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Submit news here. The SCMR news editor is Dr Juliano de Lara Fernandes from Brazil.
See the Latin American working group blogspot for more. Follow CMR news on Twitter: http://twitter.com/scmrlac

 

 

JANUARY 2012

 

02/01 - 02/05: see you in Orlando!

 

01/31/2012 - Anatomy and function: the roles of CCT and CMR

If anyone has a definite answer to the functional versus anatomical diagnosis workup of patients with stable CAD, please speak up! While results of ongoing trials are eagerly being waited some new data comes along to help physicians decide on which exams to order in assessing patients with stable angina. This paper by Kirschbaum et al investigated 232 patients with suspected CAD using CCT, CMR and invasive CFR. In the group, 34% of patients had significant disease (defined as > 50% in CCT) and CMR showed reduced perfusion in 64% of the 50 patients that subsequently underwent CMR and invasive CFR. CFR confirmed the findings from CMR in 84% of the cases. All cases with normal perfusion by CMR were confirmed by CFR. The authors concluded that CCT excluded most patients with CAD in the study while CMR had a significant impact in the detection of the functional significance of the lesions found by the positive CCT exams. While the results are far from definite (and considering the significant limitation of not having performed CMR in patients with negative CCTs), the study does confirm the rather poor correlation between anatomy and function with 36% of patients with positive CCTs with no perfusion deficits and 47% of them with no CFR reductions.

Kirschbaum SW et al. Circ J 2011;75:1678-84. Link here (free access to the full PDF).

 

23/01/2012 - LV enlargement and familial dilated cardiomyopathy

While this is not a specific CMR manuscript, it has a lot of implications for those who work with the method. Fatkin et al studied 457 asymptomatic relatives of patients with familial dilated cardiomyopathy (2 more first-degree relatives with DCM) and found that 24% of those individuals had an increase in LV measured by LVED diameter by echocardiography. Out of those, 13% developed DCM in the median time of 52 months, with echo parameters identifying 8/9 progressors. The implications of these findings reflect the importance of assessing relatives of patients undergoing CMR with familial DCM, an indication very frequent for the method. It remains to be seen whether LGE or other CMR variable could be included in further improving the prediction algorithm.

Fatkin D et al. Circ Cardiovasc Genet 2011;4:342-348. Link here.

 

23/01/2012 CMR in valve disease and pulmonary hypertension reviews

Two important and somewhat undervalued uses of CMR have been recently reviewed in JCMR. The first review authored by Saul Myerson covers heart valve disease and summarizes the advantages of CMR in the assessment of right sided valves as well as in quantification of flow and volumes, recognizing its strengths and weaknesses compared to echo. On another paper by Bradlow et al the authors also highlight the importance of using CMR in pulmonary hypertension, including assessment of right cavities, pulmonary angiography and measurement of flow in the same exam. The two links for the full PDFs are available without any charges.

Myerson SG. JCMR. Online first 19/01/2012. Link here.

Bradlow WM et al. JCMR. Online first 18/01/2012. Link here.

 

 

17/01/2012 - Pediatric Working Group and Editor for Congenital Heart Disease portion of the SCMR website

Dr Lars Grosse-Wortmann has taken the position of Editor for Congenital Heart Disease portion of the SCMR website and along with the chair Dr Mark Fogel for the Pediatric WG will provide many contributions to this area both in the main website and forum. Dr. Lars Grosse-Wortmann grew up in Germany. He attended medical school in Wurzburg and completed his pediatric residency in Aachen (Germany). Following a fellowship in pediatric cardiology in Aachen and Toronto he received his CMR training at the Hospital for Sick Children in Toronto where he has been on staff since 2008. Lars practices general cardiology with a focus on CMR and echocardiography.

 

Please find more information on the Pediatric Working Group at http://www.scmr.org/working-groups/1666.html

 

 

06/01/2012 -First ICD MR-Conditional  device

Late November, Biotronik released a new ICD series (Lumax 740), the first to offer a MR-Conditional feature (aka ProMRI). It received it CE approval on November 18^th and has been tested in many European countries.

Some important conditional statements described in the manual:

- no other implants in the body (PM or leads)

- height > 1.40m

- implantation > 6 weeks and in the chest area

- MRI field strength of 1.5T

- slew rate < 216T/m/s

- HF fields generated only by the body coil - no additional transmitting coils are used.

- dorsal position only

- accumulated imaging time < 30 minutes

- SAR < 2.0W/kg; head absorption < 3.2W/kg

The only important aspect revealed in the manual is the scan exclusion zone which includes the thorax and abdomen (pg 14 of the manual) which limits its use specifically for CMR exams.

For the manual of the ProMRI specifications, please see the link here.

 

 

DECEMBER 2011

 

This year we finish with 42 insertions. More to come next year. Happy 2012!!!

 

29/12/2011 - Exercise stress CMR

One of the limitations of stress testing using CMR is the possibility of only performing pharmacological stress. According to Foster et al in a paper published in MRM the use of treadmill exercise test might be possible inside the magnet room. The authors investigated a special non-ferromagnetic treadmill in 10 patients who underwent routine ETT. After reaching 98% of the predicted MHR, the volunteers were put into the scanner and perfusion and cine images performed with heart rates of 86 down to 81% of the MHR. All subjects completed the study with starting image time of 24 seconds and completion at 40 seconds. The use in CAD patients was not tested but the authors expect that the new method might improve diagnostic performance over other exercise stress modalities.

Foster EL et al. MRM 2011 published ahead of print. Link here.

 

23/11/2012 - CE-MARC trial: CMR performance over SPECT

Perfusion imaging has always been one of the most widely adopted uses for functional assessment of CAD. Despite previous evidence in other studies that suggested that CMR is at least as accurate as the most frequent test used for that purpose (SPECT), the use of the method is still underutilized in most parts of the world. However, according to Greenwood et al CMR should be adopted much more frequently. The authors reported a prospective trial in the Lancet investigating 752 patients (39% with CAD by angio) and found that CMR had significantly increased sensitivity and NPV compared to tetrosfomin SPECT (86.5% versus 66.5% sensitivity and 90.5% versus 79.1% NPV, respectively).  Due to the large proportion of patients with CAD among all cardiovascular disease patients, being able to robustly and accurately assess these patients is essential to any imaging method. Moreover, since CMR can also do this without any radiation involved, it certainly seems to merit a larger role in CAD management.

Greenwood JP et al. Lancet. Online First 23/12/2011. Link here.

