What is Cardiac MRI?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Christopher Nguyen, PhD:

Welcome everybody. My name is Chris Nguyen. I'm the Director of MRI research in HVTI. And joining me is...

Deborah Kwon, MD:

Hello. My name is Debbie Kwon and I'm a cardiologist, and I'm the Director of Cardiac MRI here at the Cleveland Clinic. And we're super excited to be able to talk to you a little bit about what is cardiac MRI and how it can be helpful to your health. So I guess the first question that some patients may ask is what is a cardiac MRI and what does it show?

Christopher Nguyen, PhD:

That's a really great question. It's a very boutique type of scan that we do at the Clinic and very special. Most people know about an MRI, it's this giant sort of magnet that takes these very detailed pictures of your body. A cardiac MRI just means it's an MRI of your heart and we get to be able to peek into your heart without having to cut you open or anything and it doesn't hurt at all. It uses the water molecules or the water that's in your body, very naturally, to be able to make these wonderful images.

Christopher Nguyen, PhD:

It makes a little bit of a lot of sound, but because of that, we should be able to have, within less than an hour, a fantastic image, very detailed, of your heart. Shows the different anatomy of your heart, so the different chambers or different rooms in your heart. It also shows you the blood and how it swirls around. Clinicians like Debbie and her team uses it to be able to do diagnoses, prognosis or how are you going to do better over time? And maybe you could talk more about how it's used in the care of patients, Debbie?

Deborah Kwon, MD:

So, cardiac MRI, obviously I'm biased because I love this modality, but I think it's the most comprehensive imaging modality to diagnose your disease. A lot of patients who have symptoms of chest pain or shortness of breath, and it's not really clear what is the cause of their myocardial dysfunction or the reason why their heart isn't working properly, and the cardiac MRI gives us gold standard evaluation of your heart in the sense that it gives you very precise pictures of how your heart is moving and how it's functioning. It also allows us to see exactly what's going on with the tissue of your heart, if its scarred, if there's inflammation. And a lot of these seeings gives us an idea for how best to treat your heart with the different types of medications that we have, or if you need surgery to look at your valves, if they're not functioning well.

Deborah Kwon, MD:

And so cardiac MRI is very, very useful because as Chris said, we don't have to open up your body physically to look at how the heart is functioning. We can actually do it noninvasively and get a really good, detailed picture of what's going on.

Christopher Nguyen, PhD:

Right. And I think Debbie makes a really good point and I want everyone to know about it. Is that MRI has expanded into not just looking at how the shape of your heart is, or how thick your wall is, or how much blood, but going back to that tissue characterization, that means how does our tissue have different types of disease processes? We can see that, like a map. We can see how much there are these plaques that form in your heart, or potentially how much scar. Just like the scar on your knee when you fall down, we can see that difference in change. This is drastically different than the other imaging modalities we have. We can identify what parts and what areas of the heart actually are damaged under what sort of disease process. And from there, we can decide what medication you need, what type of surgery you need. It really is new sci-fi type of work and very, very interesting.

Christopher Nguyen, PhD:

And the Clinic has ... I guess, in some ways I'm a little bit new to all of this, to the Cleveland area, but that's what attracted me to come to the Clinic in my recruitment, is I really want to expand a lot of these technologies we have, but apply them to the patient and bring them to the forefront so that we can benefit from day in, day out.

Deborah Kwon, MD:

Yeah and that's a perfect segue. Chris, maybe you can talk about all the really exciting developments that's going on, technically speaking in cardiac MRI and how we can be applying this to our patients.

Christopher Nguyen, PhD:

Yeah, absolutely. So I think the most interesting thing is that as amazing that cardiac MRI is, MRI is actually still very slow. I think probably those that have gotten an MRI before for maybe a knee surgery or for a brain, they tell you don't move. And unfortunately you can't do that to the heart. You can't stop the heart and so what we normally do to do that is we track your heart rhythm and we ask you to hold your breath. And both of those things can be very difficult when you have heart disease. Your heart might be a little bit in arrhythmia, is what they call it, or be irregular in its heartbeat. And honestly, it's really hard to hold your breath, even for me, sitting here.

Christopher Nguyen, PhD:

So the future is going to hold, in our next generation scans and working closely with clinicians here, is to develop a new scan that is under what we call free breathing conditions. Actually, the way we phrase it is, we want you to take a nap and just relax in the scanner. You don't have to hold your breath 50 to 100 times. You can just lay back and relax. When does a doctor tell you, close your eyes and sleep, and then afterwards you get all this wonderful information about that.

Christopher Nguyen, PhD:

Speaking of information, I think the interesting thing is that what Debbie has been working on, as well as others, is to use all this wealth of information to do machine learning or artificial intelligence to go dig, dig deeper. As we talked about with tissue characterization, I think it's so important to realize that there is so much more information to learn more about you, the individual, to personalize it to you. And what we've been expanding into is also into digital twins and be able to expand into this AI predictability and inferencing. So it's not just replacing doctor, but to enhance the doctor's skills to find the disease earlier. I think that's so important.

Christopher Nguyen, PhD:

And the last thing that we've been building upon between our two groups, have been to look at more of this tissue characterization deeper. So we've been able to, even though the resolution of MRI is about, let's say about a millimeter, about the size of your pinky fingernail, is that we can get even smaller to about the level of about a couple of hundred cells, what we call hundreds of microns. And so what does that mean? It means we can see the cracks in the building before they form. We can see the warning signs much before that they actually get worse. That means that our treatments are more effective, easier to be used and utilized and be able to be pioneering in being able to deliver the treatment sooner and better and faster.

Deborah Kwon, MD:

Yeah, this is really an exciting space. And I think one of the things that we're so excited about Christopher and his team coming to the Cleveland Clinic is that now we can actually have the ability to use some of these novel, technical imaging techniques to our patients and the Clinic. So we would give you your standard of care cardiac MRI that gives you all of the bread and butter types of things that you typically get in any other hospital setting or outpatient setting, where you would get a cardiac MRI. But here at the Cleveland Clinic, now that we have Chris's phenomenal expertise here, we would also apply some of these new novel techniques to see how this can augment our care. We really hope that we can get to the vision of having personalized medicine so that when a patient individually comes with their very specific issues and their other surrounding things that are also playing a role in their health, that we can give very specific, prescribed treatment plan for that patient. And we can have a good estimation of how they will respond to our treatment.

Deborah Kwon, MD:

So we're really excited about this, the future and how we can combine science and technology with our amazing healthcare that we are able to deliver here at the Cleveland Clinic. We are just really excited to see how things evolve.

Christopher Nguyen, PhD:

I'm excited too. We have a bunch of young engineers and scientists that are working closely with doctors like Debbie Kwon and others. We've worked very hard to bring them over here. They're very young and vibrant and they're just across the street. So it means that we work closely with your team and we're excited to be here and excited to bring some of these technologies to our patients, as soon as possible. That's the main reason why I came here is that I'm so impressed by Cleveland Clinic willing to put the patient first and willing to move technologies closer to the patient. I think that's what cardiac MRI at the Clinic is all about, I would say.

Deborah Kwon, MD:

Thanks so much for your time.

Christopher Nguyen, PhD:

Thank you so much for your time.

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