1) Administrative – 5 total elements (3 recommended; 2 optional)
a. Site ID (recommended): Site ID is a unique number assigned to each study performance site.
b. Site of service (recommended): Indicate the type of facility submitting the reporting data. These would include inpatient hospital, outpatient facility, free standing imaging center, ambulatory care office, or mobile unit.
c. Scanner (recommended): Indicate the type of magnet, manufacturer, model number, field strength, and software platform of the unit performing the procedure.
d. Accreditation status (recommended): This should be represented as yes, pending, or no.
e. Accreditation Entity (recommended): For example, (i.e., Intersocietal Committee for Accreditation of Magnetic Resonance Laboratories, etc.).
2) Demographics (4 recommended elements)
a) Unique patient ID: medical record number used by the health care delivery system where the CMR examination was performed
b) Patient date of birth
c) Patient Gender
d) Patient Race/Ethnicity
3) Study Referral Data (2 optional elements)
a) Referral physician - National Provider Identifier (NPI)
b) Referral physician specialty
4) Scheduling and Performance of Study (6 recommended elements)
a) Date of procedure
b) Time of procedure
c) Personnel involved in procedure
• House Officers
• Staff physicians
d) Primary indication for test
e) Study quality
f) Listing of sequences used
• T1 W dark blood with or without contrast
• T2 W dark blood with and/or without fat saturation
• Cine SSFP
• Cine FGRE
• Late gadolinium enhancement
• Phase contrast CMR flow measurements
• T1 W MRA with or without contrast
• SPAMM (Grid Tagging)
5) History and Risk Factors (2 recommended and 1 optional element)
a) Height (recommended)
b) Weight (recommended)
c) For studies using contrast, the SCMR suggests the value and date of acquisition of the most recent serum creatinine level and estimated glomerular filtration rate (GFR) should be provided.
6) Non-imaging findings associated with the examination (5 recommended elements)
a) In those studies requiring 12-lead electrocardiogram, its interpretation should be provided. This includes the presence of Q-waves, ST segment or T-wave abnormalities, or other rhythm disturbances.
b) For studies evaluating hemodynamically important conditions (i.e., valvular heart disease, intracardiac shunting, cardiac output, etc.), heart rates and rhythm, and systolic and diastolic blood pressure should be provided during the CMR acquisition. For tests incorporating stress testing, the heart rates and rhythm, oxygen saturation, systolic and diastolic blood pressures, and the predictive heart rate response for age should all be recorded during the following points in time:
• Before study
• At each level of stress
• In recovery
c) For studies utilizing cardiac active agents (i.e., stress testing), the agent, quantity, duration, and route of administration of the agents and associated medications should be provided.
d) For studies utilizing contrast agents, the type (i.e. paramagnetic), name, route, site, and speed of administration should be provided.
e) For studies utilizing sedation, general anesthesia, or supported ventilatory or cardiac (hemodynamic or electrical) assistance, the amount, type, route and measures of administration of these agents or support should be documented. Also, patients' cardiovascular and pulmonary responses (heart rate, blood pressure, respiratory rate, and oxygen saturation) should be recorded accordingly to local regulations. The reason for administration required of the agent should be provided.
7. Specific Conditions Assessed with CMR
a) Magnetic resonance arteriography
Dimensions including (4 recommended, 1 optional):
a. Aortic annulus (recommended)
b. Sinuses of Valsalva (recommended)
c. Sinotubular junction (recommended)
d. Ascending and descending diameters at the level of the pulmonary artery (recommended)
e. Comment regarding whether the aorta is right or left-sided may be provided (optional).