 

12/12/2011 - Multicenter study and prognostic value of CMR

Most data from CMR comes from single center, relatively small studies. Just recently, multicenter international studies have started to emerge more rapidly and the results are starting to show. Klem et al published the results of a 10-center, 6-countries study investigating 1500 patients who underwent CMR for function and myocardial damage assessment. After 2.4 years, all-cause mortality - the primary endpoint - reached 11.3% with age, CAD, LVEF and LGE being independent predictors of death. On multivariate analysis only LFEF and LGE were still significant predictors and on patients with LVEF>50%, more than 4 segments with DE also carried greater risk. The authors conclude that LGE and LVEF are both important independent prognostic factors in these patients and that, even in patients with near normal global function, increasing degrees of myocardial damage also represent worse prognosis.

Klem I et al. Circ Cardiovasc Imaging 2011;4:610-619. Link here.

 

 

NOVEMBER 2011

 

27/11/2011 - Newly diagnosed idiopathic DCM and CMR

CMR's utility in cardiomyopathies can hardly be questioned but it's use on recently diagnosed patients at the time of presentation is yet unclear. Leong et al investigate in a population with recent onset DCM (< 2 weeks presentation) whether CMR could predict improvement in LV function after 5 months along with other exams and variables. The authors showed that LGE mass along with strain dyssynchrony index by echocardiography were predictors of LVEF improvement after follow-up and that LGE provided added value on top of echo parameters. Twenty four percent of the 68 patients with DCM studied presented with LGE. In conclusion, the paper states that the identification of high risk individuals at onset of the disease could help stratify patients into more precise therapeutical strategies, including the possible guidance of ICD use.

Leong DP et al. Eur Heart J 2011 Epub ahead of print. Link here.

 

20/11/2011 - CMR to guide constrictive pericarditis treatment

Outcome studies using CMR to guide therapy have always been suggested as one of the stronger forces in driving the use of the method. In that regard Feng et al have provided significant initial findings in constrictive pericarditis and CMR. The authors followed 29 patients who underwent CMR with evaluation of pericardial LGE. They found that a LGE pericardial thickness of ≥3mm had significant accuracy to predict reversibility of pericarditis and that CRP and ESR were also more elevated in the group with reversible inflammation after 13 months of follow-up. The study, while preliminary, suggests that CMR should be sought in these patients and can be used to drive therapy.

Feng D et al. Circulation 2011;124:1830-37. Link here

 

02/11/2011 - Stress CMR after acute infarction

In a manuscript by Wong et al, Australian authors report the use of adenosine stress CMR for the assessment of residual ischemia in patients with acute ST-segment elevation MI treated with PCI. They evaluated 50 patients three days after a successful primary PCI to investigate the presence of non-culprit significant lesions (defined as > 70% by QCA).Visual analysis resulted in an accuracy of 93% despite a low NPV of 43%. Semi-quantitative analysis was also performed with an improvement in NPV to 86% and accuracy to 96%. The authors conclude that stress CMR can be used in this setting to further guide decision making but that maybe quantitative analysis should be used for better accuracy.

Wong DTL et al. JCMR 2011;13:62. Link here.

 

OCTOBER 2011

 

15/10/2011 - CMR endpoints and stem cell treatment

In a manuscript published by Traverse et al the authors investigate in 10 clinical trials using bone marrow mononuclear cells (BMCs) whether the assessment of ejection fraction and LV volumes using CMR would come with the same results as other published trials using different methods. In 686 patients in those trials, the authors found nonsignificant differences in LVEF and LV volumes in these trials, concluding that the benefits of BMC seem small when using CMR as the method of choice for evaluation of these endpoints. Considering that CMR is acknowledged as the gold standard for such measurements, the authors question whether LVEF should be used as the most important endpoint in such trials. This is a very good example of why CMR should be used for such assessments over other less accurate methods.

Traverse JH et al. Am Heart J 2011;162:671-7. Link here. 

 

01/10/2011 - Myocardial infarction in women with normal coronaries: use of CMR

Myocardial infarction with apparent normal epicardial arteries occurs in a specific number of cases especially in women. In a recent study published in Circulation, American investigators analyzed 50 women with documented increase in troponin and invasive angiography plus IVUS with < 50% stenosis. An abnormal CMR was found in 59% of these women with LGE present in 34% and edema (by T2W imaging) in 18%. Interestingly, edema was correlated with myocardial segments irrigated by a coronary with plaque disruption. The most common pattern of LGE was transmural or subendocardial (10/17 - 59%) but mixed and purely nonischemic patterns were also rather frequent (41%). The authors conclude that the use of IVUS and especially of CMR can aid in the identification of the causes underlying such clinical situations with possible therapeutical consequences.

Reynolds HR et al. Circulation 2011;124:1414-1425. Link here.

 

SEPTEMBER 2011

 

25/09/2011 - Cardiac Imaging Review Articles

A set of four basic review articles on cardiac MR can be found at the latest edition of AJR. Check each manuscript at the link here.

 

24/09/2011 - CMR as a gatekeeper for heart failure

In a manuscript by Assomull et al published in Circulation the authors evaluate the role of CMR to diagnose the etiology of recent onset heart failure compared to an invasive strategy. Using cine-MRI, LGE and coronary MRA they found that CMR has a diagnostic accuracy of 97%, equivalent to invasive angiography. Based on the values of £600 per CMR scan and £1255 for invasive angiography, CMR would be cost effective in avoiding unnecessary invasive procedures.

Assomull RG et al. Circulation 2011;124:1351-60. Link here.

 

18/09/2011 - Mind the gap

CMR plays a more significant role in helping electrophysiological studies and procedures each year. On this manuscript published by Ranjan et al the authors studied gaps in ablation lines in dog hearts and compared measurements by pathology and MRI. Results presented showed not only that large gaps are more prone to propagation recovery but, more importantly here, that CMR correlated significantly with pathology on gap length measurement (R²=0.81). The authors point out that the ability of acutely identifying these faults in ablation lines with CMR might allow for more accurate procedures in the near future.

Ranjan R et al. Circ Arrhythm Electrophysiol 2011;4:279-86. Link here.

 

17/09/2011 - JCMR 2010 manuscript reviews

A review indexed by subject summarized 75 articles published last year in JCMR. The editors combined in one single manuscript comments on 2010's manuscripts with comparisons from previous published articles in the journal. Very useful for a quick review on what was published in 2010 in JCMR.

Pennell DJ et al. JCMR 2011 - published ahead of print. Link here.

 

08/09/2011 - An example of CMR use in multicenter trials

This article in JAMA by Patel et al used infarct size and as the primary endpoint of an important multicenter trial in 30 sites and 9 countries (CRISP-AMI). The total number of patients enrolled was 337. This type of use of CMR should become more frequent as clinicians realize the impact of unique measurements provided by CMR as well the possibility of substantially reducing the number of patients needed for the studies.

