mass (bias of -2.9 +/- 8.1, 2.9 +/- 10.4 ml and -8.3 +/- 12.0 g for volume and mass, respectively, p >0.05). Ejection fraction by 3-dimensional echocardiography showed significantly closer agreement with MRI (bias of 4.4 +/- 5.3%) than 2-dimensional echocardiography (bias of 8.5 +/- 10.3%, p = 0.04). Thus, 3-dimensional echocardiography provides estimates of ventricular volumes, ejection fraction, and mass that are comparable to MRI in this select group of patients with single ventricles of left ventricular morphology.

Cardiac radiology. A survey of its current status.

RATIONALE AND OBJECTIVES: A number of pressures have taken their toll on cardiovascular (CV) imaging in radiology. We conducted a survey to develop accurate information about the current status of cardiac radiology (CR) that might guide future responses and initiatives. METHODS: To assess the current status of CR, a survey form was sent to all 117 active radiologist members of the North American Society for Cardiac Imaging (N = 72) and/or the Council on Cardiovascular Radiology of the American Heart Association (N = 98). The topics of inquiry included 1) present CR staffing; 2) specific adult and pediatric CR activities (cardiac plain-film interpretation, cardio-angiography (CA), echocardiography, nuclear cardiology (NC), and CV magnetic resonance imaging (MRI); 3) CR instruction of radiology residents; and 4) CR fellowship activities. RESULTS: The survey was concluded with 64 (55%) individual responses from 58 (67%) different centers with CR groups. An overall need for CR staff (average unfilled positions/center = 0.4) was indicated. Regarding CR activities, the following were reported: 1) universal cardiac plain-film interpretation by radiologists, with most CR groups involved (adult, 64%; pediatric, 64%); 2) moderate CR contributions to CA (adult, 62%; pediatric, 57%), of which cine interpretation was the most common form (79% and 85%, respectively); 3) rare CR involvement in echocardiography (adult, 9%; pediatric, 6%); 4) low-level CR involvement in NC (adult, 16%; pediatric, 17%), but high level when combined with that of nuclear medicine (93% and 91%, respectively); and 5) almost universal radiology responsibility for CV MRI (adult, 96%; pediatric, 96%), with extensive CR involvement (77% and 82%, respectively). Of 46 reporting academic centers, most (76%) required CR training of residents; a smaller proportion (33%) of all centers offered CR fellowships. CONCLUSIONS: Because of the insights gained from this survey, recommendations can be better made to strengthen CR based on a foundation in plain-film interpretation, computed tomography, NC, and MRI.

Computer-assisted, operator-interactive technique for calculating pulmonary arterial taper.

We have developed a computer-assisted, operator-interactive technique which performs fast, precise computations of pulmonary artery taper. Individual 35-mm cineframes from balloon-occlusion pulmonary arteriograms are digitized into a 640 X 480 matrix in 8-bit depth and loaded into a VAX 11/780 computer for analysis. After operator identification of the arterial segment, an automated process of caliber analysis is initiated. By fitting a cubic spline function to the densitometric profiles extracted from the arterial segment, serial arterial cross-sectional diameters are calculated from the mathematically-derived points along the fitted curves. Spurious profiles, caused by sectioning at bifurcations, can be overridden by an operator-interactive subroutine. Taper is derived from the slope of the least-squares fit of vessel caliber with respect to its distance along the arterial segment. Results obtained by calculations from the computer-assisted caliber measurements were compared with those obtained by hand-tracing the same vessel segments. Correlation between computer-traced inflection points and hand-traced taper was very significant (r = .96, n = 13, P less than 0.001).

Nuclear magnetic resonance spectroscopy of rat ventricles following supravalvar aortic banding. A model of left ventricular hypertrophy.