Findings when present (7 recommended, 1 optional):
a. Comment on sinotubular effacement (recommended)
b. Comment on tortuosity (recommended)
c. Aortic atherosclerosis (recommended): description of location, mobility and extent, estimate %-stenosis when advanced
d. Aortic aneurysm (recommended): size (AP × LR × CC), morphology (saccular versus fusiform), location in the aorta, relation to branch vessels, presence of mural thrombus, visceral compressive effects (effacement expansion of the aorta against surrounding structures), post-contrast appearance (if these sequence were acquired), presence of periaortic, mediastinal, pericardial, or pleural fluid.
e. Aortic dissection (recommended): dissection classification (either DeBakey or Stanford), presence of intimal flap, location of tear or areas of communication (if possible), description of the size and extent of the true and false lumens, presence of murmal thrombus or blood in false lumen, branch vessel involvement, presence of periaortic, mediastinal, pericardial, or pleural fluid,
i. Intramural hematoma (IH): in cases of IH and penetrating aortic ulcer, the CMR practitioner should describe carefully the morphologic findings in much the same way as an aortic dissection paying careful attention to select wording to convey a diagnosis of limited ulceration or dissection.
ii. Post-operative appearance: this should be described in accordance with (a-e) above noting additional graft insertion points and dimensions.
f. Inflammatory diseases of the aorta (recommended): aortic wall thickness, multispectral appearance on different pulse sequences, contrast enhancement pattern, branch vessel involvement, presence of periaortic, pleural, or pericardial fluid
g. Congenital disease involving the aorta and ventriculoarterial connections: see recommended congenital report below.
h. Aortic flow (optional): On CMR scans of the aorta in which PC-MR measures are obtained, the direction and magnitude of flow should be provided.
2. Peripheral arterial disease (2 recommended, 1 optional):
a) Vessel location and orientation. Descriptions of each territory are required when the study is ordered to examine the respective site (recommended). When severe stenoses or vessel occlusions are identified, common collateral pathways should be described.
• Arch vessels
• Carotid bifurcation
• Celiac trunk
• Proximal SMA
• Renal arteries and their accessory vessels
• Common and external iliac
• Femoral, brachial or other more peripheral arteries.
b) Quantitation of luminal narrowings or stenoses (recommended)
SCMR recommends that the CMR practitioner avoid descriptive terms such as "mild" or "moderate" stenosis, but rather adopt a semi-quantitative method that scores the severity of luminal occlusion. Accordingly, stenosis severity should be reported in 25% increments (i.e., <25%, 26% – 50%, 51% – 75%, and >75%) or, in cases with high spatial resolution, finer increments of 10% may be employed. Descriptive terms may convey the wrong impression to the clinical importance of occlusive disease (e.g. a series of "moderate" stenoses in the diabetic patient with poor wound healing of the lower extremity may be clinically significant)
c) Optional functional measures of the vascular system may also be reported, including:
i.) flow measurements in the forms of milliliters or liters per minute, and
ii.) measures of vascular stiffness: aortic distensibility, or pulse wave velocity.
When functional measures are provided it is recommended that the vascular territories be specified and values provided at the specific location of acquisition.
b) Cardiac Size and Function
1) The reporting of right ventricular (RV) and left and right atrial chamber sizes and volumes are optional. Reporting of left ventricular (LV) volumes is recommended when multi-slice cine short axes data are acquired from the mitral annulus to the cardiac apex. When reported, SCMR suggests that right-sided chambers measurements and the angulation from which the diameters or dimensions are acquired should be reported. For the left-sided cardiac chambers, the 3-chamber long axis view should be used for identifying LV dimensions. The SCMR encourages quantitative measures reported on their forms; however, determination of normal, enlarged, small, or not reported may be substituted.
2) Although not required, the SCMR encourages the reporting of LV end diastolic wall thicknesses acquired in the 3-chamber view of the left ventricle at the mitral leaflet tips; it is suggested that the end diastolic thickness be acquired at the septum and inferior lateral or posterior wall.
3) When assessing the right ventricle, the free wall end diastolic thickness (in the middle atrium portion of the wall) may be reported.
4) For those studies targeting the heart, the SCMR recommends the reporting of LV ejection fraction, and regional wall motion abnormalities. The method of acquisition should be reported, including:
Multi-slice disk summation technique
Values should be reported as absolute values and indexed for body surface area.
• Measurements derived from these values (i.e., cardiac output) should be expressed as absolute as well as indexed values and the reference heart rates used for these calculations should be provided in the report.