Patel MR et al. CRISP-AMI Randomized Trial. JAMA 2011; published ahead of print. Link here.

 

05/09/2011 - Early gadolinium enhancement: double the information in a single shot

LGE is a trusted and proven way to assess areas of myocardial infarction as well as other myocardial scars. However, with the increasing use of CMR in acute settings, area at risk assessment has become a clinical relevant information for prognosis or even indication of invasive studies. While T2W imaging became the first technique to allow for that goal, Matsumoto et al describe the use of early gadolinium enhancement (EGE) - performed at 2 minutes after gadolinium injection - to evaluate area at risk. The authors showed in 34 patients with reperfused AMI that the areas of EGE were larger than LGE and inversely correlated to symptom-to-needle time. Correlation with traditional T2W images was very good with an r=0.86. The accompanying editorial by Dr Andrew Arai points out that LGE should be done at least after 10 minutes to accurately depict infarct area and not overestimate this measurement including EGE areas as well. The timing definition for both EGE and LGE are still not yet defined but the use both time points should  add further information to traditional LGE, especially in the acute setting.

Matsumoto H et al. JACC Img 2011;4:610-8. Link here.

AUGUST 2011

 

21/08/2011 - Left atrial flow patterns in mitral regurgitation

4D cardiac imaging has been gaining rapid momentum as more robust sequences enter mainstream clinical applications. In this paper by Dyverfeldt et al the authors analyze left atrial flow patterns and turbulent kinetic energy in patients scheduled for mitral valve repair surgery secondary to mitral regurgitation. Generalized 3D cine phase contrast MRI during free-breathing was used for the measurements. Results from the study showed that the technique is very robust in determining mitral jet direction and measuring turbulent kinetic energy. Average energy per cycle was very associated with regurgitante volume, reflecting regurgitation severity.  This new quantitative measurement might offer new insights in this disease which is becoming more frequent as asymptomatic patients are referred for mitral surgery earlier.

Dyverfeldt P et al. JMRI 2011;33:582-8. Link here.

 

Want to learn more about CMR and flow? Attend the SCMR/ISMRM Workshop "Exploring New Dimensions of Cardiovascular Flow and Motion", Feb 1-2, 2012, Orlando, FL, USA. More information here.

 

10/08/2011 - LBBB and CMR

 

Left bundle branch block (LBBB) is a rather common indication for CMR assessment, even in asymptomatic cases with at least moderate CAD risk factors. Because of the lack of limitations common to other methods such as echo or nuclear medicine, CMR might be a valuable tool in the investigation of these situations. This hypothesis was verified by Mahmod et al who retrospectively evaluated 54 patients with LBBB and no cardiac symptoms. The value of CMR was demonstrated by showing that in 31% of the cases with normal echocardiograms (29 patients), CMR provided a pathological finding (DCM and LVH most commonly). Even in patients with abnormal echocardiograms (25 patients), CMR still added new data in 52% of them, with more than two thirds being diagnosed with LGE. The authors concluded that CMR is thus valuable in the assessment of these patients even if an abnormal echocardiogram was already identified.

Mahmod M et al. Int J Cardiovasc Imaging 2011; online Jul 31. Link here.

 

 

04/08/2011 - ID bracelets and MRI safety

New warnings have started to show up regarding the safety of ID bracelets worn by patients in hospitals and MRI scans. A case report by Jacob et al published in Radiology demonstrated a severe thermal burn from an ID band in a patient who underwent a lumbar spine MRI. The patient was sedated and complained of wrist pain only after the procedure. Redness, followed by blisters were observed and the patient developed an acute carpal tunnel syndrome which needed surgical release and fasciotomy of the forearm. Intraoperative findings demonstrated muscle necrosis and median nerve edema, characteristics of electrical burn injury. The learning point here is the need to remove id bracelets or at least pad them to prevent direct contact to the skin, especially in sedated patients.

Jacob ZC et al. Radiology 2010;254:846-50. Link here.

 

 

24/07/2011

The newly elected SCMR Web Committee Vice Chairman is Dr. Andrew Flett from the Heart Hospital, London.

 

24/07/2011 - Early changes in HCM detected by CMR

Adding upon a quite wide list of advantages in using CMR to assess HCM in terms of diagnostic and prognostic information, Maron et al showed the potential use of CMR in the detection of early changes in patients with this condition. The authors studied three distinct groups: patients with HCM, control subjects and gene-positive/phenotype-negative HCM relatives. They found not only that in HCM patients the anterior and posterior mitral leaflets lengths were longer compared to controls, but that also that in the phenotype-negative subjects this was also true. The lengths of the mitral leaflets were independent of other variables, and this novel finding is additive to the previous roles played by CMR in HCM.

 Maron MS et al. Circulation 2011;124:40-7. Link here.

 

20/07/2011 - Stress cardiomyopathy multicenter study

Proving what has been argued many times and an important highlight in this year's Scientifc Sessions, CMR multicenter studies provide significant contributions to cardiovascular knowledge. This, in turn, is recognized and gains wide appearance to clinicians, moving the method forward and increasing its utility. The paper by Eitel et al is exactly this case: the authors conducted a 256 patient study on 7 EU and US centers in stress cardiomyopathy demonstrating a wider clinical profile for the disease than was previous thought of. By using specific CMR criteria - including T2 imaging for myocardial edema - they were able to demonstrate distinct patterns of regional ballooning as well as tissue characterization not widely demonstrated before. The clinical journal chosen to publish the findings reveal the amplitude of the study to clinicians as a whole and will certainly help reinforce the indications for CMR in similar cases worldwide.

Eitel I et al. JAMA;2011:277-286. Link here. 

 

US Action requested: SCMR grassroots alert on imaging cuts.

11/07/2011 - New JCMR Impact Factor 4.33

The new JCMR Impact Factor has increased to a solid 4.33. In the last year it has steadily risen with 2010 showing a huge gain:

2006      1.74
2007      1.87
2008      2.15
2009      2.28
2010      4.33

Interestingly, self-reporting has been relatively low at 14% with a bit upward numbers to 26% to years used in IF calculation. Even without self cites, it would still post a significant increase to 3.2 this year.
How do we compare to other CV and Rad journals? The median values for CV and Rad are 1.99 and 1.87 respectively. Here is a selected list of journals in order of IF:
Radiology 6.1
JACC Imaging 5.5
Circ Imaging 4.8
Invest radiol 4.7
Eur Radiol 3.6
MRM 3.3
Int J Cardiovas Imag 2.5 

01/07/2011 - T2W imaging with a new sequence

Authored by Payne et al a recent manuscript published on Circ Imaging proposes the use of a new sequence to identify myocardial edema by T2W imaging. The new sequence is based on a bright-blood SSFP readout approach which was compared to a regular black-blood STIR sequence in 54 patients with ACS. The authors demonstrated that the new sequence was able to correctly identify the culprit lesion in 94% of the cases compared to only 61% in the black-blood STIR images. Moreover, the authors also state that the bright-blood T2W images provide less interobserver variability and more accurate area at risk identification. This paper, in companion to other recent published data on T2 mapping, provide new insights and novel prospects for the use of CMR in acute clinical conditions in a more robust and reproducible way.