Left ventricular hypertrophy produced by supravalvar aortic banding in infant rats was studied by proton magnetic resonance spectroscopy. Weight gain at 11 weeks of age in the 11 male Sprague-Dawley rats with aortic bands placed at three weeks was similar to that of the 14 controls. The left ventricle of banded rats hypertrophied, increasing the ratio of left ventricle plus septum to body weight (LV + S/BW) by more than 50% (P less than .00001). Right ventricular weight (RV/BW) increased slightly (P less than .03). T1 and T2 relaxation times of LV + S, RV, and thigh muscle (Th) from the banded and control rats were compared. The T2 value distinguished hypertrophied from control LV + S (P less than .003), but not between RV or Th from the two groups. For banded rats only, the T2 value distinguished each muscle type: LV + S from RV, LV + S from Th, and RV from Th (P less than .00001 for each). For control rats, cardiac muscle was distinguished from Th (P less than .00001), but LV + S and RV were similar. The T1 value did not distinguish either the banded from the control group or any of the muscle types. Percent water content was similar for all tissues. Any correlation between water content and T1 or T2 was inconsistent or weak.

Automated morphologic evaluation of pulmonary arteries in primary pulmonary hypertension.

Pulmonary wedge angiograms have been shown to reflect the severity of pulmonary vascular disease in congenital heart disease. Thirteen pulmonary wedge angiograms with a balloon occlusion catheter were performed in 11 adult patients (five normals and six with primary pulmonary hypertension [PPH]) and their features related to the resting pulmonary artery pressure (PAP). Individual cine frames from each study were selected and digitized with a computer-assisted operator-interactive program. By fitting densitometric profiles from the vessel segments, serial arterial cross-sectional diameters were calculated from mathematically derived points. There was a strong correlation between arterial taper (T, change in vessel caliber per unit axial length) and a power function of mean PAP with T = 0.304 X PAP-0.59, R = .91, P less than .001. These results demonstrate a correlation between an angiographically derived morphologic characteristic of the pulmonary vasculature (taper) and a hemodynamic parameter (PAP) in PPH. This offers a method to follow the course of the disease and the effects of drug therapy by assessing anatomic changes in the vessels.

Comparison of the response of the renal blood supply to acetylcholine and to a calcium channel blocking agent, diltiazem, in the dog.

Several vasodilators, including acetylcholine, are capable of inducing maximal renal vasodilatation when infused into the renal artery. Despite substantial interest in the renal vascular response to calcium channel blocking agents, there has been no systematic comparison of any of these agents to an index vasodilator, such as acetylcholine. We compared the renal vascular angiographic response to acetylcholine and diltiazem, infused into the renal artery in graded dosage, in 14 dogs. In eight of the dogs renal blood flow was measured with an electromagnetic flowmeter. At peak, the acetylcholine-induced increase in renal blood flow (155 +/- 25 to 309 +/- 55 ml/min) slightly exceeded that induced by diltiazem (143 +/- 13 to 257 +/- 58 ml/min). A close correlation was found between the maximal blood flow increase induced by acetylcholine and by diltiazem (R = .95). Dilatation of the intrarenal arterial tree evident on the renal arteriogram was substantially less striking with diltiazem than with acetylcholine in these eight dogs. To ascertain the possible contributing role of the surgery required for blood flow measurement, the two agents were assessed in six additional dogs without blood flow measurement. In these six dogs diltiazem and acetylcholine induced essentially identical degrees of renal arterial vasodilatation. It is concluded that diltiazem, the calcium channel blocking agent, produces near maximal renal vasodilatation at the arteriolar level and that responses of more proximal elements of the renal arterial tree, visible during renal arteriography, are sensitive to the conditions of the experiment.

Evaluation of optimized biplane pulmonary cineangiography.

Biplane pulmonary cineangiograms utilizing a short cine pulse width and automatic brightness control were performed in 47 patients during normal respiration. The diagnostic quality of the arteriograms was categorized as good in 33 patients, fair in 12 patients, and poor in two patients. Of the 18 patients in whom pulmonary emboli were identified, cineangiography displayed certain diagnostic features to advantage, including motion of emboli in ten and respiratory scissoring of vessels overcoming vascular superimposition in three. Optimized pulmonary cineangiography is an acceptable alternative to serial film pulmonary angiography for the diagnosis of pulmonary embolism.