• Regional wall motion should be described as qualitatively or quantitatively assessed in the 17-segment model adopted by the ACC/AHA guidelines2 for noninvasive testing (Figure ). Qualitative assessments should follow the following nomenclature in which each segment is identified as:
17-segment model of the LV myocardium developed by the ACC/AHA for reporting abnormalities of wall motion, perfusion or injury.
• If the respective site seeks to report quantitative measures, such as thickening or strain, these should be performed and reported according to previously published techniques.
c) Cardiovascular stress testing
As described in the non-imaging findings component of the reported list above, parameters such as vital signs, medications, and contrast agent administration should be reported. The SCMR recommends the reporting of LV myocardial information in the format of a 17-segment model through the use of a chart, table, or bipolar maps (so called "Bullseye" plot
1. Wall motion stress:
Wall function should be designated as qualitative (wall motion) or quantitative (referenced measure such as % wall thickening, or strain) during testing. In addition, wall motion score index (the sum of the wall motion scores divided by the number of segments scored) should be reported at each level of stress. Inducible ischemia or contractile reserve should be identified in each study according to previously published referenced methods. Identification should be made of when global LV function does not improve or worsens during stress.
2. Gadolinium, 1st pass myocardial perfusion:
Existing literature regarding the prognostic significance of qualitative perfusion defects is unavailable at this time; nevertheless, SCMR suggests that perfusion in each of the 17 segments (Figure ) be defined according to the transmurality, and persistence of the defect. The committee recommends that stress induced (vasodilator or inotropic) perfusion defects be compared with co-registered rest perfusion or late enhancement segments in order to identify ischemic, infarcted, or non-ischemic areas. The SCMR also recognizes that observed defects may be characterized as artifacts. These should be described.
3. Late gadolinium enhancement (LGE):
The amount of intense signal >2 SD above the average of normal myocardium should be reported for the area within each segment. Overall, LGE should be described as subepicardial, intramural, subendocardial, or transmural. Patchy or linear streaks of LGE should be identified. The transmural extent of the LGE should be defined as 0, ≤ 25%, 26% to ≤ 50%, 51% to ≤ 75%, and 76% to 100%. In addition, the total amount of infarcted tissue (volume or grams) relative to the total myocardial volume or mass (g) may be reported. It is not recommended, but measures of LV end-diastolic wall thickness for the 17 myocardial segments may also be reported. When clinically appropriate, those providing an interpretation should indicate whether the pattern of LGE is consistent with ischemic heart disease, myocarditis, etc.
4. Microvascular obstruction (MVO) :
If MVO is observed during LGE, its location and presence within the 17 myocardial segments should be provided.
Integrative stress imaging:
It is recognized by the SCMR that the procedures mentioned above can be performed in a single setting and thus must be integrated to arrive at a diagnosis. The committee recommends reporting data for all 17 myocardial segments in all modalities (Figure below). Based on previously published techniques, segments should be identified as ischemic, infarcted, mixed ischemia/infarction, or normal. It is recommended that all information for baseline function be reported in patients referred for stress testing or evaluation of acute or chronic ischemic syndromes.
For these clinical conditions, the following items are recommended for reporting by the SCMR.
• LV volumes (EDV, ESV, SV, EF) with and without indexing to body surface area.
• Presence and extent of (T2) signal intensity
• Presence and extent of irreversible injury (LGE)
• Presence of pericardial effusion
• In the case of iron overload: T2* in ms may be reported
• Optional: early enhancement ratio† or the % injury related to LV mass
†: see Lake Louise Criteria, Consensus Group on CMR in Myocarditis
e. Coronary Arterial Segments
It is recommended that when examining the course of anomalous coronary arteries, the origin and course of the coronary artery segments be reported, as well as the length of the segments visualized. If anomalous artery is intramural, it should be noted. If a study is performed for the purpose of identifying coronary artery or bypass graft anatomy, the patency of these conduits should be indicated.
f. Valvular Heart Disease
The following lists of items should be reported for the cardiac valves.