Payne AR et al. Circ Cardiovasc Imaging 2011;4:210-219. Link here

 

JUNE 2011

30th June

Dear SCMR community, It is with deep sadness that we share with you news of the untimely death of Stefan Fischer, Director of Clinical Science for Philips Healthcare, North America and a longstanding member of SCMR. Stefan´s sudden passing occurred unexpectedly while on business travels to Europe.   Stefan leaves his wife, Elisabeth, and two sons. Tomorrow the Fischer family will travel to Europe, and following memorial services in The Netherlands, they continue to Switzerland to lay Stefan to rest.  Our thoughts are with the Fischer family in this time of sorrow. Stefan was one of the most senior and experienced members of the CMR community, his career spanning more than 20 years of work in MR.  Let us remember him as a role model - for his deep technical understanding of MRI systems, his passion for teaching, and his great contributions to the field.  Stefan was also a respected mentor and colleague to many of us for his great knowledge, deep insights, and engaging fellowship. We shall keep his memory alive in our work and beyond.  He leaves a gap that is impossible to fill, both in our society, and in our hearts.                                                                                        With deepest sympathy, Scott D. Flamm,  President, SCMR

 

18/06/2011 - How do you measure scar?

Flett et al recently published a manuscript in JACC Imaging comparing seven different techniques to measure LGE in both acute and chronic myocardial infarction and HCM. The authors studied 60 patients and showed that the full width half maximum (FWHM), manual and 6-SD or 5-SD methods provided the same values. Measurements were particularly more difficult in HCM compared to AMI and CMI, but FWHM was the most accurate among the three diseases. As a conclusion, commented by the accompanying editorial by Raymond Kim and Afshin Farzaneh-Far, the authors report that FWHM may provide the most reproducible results in LGE quantification. Nevertheless, the method still requires plenty of manual editing and its objectiveness is still not yet settled.

Flett AS et al. JACC Imaging 2011;4:150-6. Link here.

 

13/06/2011 - CMR and Rheumatic Disease: lots of space to grow

In a review article by Mavrogeni et al in a non Radiology or Cardiology journal (Semin Arthirtis Rheum) the authors review the role of CMR in evaluating heart involvement in rheumatic diseases. While the technical descriptions of CMR might interest only non-experts, the authors explore the literature by revising what has been published regarding many diseases not so commonly studied by the CMR community such as SLE, Churg-Strauss, sarcoidosis, Kawasaki, Behcet among others. The last sentence of the manuscript which asks for more collaboration between rheumatologists and the CMR community is essential to further promote the use of the method in these vast and rather diverse clinical scenarios.

Mavrogeni S et al. Semin Arthiritis Rheum 2011 - published ahead of print. Link here.

 

MAY 2011

 

31/05/2011 - Coronary MRA in infants and children

Given the important discussion of radiation issues in coronary CTA and, moreover, the apparent age-risk relationship, non-invasive coronary angiography using CMR seems a very appropriate niche for the method. This was explored by Tangcharoen et al in a recent paper in Radiology where the authors studied 100 children under sedation with a mean age of 3.9 years to assess coronary anomalies. Using a whole-heart 3D SSFP sequence with isotropic spatial resolution of 1.0-1.3mm³ the paper shows a 88% rate of success for patients over four months old but only 17% for patients younger than that. Overall, diagnostic image quality was obtained in 79% of the patients. The paper concludes that for the assessment of origin and course of coronary arteries in patients over four months old, coronary MRA can be viewed as a very suitable alternative to other methods with no radiation involved.

Tangcharoen T et al. Radiology 2011;259:240-247. Link here.

 

19/05/2011 - Measuring Myocardial 02 Consumption with a new BOLD method

Published in JMRI by McCommis et al, this paper validates a new T2prep method to measure myocardial O2 consumption by CMR comparing the results to PET. The new sequence suggested by the authors use more numbers of TEs for the BOLD image for a more robust T2 map. The technique demonstrated a very close relation to PET (R2 = 0.85) during stress and rest with a repeatability of 2.3% (lower than the 3.5% mean reported with other sequences). The authors conclude that this single breath-hold bright blood technique could help implement BOLD imaging clinically in a larger set of patients if the model can be replicated in human patients as well.

McCommis KS et al. JMRI 2011;33:320-327. Link here.

 

07/05/2011 - Cardiac Prostheses, devices and MRI safety - clinical view

In a review published by Baikoussis et al in Annals of Thoracic Surgery, the authors present a clinician's view on the use of cardiac prostheses and metallic electronic devices in MRI. The paper not only revises literature regarding ICD and pacemakers but also discusses the safety on valve prostheses and stents. The conclusions of the authors - while not totally new - demonstrate that from the clinician's/surgeon's point of view CMR is considered safe but the acceptability of using it on patients with ICD/pacemakers is still no thorough.

Baikoussis NG et al. Ann Thorac Surg 2011; published ahead of print. Link here.

 

APRIL 2011

 

27/04/2011 - Hypointense Infarct Core: prognosis and determinants

Intramyocardial hemorrhage - defined as a hypointense core in LGE scar in acute coronary syndromes by T2W imaging - has been associated with adverse prognostic events. In a study by Eitel et al the authors measured the hypointense core and microvascular obstruction in 346 patients with STEMI who underwent primary angioplasty. In the 35% of patients where this core was observed there was an increase in MACE at 6 months with a HR of 2.59(CI 1.27-5.27) and incidences of 16.4% vs 7.0%. The authors concluded that the presence of a hypointense core was associated with adverse clinical outcomes and correlated to infarct size and LV dysfunction.

Eitel I et al. Circ Imaging 2011 Published online before print April 25, 2011. Link here. 

