CONGENITAL HEART DISEASE Technical Aspects of Pediatric CMR

Cardiac magnetic resonance (CMR) of the pediatric patient involves a unique set of technical challenges above and beyond those encountered in adult imaging. Anatomical structures are smaller, demanding greater spatial resolution; heart rates are high, demanding greater temporal resolution; and patients maybe sedated or uncooperative, rendering breath-hold imaging strategies useless. Despite these difficulties, CMR offers several advantages over other imaging modalities, including soft tissue contrast, lack of ionizing radiation, a capacity for true threedimensional imaging, accurate flow quantification, and freely selectable imaging planes. These advantages and continued advances in MR hardware, software, and imaging techniques are bringing CMR into more widespread use in pediatric cardiology. This review is a summary of the primary techniques used in pediatric CMR for both congenital and acquired cardiovascular disease. The fundamentals of CMR pulse sequences and physiological synchronization of data acquisition are described, and imaging applications are reviewed. While the basic imaging sequences and techniques are common to both pediatric and adult CMR, some significant differences in imaging priorities and strategies are discussed.