• morphology of each component of the valve complex (e.g. leaflets, annulus, chordae)
• presence of any insufficiency or reduced valvular excursion
When quantitative flow measurements are acquired:
• the velocity encoding Venc setting;
• the peak velocity, a single value when recorded across semilunar valves or a vessel in cross-section, or both early (E) and late (A) peak velocities for atrioventricular valves;
• the forward stroke volume and peak and mean transvalvular gradients;
• the regurgitant volume and fraction;
• the heart rate during acquisition;
• the method and determination of valve area (by planimetry or the continuity equation);
• the measurement of ventricular dimensions and volumes as described in III-B.
g. Arrhythmogenic RV Cardiomyopathy (ARVC)
1) It is recommended that each report identify major and minor criteria associated with ARVC. This should include a statement regarding:
a) Global right ventricular performance (RVEF);
b) RV dilation;
c) Location of Regional RV wall motion abnormalities (infundibulum, body or apex of right ventricle).
a) Fatty infiltration of the right ventricle, and
b) Occurrence of fibrosis by LGE should be provided.
h. Cardiac and paracardiac masses (including pericardium)
The standard report should consist of the following components:
Myocardial mass description:
Location (pericardial, myocardial, valve relationship, chamber relationship)
Size (cross-sectional dimensions)
T1 signal intensity (homogeneous, heterogeneous, hyper, iso or hypo intense to myocardium/or chest wall (specify reference tissue)
T1 fat sat images signal intensity (if performed) (homogeneous, heterogeneous, hyper, iso or hypo intense to myocardium/or chest wall (specify reference tissue)
T2 signal intensity (homogeneous, heterogeneous, hyper, iso or hypo intense to myocardium/or chest wall (specify reference tissue)
STIR signal intensity
Perfusion pattern (if perfusion performed)
Late gadolinium enhancement pattern on static/delayed images (if gadolinium administered)
Relationship to myocardium/pericardium, mediastinum
Margins (e.g., smooth, irregular, infiltrating, pediculated)
Cine CMR appearance (pedunculated, motion with myocardium/pericardium)
Myocardial function (if performed, qualitative or quantitative as appropriate)
Pericardial abnormalities if present (pericardial thickness should be reported along with determination of the presence or absence of a pericardial effusion)
1. Pericardial Thickness: describe as local or circumferential and list thickness measurements
2. Pericardial effusion (None, trace, small, moderate, large)
1. LV volumes (EDV, ESV, SV, EF) with and without indexing for body surface area.
Ventricular wall motion
1. Systolic wall motion
2. +/- abnormal septal motion during normal respiration and breath holding.
4. Presence or absence of atrial inversion
Late Gadolinium Enhancement
1. RV – site
2. LV – site
i. Pulmonary Vein assessments
Qualitative elements that should be included in CMR-based PV reporting include:
1. Number of pulmonary veins;
2. Atrial side of pulmonary vein return;
3. Recongition of accessory or anomalous pulmonary veins; and
4. Presence or absence of stenosis in each PV, especially in reporting post-ablation CMR exams.
Quantitative elements that should be included in CMR-based PV reporting are:
1. Maximum ostial diameter of each pulmonary vein;
2. Cardiac phase (e.g. end-atrial diastole) and respiratory phase (e.g. end-expiration) during acquisition of images used for ostial measurements;
3. Minimum ostial diameter of each stenotic pulmonary vein; and
4. Imaging technique used for measurements
The number and position of pulmonary veins is accounted for noting common trunks, accessory veins, and evidence for stenosis or thrombosis cross sectional area of the pulmonary vein may be provided. A 3D workstation may be used to calculate major and minor axes, and cross sectional area of each pulmonary vein ostium, and compare pre- and post-ablation images side by side.