 

20/04/2011 - New MRI pacemaker approved in Europe

As has been posted a few weeks ago, MRI-conditional pacemakers are slowly entering the market. This week St Jude Medical - another important player in the EP business - released it's version of an MRI-conditional pacemaker: the Accent MRI pacemaker with its corresponding MRI lead. This version requires no programmer and promises easy to use switch between on-MRI and off-MRI settings. As technology evolves in a few years we should see more and more patients with these compatible devices which will allow for new studies in the widening field of arrhythmia and CMR.

Read the full news on the company page here. 

The homepage message from the SCMR president.
This was on the SCMR homepage in the weeks post the Japan crisis.

To our colleagues and friends in the Asian SCMR Working Group in Japan,
We have all been following the events and unfolding crisis in Japan.  Our hopes and prayers are with you and your families, and your fellow countrymen who are being affected by this ongoing tragedy.  We trust, like you, that this will come to a rapid and safe resolution.
Until then, you will remain foremost in our thoughts, as we wish for your continued safety,
Scott Flamm
President, SCMR

13/04/2011 - Cardiac T2* and Iron Overload Validation Study

On a long effort to collect twelve human hearts for assessment of cardiac iron concentrations using T2*/R2* and myocardial biopsy, Carpenter et al published their results recently in Circulation. The authors showed a strong correlation of ln[R2*] to ln[Fe], producing the equation [Fe]=45xT2^*-1.22.  The paper also emphasizes that septal iron concentrations strongly correlates to global iron burden and that the there is a gradient of iron concentration from the epicardium to the endocardium.  The papers accurately addresses the validation of T2* in human hearts and provides decisive evidence on the use of CMR in the assessment of heart iron overload.

Carpenter JP et al. Circulation 2011;123:1519-28. Link here.

 

04/04/2011 - Every detail counts in CMR

After following up 908 patients for a mean of 2.6 years that underwent CMR for investigation of myocardial ischemia, Bingham et al analyzed which factors were predictors of events in this population. The authors specifically studied the results on top of pre-imaging risk factors such as age, diabetes mellitus, prior CAD, etc. They showed that four elements in CMR added prognostic and stratification information on top of the pre-imaging data: LVEF, aortic flow, LGE and stress perfusion. The authors also showed that a normal CMR portraits a risk of 0.6% of hard events/year (death/MI) and 2.4%/year if all cardiac events are considered.

Bingham SE, Hachamovitch R. Circulation 2011; published online Mar 28,2011.  Link here.

 

 

MARCH 2011

 

31/03/2011 - CMR and CTCA working together

In a paper by Stolzmann et al from Zurich the researchers evaluated with both CMR and CTCA 52 patients with suspected CAD undergoing invasive coronary angiography. CMR was used to evaluate ischemia while CTCA quantified coronary plaques. The authors found that the total number of plaques and the number of calcified plaques were the best predictor of ischemia, similarly to the degree of stenosis observed by invasive angiography. The authors conclude that plaque evaluation by CTCA has the same predictive value as stenosis assessment for determining myocardial ischemia. In another paper by the same group, the authors had also found that adding calcium score values to myocardial ischemia assessment by CMR improved the diagnostic accuracy from 82% to 87%.

Stolzmann P et al. Eur Radiol 2011; Epub ahead of print March 4. Link here.

 

16/03/2011 - Rapid 13C Hyperpolarized Imaging

The use of hyperpolarized 13C labeled substances has been suggested before to characterize myocardial metabolism. However, since coverage of the full heart at high resolution was very time consuming, this limited its application. Lau et al published a recent paper using a new spiral sequence which permits full heart coverage at moderate resolutions of 8.8mm within one breath-hold. Using 13C pyruvate injections in pigs the authors were able to evaluate both pyruvate and bicarbonate metabolism using chemical shift relative to 13C pyruvate with each slice being acquired in 80ms with a single excitation. The authors conclude that the new sequence presented may allow for better monitoring of metabolites in diverse cardiac disease while covering the whole heart.

Lau AZ et al. Magn Reson Med 2010;64:1323-31. Link here.

 

06/03/2011 - Myocardial extravascular volume measurements

Schelbert et al report the comparison of two methods to assess myocardial extravascular volume using a continuous infusion of gadolinium versus a bolus technique. The importance of the paper relies on the use of CMR to detect diffuse fibrosis and increase extracellular volume fraction, a unique utility of the method. The authors demonstrated that either the constant infusion or the bolus method derived the same results with a difference of 0.1% (P=0.38), concluding that diffuse fibrosis can be accurately be measures after a simple bolus of gadolinium agents.

Schelbert EB et al. JCMR 2011;13:16. Link here (full text free).

 

FEBRUARY 2011

 

27/02/2011 - Quantifying MBF in post bypass patients

Because of possible differences in the quantification of myocardial blood flow (MBF) in coronary arteries supplied by bypass grafts, Arnold et al evaluated 28 patients before and after CABG to measure MBF in coronary arteries with non-critical stenosis (<85%). The authors found that rest MBF was not altered comparing grafted versus ungrafted arteries as well as its value in grafted coronaries before and after surgery. The authors used a model-independent deconvolution method and concluded that this methodology can be used irrespectively if the patient undergoes CABG or not.

Arnold JR et al. Circ Cardiovasc Imaging 2011;Epub ahead of print. Link here.

 

12/02/2011 - CMR to guide ICD implants

LGE has been shown to predict adverse outcomes in innumerous settings but not so many papers have investigated its use to effectively drive therapy. The paper by Iles et al maybe one of the first to go into that direction by prospectively studying 103 patients who underwent ICD implantation by CMR. The authors showed that only patients with LGE had an appropriate discharge after 573 median follow-up compared to no discharges in patients with no LGE, despite similar ejection fractions. One of the conclusions of the study was that CMR might aid in identifying a group of low risk patients whose chance of malignant arrhythmias are low enough not to warrant ICD implantation. An accompanying editorial calls for the attention that the number of patients were a bit low and the follow-up period maybe too short but that the paper certainly adds very interesting information worth looking at.

Iles L et al. JACC 2011;57:821-8. Link here.

 

10/02/2011 - First MRI-Safe Pacemaker approved by the FDA

The first FDA-approved pacemaker device for MRI has been announced this week after a review of the previous trial involving 464 patients. The pacemaker - REVO Surescan from Medtronic - will start sales immediately. However, some important points to remember regarding CMR:

- limited to 1.5T

- gradient slew rate of < 200T/m/s

- Normal operating mode only

- isocenter above C1 and inferior to T12 (precludes the heart!)

Read the full statement on indications, safety and warnings in this link.

