HeartMRI goes by many names including cardiac MRI and CMR. Its utility in both routine cardiovascular and subspecialty care is increasing. It has the ability to diagnose obstructive coronary artery disease, inherited cardiomyopathies, arrhythmogenic substrate, valvular disorders, and vascular disease.
HeartMRI without contrast
Cardiac MRI without contrast (CPT 75557). Based on inherent differences in water content of tissue, we are able to evaluate the structure and function, and obtain accurate ventricular volumes, and ejection fraction without the use of contrast. This order is sufficient in the assessment of severity of iron overload cardiomyopathy.
HeartMRI with contrast
Cardiac MRI without and with contrast (CPT 75561). After performing a non-contrast HeartMRI for structure, function, and volumes, gadolinium is injected. After 7 to 10 minutes, the patient is reimaged, and late gadolinium enhancement which may represent scar or edema. This is the most commonly ordered test for HeartMRI, and is useful to assess viability, cardiomyopathies, and cardiac masses.
Velocity Flow Mapping
Velocity Flow Mapping (CPT 75565). Velocity Flow Mapping is an added option for HeartMRI. This procedure can be used in addition to non-contrast (CPT 75557), contrast HeartMRI (CPT 75561), stress HeartMRI (CPT 75559, 75563). Flow contrast is useful in assessing valvular disease by quantifying blood flow and velocity to determine severity of valvular stenosis and regurgitation. It is also useful for congenital heart disease to assess amount of shunting.
Stress cardiac MRI (CPT 75559, 75563). Stress HeartMRI can be used to detect obstructive epicardial coronary artery disease, and microvascular disease. There are two types of stress HeartMRI: without contrast, and with contrast. The most commonly performed stress HeartMRI is with vasodilator and contrast (75563). This is also the type that can be used to detect microvascular disease.
Some centers may perform stress HeartMRI without contrast (75559), by using dobutamine as the stress agent, and assess wall motion.
Different HeartMRI centers have different abilities, please check with your HeartMRI center to see if:
1. they perform stress HeartMRI
2. they have the ability to diagnose microvascular disease
3. they perform non-contrast stress HeartMRI
Magnetic Resonance Angiography (MRA) Chest Without Contrast (CPT C8910), with contrast (CPT C8909) or without and with contrast (CPT 71555). This procedure can be ordered with HeartMRI or independently. This is useful in the assessment of the aorta, pulmonary arteries, pulmonary veins and great vessels without the use of radiation or nephrotoxic contrast agents. This procedure is commonly ordered with HeartMRI for the assessment of congenital heart disease.
At some HeartMRI centers, the origin and proximal course of coronary arteries can be detected by using MRA chest without contrast to diagnose anomalous coronary arteries.