SCMR recognizes the value of pictorial display of the pulmonary vein orientations, and suggests implementation of diagrams when feasible.
j. Congenital Heart Disease
a. Simple Lesions
b. Complex Lesions
ii. ventriculoarterial relationship
iii. artioventricular relationship
iv. pulmonary venous connection
v. systemic veins and connections
vi. septal defects
vii. valvular lesions (including atresia)
viii. pulmonary arteries (systemic pulmonary collaterals)
RV and LV Volumes with and without indexing to body surface area
PA and Aortic Dimensions (diameters)
iii. Coarctation (minimum)
iv. Shunt or conduit (minimum and maximum)
Blood Flow, Velocity
a. Pulmonary/systemic flow ratio
b. Valve (if regurgitant) (name of valve)
i. forward flow
ii. regurgitant flow
iii. regurgitant fraction
c. Valve (if stenotic) (name of valve)
i. peak velocity (gradient)
i. peak velocity (gradient)
ii. collateral flow estimate
e. Pulmonary arterial flow
f. Shunt or Conduit Flow (name of shunt or conduit)
ii. peak velocity (conduit)
8) The SCMR recognizes that more extensive historical information may be desired by certain institutions that perform CMR. At the time of this publication, SCMR considers this information optional for inclusion in the final report. Accordingly, in the case in which further data are desired, the following outline for data collection is provided:
a) Relevant Medications
• Other anti-platelet
• ACE inhibitor
• Angiotensin receptor blocker
• Erectile dysfunction medication
• Calcium channel blocker
b) History and risk factors
2) Dyslipidemia – Indicate if the patient has a history of dyslipidemia, diagnosed or treated by a physician or documentation of a total cholesterol >200 or an LDL ≥130 or an HDL < 30.
3) Is the LDL > 100 mg/dl or 2.59 mmol/l? Yes/No
4) Tobacco use: Current, Former, Never
5) Diabetes – Yes/No
c) Peripheral arterial disease
1) Claudication with exertion
2) Amputation for arterial vascular insufficiency
3) Aorta or iliac occlusive disease reconstruction
4) Peripheral vascular bypass surgery or percutaneous intervention
5) Documented AAA repair or stent
d) Other cerebrovascular diseases
1) Cerebrovascular accident
4) Carotid test >75% occlusion
5) Prior carotid surgery
1) Atrial fibrillation
2) Frequent PVC's
3) History of ventricular tachycardia
4) History of ventricular fibrillation
f) Heart failure
1) Previous history: Yes/No
2) NYHA Class Heart failure: Class I/Class II/Class III/Class IV
g) Presence of angina: None, typical angina, atypical angina, non-anginal chest pain
h) Characteristics of chest pain or suspected angina equivalent: Substernal chest pain, provoked by exertion, or relieved by rest &/or nitroglycerin
i) Ability to exercise prior to testing (METS)
j) Previous noninvasive cardiovascular imaging tests
• Nuclear myocardial scintigraphy
• Cardiovascular computed tomography
• Cardiovascular magnetic resonance
• Cardiac catheterization
j) Surgical risk
• Low risk surgery
• Intermediate risk surgery
• High risk surgery
k) For studies incorporating CV stress, prior to the procedure, the following information should be verified:
• Prior MI
• Prior coronary revascularization (PCI and/or CABG)
• Pretest Probability of CAD (none, low, medium, high)
• Is the ECG interpretable for ischema? Yes/No
• Framingham Risk Score
• Estimate of CAD risk (<10%, 10–20%, >20% over 10 years
9. Noncardiovascular Findings
It is recognized that there may be findings unrelated to the cardiovascular system identified during CMR imaging procedures. Such findings should be reported in accordance with local standards. However, SCMR recognizes that the contrast, resolution and field of view of a CMR study are optimized for the cardiovascular system rather than to assess for abnormalities outside of the cardiovascular system.
10. Summary and Conclusions
SCMR recommends that each report conclude with appropriate statements that relate the study indications to the imaging acquisition and findings associated with performance of the study. SCMR recommends that these statements provide referring physicians with conclusions that allow the prescription of therapy based on the study findings. SCMR recommends that the conclusion of the report provide the written or electronic signature of the individual accomplishing the report along with the time and date of the signature. SCMR considers it optional to provide the National Provider Identifier for the physician signing the report.