JANUARY 2011

31/01/2011 - Predicting success in atial fibrillation ablation with CMR

The use of CMR in helping electrophysiologists deal with atrial fibrillation has been shown in many studies. Besides appointing pulmonary vein anatomy, the degree of LGE of the atrial wall has also been shown to evaluate the success of the isolation procedure. This new paper by Jahnke et al from Germany adds a new measurement of atrial volume that could help predict the success of PV isolation. Using the cutoff of 112ml of diastolic volume the authors report a sensitivity and specificity of 80% and 70% for persisting sinus rhythm 12.6 months after the procedure. Therefore, the routine use of volume assessment of the left atrial chamber might be added to the regular sequences used in PV CMR studies.

Jahnke C et al. JMRI 2011;33:455-463. Link here.

24/01/2011 - Thalassemia major - no fibrosis there

Contrary to previous published manuscripts, the recent paper by Kirk et al investigated 45 TM patients with and without heart failure and found only one patient with macroscopic myocardial fibrosis. Despite studying 18 patients with T2* less than 20msec (which in theory should be more prone to developing fibrosis due to iron overload), none of these subjects had any evidence of LGE. The authors also point out that since reversal of iron overload results in partial to complete improvement of cardiac output, fibrosis if present would also have to be reversible.

Kirk P et al. JCMR 2011;13:8. Link here.

19/01/2011 - Identification of VT conducting channels by CMR

The use of CMR as the method of choice for guiding EP studies has been shown before in both ischemic and nonischemic cardiomyopathies. The recent paper by Perez-David et al published on JACC adds to current knowledge by showing that LGE SI thresholds can be used to identify heterogeneous tissue in the myocardium of patients with previous MIs that present channels more prone to ventricular tachycardia. These channels were much more prevalent in the VT group than in controls and matched slow conduction channels identified on EP studies. The usefulness of the method to possibly provide a noninvasive roadmap to VT ablation is suggested and should be tested in future studies.

Perez-David E et al. JACC 2011;57:184-94. Link here.

 

13/01/2011 - Faster Real Time MRI

Despite the high spatial and temporal resolution, acquiring cine images using traditional SSFP sequences requires careful programing of image slices and is quite time consuming. With the advances in MR hardware and new sequences, real time MRI became feasible in the last years. A new manuscript by Uecker et al advanced this concept by applying a FLASH sequence combined with radial encoding and iterative reconstruction to allow for up to 18msec cine images with a resolution of 2.0x2.0x8mm with no synchronization and during free breathing using a 3T scanner with 32 channels. This new approach widens the possibilities of using interventional MRI with real time monitoring and better image quality on patients with very irregular heartbeats for example.

Uecker M et al. NMR in Biomedicine 2010;23:986-994. Link here.

07/01/2011 - Jan/Feb/Mar Edition of SCMR-LAC Newsletter. Link here.

03/01/2011 - LGE as a marker of AF in HCM

 

In a paper by Pujadas et al from Spain the authors describe another prognostic correlation of LGE in HCM. Summing to previous evidence that LGE is an independent and  very powerful marker of poor prognosis in HCM, in this manuscript the authors studied 67 patients in which 25% presented with AF and 57% with fibrosis. In the group with fibrosis 42% of the patients also had AF versus only 3.4% in the group with no LGE. The left atrium area was also significantly increased in these patients. Despite not demonstrating a causal effect or a direct link between the two findings, this new result reinforces the need of determining the presence or absence of LGE in HCM patients for clearer determination of their prognosis. Despite that, the current clinical guidelines still do not yet reflect the use of CMR routinely in these cases and LGE is not completely recognized as an adverse marker as are increased septal wall thickness, outflow tract obstruction and others.

Pujadas S et al. European Journal of Radiology 2010;75:e88-91. Link here.

 

 

 

30/12/2010 - Happy New Year!

 

This is the last post of the year and we just want to wish all readers a great 2011! Thanks for all the feedback along these last months and we hope to improve the news section even more next year.

28/12/2010 - High resolution CMR perfusion at 3.0T

 

A new manuscript from Lockie et al from the United Kingdom has reported new data regarding the use of high resolution CMR perfusion at 3.0-Tesla for detecting significant stenosis. The authors should be congratulated on using the gold standard of fractional flow reserve to assess lesion severity in addition to the more common visual or even QCA analysis, much more prone to errors. With FFR < 0.75 as the cutoff visual CMR analysis provided very high AUC of 0.92. This is of a very practical matter since most sites only do clinical CMR perfusion analysis and this proved very accurate as reported. Nonetheless, the authors used a k-t SENSE acceleration of 5 with an inplane resolution of 1.2x1.2mm.

Lockie et al. JACC 2011;57:70-5. Link here.

 

 

19/12/2010 - How fast can you go?

A review article by Tsao J et al published in JMRI summarizes the latest techniques on ultrafast MRI. Especially useful in CMR, the manuscript focus on the development of echo-planar imaging and spiral imaging pushing the limits of where these pulse sequence methods can go. The manuscript also covers potential pitfalls when using ultrafast sequences including reduction of SNR, signal evolution and artifact formation as well as faster switching of strong gradients (eddy currents, errors in timing, responses among gradients). Besides pointing potential errors, the author also offers possible solutions to these limitations which should help CMR users overcome part of the problems discussed.

Tsao J. JMRI 2010;32:252-266. Link here.

 

04/12/2010 - Physics for clinicians - a primer part 1

In a review article published with open access in JCMR, Ridgway revises the principles of physics applied to CMR. In a very concise and explanatory way, the manuscript provides many diagrams and figures that accurately illustrate the basics behind MRI and CMR in particular.  Anyone who has given lectures to fellow clinical cardiologists or non-specialized physician on how CMR works knows the difficulty in explaining some terms to a reluctant audience. This manuscript should become a starting point to anyone who is beginning to work with CMR or just wants to brush up previously acquired knowledge. Part II to come soon.

Ridgway JP. JCMR 2010 Epub ahead of print. Full text free link here.

 

NOVEMBER 2010

 

27/11/2010 - Apical hypertrophic cardiomyopathy

A variant of hypertrophic cardiomyopathy, apical HC was found to be frequently missed by echocardiography which diagnosed only 69% of patients in a paper published by Fattori et al in AJC. All patients were identified by CMR and the authors found that T-wave inversion in anterolateral lead was present in 92% of patients. Another interesting finding in the study showed that LGE is very frequent in these cases (85%) with its recognition not limited to hypertrophic areas only. Finally, the authors demonstrated the presence of apical aneurysm in 31% of patients. The paper illustrates the high clinical suspicion that should be placed in patients with unexplained inverted deep T waves and apparently normal echocardiograms.

Fattori R et al. Am J Cardiol 2010;105:1592-6. Link here.

