Cardiovascular MRI in Practice

Cardiovascular MR imaging has become a robust, clinically useful modality,
and the rapid pace of innovation and important information it conveys
have attracted many students whose goal is to become adept practitioners.
In turn, many excellent textbooks have been written to aid this process.
These books are necessary and useful in helping the student learn the
underlying pulse sequences used in CMR, as well as the imaging findings in
a variety of disorders. However, one of the difficulties inherent in learning
CMR from a book is that the printed format is not the ideal medium to display
the dynamic imaging that comprises a typical CMR case. For instance,
it may be difficult to perceive focal areas of wall motion abnormality on
serial static pictures, but these abnormalities are often easily seen on cine
loops. One might say that trying to learn CMR solely from a standard
textbook with illustrations is like trying to learn to drive by looking at
snapshots obtained through the windshield of a moving car. The learner
needs to see the cardiac motion and decide if it is normal or abnormal; he
or she needs to be in the driver’s seat. An additional limitation of the available
textbooks on CMR is that while they often have superb illustrations
of abnormal findings, these images have been preselected. In transitioning
to the “real world,” the challenge is for the student to be able to find the
pathology. Therefore, ideally the student should make an initial attempt at
deciding what is normal and abnormal in a given scan, as it is our experience
that it is not uncommon for patients to leave the CMR facility with a
diagnosis that differs importantly from the original indication for the scan.
To do this successfully, the student needs to see the entire scan, with the
mistakes and inconclusive images included, rather than attempt to become
proficient in CMR based solely on preselected images that simply support
the final diagnosis.