Quantitative three dimensional echocardiography in patients with pulmonary hypertension and compressed left ventricles: comparison with cross sectional echocardiography and magnetic resonance imaging.

OBJECTIVE: To evaluate the accuracy of quantitative three dimensional echocardiography in patients with deformed left ventricles. DESIGN: Three dimensional and cross sectional echocardiographic estimates of left ventricular volume and ejection fraction were prospectively compared to those obtained from magnetic resonance imaging. SETTING: Echocardiography laboratory of a university hospital. PATIENTS: 26 patients (9 months to 42 years, median age 11 years) with pulmonary hypertension and fixed reversal of normal interventricular septal curvature. MAIN OUTCOME MEASURES: Left ventricular end diastolic and end systolic volumes and ejection fraction. RESULTS: Three dimensional echocardiographic comparison to magnetic resonance imaging (MRI) yielded r values of 0.94 and 0.87 with a bias of -6.9 (SD 6.9) ml and -16 (11.2) ml for systolic and diastolic volumes respectively. Inter-observer variability was minimal (8.3% and 7.6% respectively). Cross sectional echocardiography gave correlation coefficients of 0.62 and 0.80 and bias of 3.1 (14.1) ml and 16.3 (18.3) ml for systolic and diastolic volumes respectively. Ejection fraction by three dimensional echocardiography also had closer agreement with MRI (bias = 1.1 (7.7)%) than cross sectional echocardiography (bias = 4.4 (13.9)%). CONCLUSIONS: Three dimensional echocardiography provides reliable estimates of left ventricular volumes and ejection fraction, comparable to magnetic resonance imaging in pulmonary hypertension patients with compressed ventricular geometry. Because it eliminates the need for geometric assumptions it shows closer agreement with magnetic resonance imaging in that setting than cross sectional echocardiography.

Freehand three-dimensional echocardiography for determination of left ventricular volume and mass in patients with abnormal ventricles: comparison with magnetic resonance imaging.

OBJECTIVE: The objective of this study was to validate the freehand three-dimensional echocardiographic method in patients with abnormal ventricular geometry compared with two-dimensional echocardiography using magnetic resonance imaging as a standard. BACKGROUND: Two-dimensional echocardiographic methods for estimating left ventricular volume and mass in clinical use today are limited by inaccuracies and variations caused by use of geometric assumptions and errors in image plane positioning. Freehand three-dimensional echocardiography with operator guidance by a "line of intersection" display eliminates these assumptions and errors. This method of volume and mass computation has been validated as highly accurate and reproducible in healthy subjects. METHODS: Left ventricular end-systolic and end-diastolic volumes and myocardial mass were determined by freehand three-dimensional echocardiography, by conventional two-dimensional echocardiography using the apical biplane summation of discs method (volume) and the truncated ellipsoid method (mass), by M-mode echocardiography using the Penn method (mass), and by magnetic resonance imaging in 30 patients selected only for the presence of an abnormal ventricle. Results were compared by means of linear regression and the Bland-Altman method of analysis. RESULTS: There was excellent correlation, low bias, and low variability between three-dimensional echocardiography and magnetic resonance imaging for end-diastolic volume (r = 0.90, standard error of the estimate = 31.8 ml, bias = -28.4 ml), end-systolic volume (r = 0.93, standard error of the estimate = 24.1 ml, bias = -13.1 ml), and mass (r = 0.90, standard error of the estimate = 27.3 gm, bias = -22.6 ml). Two-dimensional echocardiography was less accurate and more variable as follows: end-diastolic volume (r = 0.70, standard error of the estimate = 39.8 ml, bias = -33.5 ml), end-systolic volume (r = 0.78, standard error of the estimate = 31.2 ml, bias = -26.7 ml), and mass (r = 0.80, standard error of the estimate = 37.3 gm, bias = 28.9 ml). M-mode echocardiography mass determination (Penn method) was least accurate and most variable (r = 0.075, standard error of the estimate = 78.3 gm, bias = 78.3 gm). CONCLUSIONS: Freehand three-dimensional echocardiography is a method of high accuracy and low variability for computing left ventricular volume and mass in clinical patients with abnormal ventricles. It is superior to conventional one- and two-dimensional echocardiography. The improvement achieved is attributed to elimination of geometric assumptions and image plane positioning errors and additional sampling of the ventricle.