 

 

21/11/2010 - Cardiac resynchronization therapy guided by CMR

One of the hot topics in the recent AHA, CRT still lacks an imaging standard for precise indication of its use. While echocardiography provides many solutions, recent data suggests data CMR may add more information regarding dyssynchrony status as well as scar information. With possible increases in the use of CRT after the RAFT trial results, evaluation of dyssynchrony may require an expansion in the use of imaging modalities that assess this finding. A recent review on the topic by Dr. Francisco Leyva might help CMR physicians choosing which technique to use.

Leyva F. JCMR 2010;12:64 - link here.

 

 

08/11/2010 - MRI and inflammation in atherosclerosis

While new contrast agents are still under development, the ability of MRI to detect inflammation in plaques with conventional contrast enhanced imaging follows through. Hur et al published this week in JACC Imaging a new study where the applied a 3D black-blood technique in rabbits' aorta pre and post gadolinium injection. Not only did they find increased enhancement in atherosclerotic vessels compared to normals but they also demonstrated higher enhancement ratios in lipid-rich and macrophage-rich plaques.  The findings corroborate other papers that have demonstrated similar findings in human carotids and strengthen the use of the method for this objective. How to apply this clinically is still not settled and what to do with that information to guide therapy is yet to be investigated.

 Hur J et al. J Am Coll Cardiol Img, 2010; 3:1127-1135. Link here.

 

01/11/2010 - CMR in athletes

Differentiating athletes' hearts from pathological cases such as hypertrophic cardiomyopathy can be a challenge. Not only that, but since different sports cause different functional changes in the heart can lead to further confusing. In that regard, Scharf et al assessed the cardiovascular adaptations of elite triathletes with CMR, a group subject to intense aerobic exercises. The authors found that the hearts of these athletes differed significantly compared to normal active controls with increased mass, LV and RV volumes. The eccentric and concentric remodeling observed differed compared also to other elite athletes. The manuscript adds more data on the knowledge of how different activities may provoke subtle changes in the heart that should alert CMR physicians in borderline cases of possible cardiomyopathies.

Scharf M et al. Radiology 2010;257:71-9. Link here.

OCTOBER 2010

 

24/10/2010 - T2W imaging in chronic dilated cardiomyopathy: the evidence evolves

In a recent manuscript published by Voigt et al twenty three adults with chronic dilated cardiomyopathy (DCM) underwent both CMR and endomyocardiocardial biopsy to assess the degree of inflammation. Using the three sequences described in the Lake Louise Criteria (positive LGE, T2W SIm/SIs > 1.8 and global RE > 5.0) the authors report that global edema (as measured by T2W imaging) had the highest acuracy to identify active inflammation compared to EMB, yielding superior results than the combined criteria with a sensitivity as high as 91.7%. While the small number warrants further confirmation, the study is another step in the sum of evidence towards routine use of T2W in cardiomyopathies with unknown origin, despite the controversy that still surrounds it.

Voigt A et al. Eur Rad 2010; DOI 10.1007/s00330-010-1985-2. Link here.

 

 

19/10/2010 - Cardiovascular MR at 3.0T - a review

In a review article in JCMR Oshinski et al appraise the use of CMR at 3.0T. The authors discuss the physics behind moving to higher fields with the enhanced benefits of increased SNR, wider separations in spin frequencies for fat and water, increase in T1 times, parallel imaging and reduction in T2* with increased BOLD sensitivity. Moreover, they also discuss the clinical applications of high field strengths including better tag imaging, coronary angiography gains, myocardial perfusion and late gadolinium enhancement. Each clinical application is discussed comparing the pros and cons of 3.0T imaging to 1.5T separately. The comprehensive list of ninety two references is a good point for further advancing each topic presented.

There is increasing evidence and opinions that CMR will move to 3.0T in a definite way in the future to exploit all the advantages of high field imaging once the cons are dealt with. This review is certainly welcome in helping with that.

Oshinski JN et al. JCMR 2010; 12:55 epub ahead of print. Link here.

 

 

13/10/2010 - CMR as a choice for noninvasive imaging study after inconclusive exercise test?

In a review article on Circulation on imaging test choices for inconclusive exercise tests CMR is listed as a recognized option, but several limitations were raised including: lack of availability, claustrophobia, implanted ferromagnetic objects, life-threatening NSF in renal insufficiency and reduced specificity due to transient dark rim in small subendocardial defects. While all true, the percentage of real life patients that present with any of these is in fact quite small and availability issues have been significantly reduced in most countries. The possible advantages of CMR perfusion (lack of radiation, multicenter data, prognostic data, complimentary information, etc) are mentioned along the discussion. However, the text appears to give the impression that CMR perfusion is just not really there. This is a recurring view also passed on by other review articles mostly target to clinical cardiologists. Despite all the advances, it looks as if there is such a long way to go before CMR can truly be considered a competing choice in this scenario. A lot of work for SCMR.

Blankstein R, DeVore AD. Circulation 2010;122:1514-18.

 

04/10/2010 - Perfusion: what is the best parameter to adjust?

Maredia et al investigated how to use the extra acceleration provided by a k-t SENSE sequence in a 1.5T scanner in ten volunteers at rest and under adenosine stress. The authors compared a regular SENSE sequence with a factor of 2 to three k-t SENSE sequences adjusted for high spatial resolution, high temporal resolution or a hybrid of the two. The best sequence to reduce dark rim artifacts while achieving similar myocardial perfusion reserve index was the high spatial resolution and hybrid sequences. Dark rim was reduced not only in thickness but also in duration and extent with maintenance of diagnostic accuracy. The manuscript concludes that focusing on spatial resolution is the most recommended option when using highly accelerated parallel techniques.

Maredia et al. Magn Reson Med 2010; published ahead of print.

SEPTEMBER 2010

 

30/09/2010 - The value of CMR in PVCs with LBBB

Patients with frequent PVCs with LBBB morphology are rather common in a busy cardiologist office. The substrates that underlie these frequent arrhythmias are not completely understood but morphologic imaging studies are usually recommended in the workup of these patients. CMR may play a significant role in these cases as proposed by Aquaro et al in a recent manuscript in JACC. The Italian group studied 440 patients with > 1000 LBBB PVCs with CMR analyzing RV wall motion, signal abnormalities, volumes and function. The patients were followed for 1348 days with evaluation of death, resuscitated sudden death and appropriate ICD shocks. The investigators found that patients with at least one RV abnormality already had worse outcomes compared to patients with no RV variations despite very few of these individuals actually having definite diagnosis of ARVD/D (< 10% in the group with multiple abnormalities). The authors suggest that CMR may stratify patients with frequent LBBB PVCs if any of the RV abnormalities are found.