Three-dimensional echocardiographic volume computation by polyhedral surface reconstruction: in vitro validation and comparison to magnetic resonance imaging.

Two-dimensional echocardiographic methods of left ventricular volume computation are limited by geometric assumptions and image plane positioning error in the nonvisualized dimension. We evaluated a three-dimensional (3D echocardiographic method that addresses these limitations. Our method uses a volume computation algorithm based on polyhedral surface reconstruction (PSR) and nonparallel, unequally spaced, nonintersecting short-axis planes. Seventeen balloon phantoms were subjected to volume computation by the 3D echocardiography-PSR method and by magnetic resonance imaging (MRI) and compared to true volumes determined by water displacement. The results for 3D echocardiography-PSR were: accuracy = 2.27%, interobserver variability = 4.33%, r = 0.999, SEE = 2.45 ml, and p less than 0.001. Results for MRI were 8.01%, 13.78%, r = 0.995, SEE = 7.01 ml, and p less than 0.001. There was no statistically significant difference between the methods. We conclude that precise image plane positioning and use of the 3D echocardiographic-PSR volume computation method achieves high accuracy and reproducibility in vitro. The excellent in vitro correlation between 3D echocardiography-PSR and MRI indicates that MRI may also serve as an in vivo standard of comparison.

Feasibility of a two-dimensional echocardiographic method for the clinical assessment of right ventricular volume and function in children.

The relative ease of acquisition and safety of two-dimensional echocardiography has established it as the mainstay for routine cardiac imaging. Translation of imaging data into useful quantitative information, however, requires fitting the ventricle to a specific geometric model. Because of its complex shape and anterior position, many attempts at right ventricular quantitation by two-dimensional echocardiography have been criticized as impractical and not reproducible. A simple method incorporating subcostal and apical imaging was introduced in 1984. This approach appeared to combine accuracy and practicability but was never validated in a clinical setting because of the difficulties of subcostal imaging in adults. This study assessed the feasibility and accuracy of this technique in the pediatric population. Results of volume comparison to values derived by magnetic resonance imaging were r = 0.96, standard error of the estimate (SEE) = 19.3 ml, and mean difference = 15 +/- 19.4 ml and r = 0.97, SEE = 12.3 ml, and bias = 5 +/- 11.8 ml for diastolic and systolic volumes, respectively. Comparison of estimates of ejection fraction with magnetic resonance imaging demonstrated r = 0.90, SEE = 5.9%, and bias = 3% +/- 5.7%. Interobserver and intraobserver variability was 9.9% and 8.2%, respectively, for systolic volumes and 11.5% and 8.9%, respectively, for diastolic volumes. Evaluation of right ventricular size and function by this approach is comparable to determinations by magnetic resonance imaging and may be clinically useful in the management of pediatric patients.

Radiology of the right ventricle.

RV changes may be generalized into dilatation and hypertrophy. Increased preload results in ventricular dilatation. Increased afterload causes hypertrophy. Change in the shape of the RV resulting from increased afterload and myocardial hypertrophy induces tricuspid regurgitation, which superimposes changes of chamber dilatation onto those of hypertrophy. Sustained ventricular dilatation and hypertrophy frequently progresses to RV failure. In these cases, RV systolic function decreases in association with elevation of RV and right atrial diastolic pressure. Changes in the wall thickness and shape of the RV are variable, and depend upon the severity of the volume or pressure load presented, as well as its duration and rate of progression. Because the RV is an anterior cardiac structure, it occupies little of any heart border. Therefore, the sensitivity of plain film examination to RV disease is limited. Inferential diagnosis of RV disease can often be made based upon identification of other radiographic changes, notably the state of the pulmonary circulation, and the position of the heart in the chest. Conventional contrast right ventriculography may be used to assess the size and position of the RV, as well as associated acquired and congenital lesions that result in RV dysfunction. Due to the unusual shape of the RV cavity, however, and the unpredictable manner in which it dilates, accurate quantitative analysis by this technique is limited. Furthermore, the common association between RV disease and pulmonary hypertension limits the applicability of this imaging technique for evaluating patients with RV disease. Multiplanar MR imaging allows direct demonstration of changes in RV size and wall morphology. Furthermore, application of Simpson's rule to tomographic slices acquired at ventricular diastole and systole allows direct, accurate, and reproducible quantitative analysis of ventricular volume and myocardial mass, allowing radiographic assessment in patients for diagnosis, as well as longitudinally during medical management or after surgical treatment for congenital and acquired diseases that result in RV dysfunction.

MR imaging of adult patients with congenital heart disease.

Although the incidence of congenital heart disease remains constant among newborns, improved medical and surgical techniques have dramatically prolonged life expectancy and produced a new, growing group of patients harboring these lesions: adults with congenital heart disease. Conventional imaging techniques in these patients may be limited because of patient size, chest configuration, or poor ventricular function. MR imaging provides a noninvasive means of directly demonstrating their developmental abnormalities and the sequelae of pathophysiologic changes caused by these lesions. Combined use of spin echo and gradient reversal echo acquisition techniques allows complete evaluation of cardiac morphology and function in these patients. An new medical and surgical therapies prolong the lives of these patients, the role of MR imaging for physiologic assessment and surgical planning will expand further.

Introduction to coronary arteriography.

Coronary arteriography is the most reliable means of investigating and quantitating the severity of coronary artery occlusive disease. Although the procedure is no longer performed exclusively by radiologists, their input into its interpretation is valued. Furthermore, current and future advances in nonangiographic means of demonstrating coronary artery morphology, including magnetic resonance angiography, reinforce the need for radiologists to remain familiar with techniques for the performance of coronary arteriography, the basic anatomy of the coronary artery tree, and patterns of congenital and acquired coronary artery disease.

Angiocardiography in the diagnosis of congenital heart disease.

Despite tremendous advances in cardiac imaging technology, there still exists an important role for the performance of angiocardiography in children with congenital heart disease. This article contains an outline describing the facilities in which the examinations are performed, how the examination is performed, and, most importantly, the basic tenets of interpretation.

Percutaneous transluminal coronary angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA) has revolutionized the treatment of patients with coronary disease. As many as 25 per cent of those requiring myocardial revascularization can now undergo PTCA instead of bypass surgery. This article reviews PTCA techniques, clinical results, case selection, complications, recent advances in equipment design, restenosis rate, use in acute myocardial infarction, and PTCA of coronary bypass grafts.

Primer on cardiac magnetic resonance imaging: how to perform the examination.

Cardiac magnetic resonance imaging is made possible by utilizing an external signal, the patient's own electrocardiogram, to time image acquisition. ECG gated cardiac magnetic resonance examination may be performed using spin-echo or gradient reversal techniques or their newer k-space segmented variants. Spin-echo techniques provide the highest contrast between rapidly moving blood and the cardiac chambers and arteries and veins containing the blood, but are of relatively low temporal resolution. Gradient reversal acquisition, however, provides higher temporal resolution ideal for evaluating changes in myocardial thickening, ventricular wall motion abnormalities, and changes in chamber volume through the cardiac cycle; gradient reversal technique has significantly lower contrast resolution. Careful attention to the details of image acquisition will provide high-quality images of the heart and great arteries from which important morphologic and physiological information may be obtained, aiding in the diagnosis and management of patients with cardiovascular disease.