Aquaro GD et al. JACC 2010;56:1235-43.

 

 

19/09/2010 - Multicenter MR Coronary Angiography Trial

Released in JACC last week, Kato et al from Japan published the latest multicenter trial on coronary angiography by MR. Using a 1.5T scanner with SSFP whole-heart acquisition the authors imaged 127 out of 138 patients enrolled in 7 hospitals. Using parallel imaging with a factor of 2 and giving nitrates to all patients (but not beta-blockers) the overall imaging time was an acceptable 9.5±3.5 minutes with an interpolated resolution of 0.59x0.59x1.15mm. The intention-to-read sensitivity achieved against 50% stenosis by QCA with invasive angiography was 88% with specificity of 72%, PPV of 71% and NPV of 88%. Three vessel disease and LM stenosis had a NPV of 99%. No differences were observed between high and low heart rates, neither with different BMI values. This is one the few multicenter trials on MRCA and despite not using 3T or 32-channel coils did achieve a very reasonable result. Can it be reproduced in daily life with less experience centers to be adopted regularly in clinical practice? This is a question still unanswered.

Kato S et al. J Am Coll Cardiol 2010;56:983-91.

 

13/09/2010 - ESC Congress 2010 Highlight Session - Imaging. A 9 minute webcast overview directly from the ESC site. Many comments on CMR perfusion is ischemia, HCM and others topics. Link here.

 

13/09/2010 - Jul/Aug/Sep Edition of SCMR-LAC Newsletter. Link here.

06/09/2010 - Angiographic plus CMR Myocardial Salvage Index

 

 

We have commented previously on the use of CMR in acute myocardial infarction settings. This manuscript by Ortiz-Pérez et al further expands the concept of CMR used in these situations by proposing a myocardial salvage index (MSI) composed of both the BARI score determined by angiography as well as infarct size and LV mass measured by CMR. The authors show that the combination of the two methods was the best predictor of functional recovery and improved prognosis as measured by repeated CMR study at five month follow-up.  In an editorial on the same issue of JACC Imaging Dr. Reichek and Dr. Kodali comment that the score proposed is of value but the integration of this information with T2W imaging could result in even further understanding of the problem studied.

JACC Cardiovascular Imaging 2010;3:491-500. Link here.

 

01/09/2010 - ASCI 2010 appropriateness criteria for CMR

The Asian Society of Cardiovascular Imaging published their recent recomendations on the use of CMR classifying indications as appropriate, uncertain and inappropriate following system used in the ACCF publication. Based on a questionnaire answered by 23 technical panel members from Asia the manuscript includes changes from the ACCF 2006 report in only 14% of the indications, with 22 highly agreed indications among the 50 proposed. The paper should help Asian adopters of CMR in the establishment or maintenance of CMR centers in the region.

Int J Cardiovasc Imaging 2010; Aug 24. [Epub ahead of print] - Link here for the fulltext (open access).

AUGUST 2010

 

22/08/2010 - CMR-guided biopsy is not recommended routinely for myocarditis

Yilmaz et al evaluated 755 patients with suspected myocarditis or non-ischemic cardiomyopathy by LV and/or RV endomyocardial biopsy with 540 (71%) patients undergoing CMR with LGE as well. The authors found that the use of CMR to guide the region for biopsy samples did not increase the diagnostic performance of the invasive procedure. The authors also reported a low sensitivity of 54.2% and specificity of 64.3% for CMR for the diagnosis of myocarditis having EMB as the gold standard. As discussed in the manuscript the use of LGE only to look for areas of active inflammation may have been the reason for such low numbers as well as the lack improvement in the use of CMR. If T2 or post-contrast T1 imaging had been used with that purpose, the results might have differed. Nevertheless, as it stands, the use of CMR with LGE only to guide EMB in these cases should not be recommended routinely.

Yilmaz A et al. Circulation 2010;122:900-9.

 

 

19/08/10 LOX-1 receptor target for MR Imaging

As new targets for molecular MRI are revealed the discrimination of vulnerable plaques by imaging shows more promising results. Li et al published a new manuscript in Circ Imaging where they use multimodality imaging including MRI to investigate the location of LOX-1 receptors in atherosclerotic plaques of mice. Specifically for MRI, LDLR(-/-) mice showed significant gadolinium enhancement with the LOX-1 probes compared to nonspecific IgG probes, especially in plaque shoulders. This results further advance this exciting new field in which MRI is certain to play a significant role due its many advantages.

Li D et al. Circ Cardiovasc Imaging 2010;3:464-72. Link here.

 

 

10/08/2010 - Advancing CMR perfusion imaging

The limitations of CMR perfusion - despite its undisputed clinical relevance and accuracy - have somehow slowed its acceptance in daily practice. Parallel imaging and 3T seem to be rapidly overcoming these problems as published by Manka et al in a recent paper in JACC Imaging (J Am Coll Cardiol Img 2010;3:370-7). The authors compared the results of 20 patients that underwent perfusion CMR with invasive angiography using a rapid and high-resolution technique with a net 6-fold acceleration factor. With AUCs of 0.94 and 0.82 for 50% and 70% stenosis detection the technique was able to obtain a resolution as low as 1.1mm while using only a 6-element coil.

Increase in use of CMR has to go through more robust methods of perfusion and/or coronary imaging as a simple prevalence factor can assess. This work seems to go in this way of making CMR perfusion a definitive method in clinical cardiology.

The link to the manuscript can be found here.
See an SCMR case of the week here
See the SCMR resources section on perfusion here

 

 

01/08/2010 - Contrast agents in CMR

A review article published by Moriarty et al discuss the use and evolution of different contrast agents used in CMR. As more contrasts reach the market the safety, correct dosing and appropriate use of these substances is essential. The authors provide for a thorough review of the literature on the subject, including clinical scenarios and future perspectives on the subject. The link to the abstract is found here.

Moriarty JM et al. Am J Cardiovasc Drugs 2010;10:227-37.

 

JULY 2010

 

26/07/2010 - Papillary muscle insights in mitral valve prolapse by CMR

Mitral valve prolapse is a very frequent condition commonly diagnosed only by echocardiogram. However, Han et al demonstrated that CMR can add new data to this widespread finding. The authors report the finding of 46% of 13 patients with definite diagnosis of papillary LGE despite none of these patients having a previous history of CAD. Despite not showing a close correlation to either velocity or excursion of the papillary muscles the rather high rate of fibrosis is certainly intriguing, raising the issue if this is cause or consequence of MVP. The manuscript can be linked here.

Han Y et al. Am J Cardiol 2010;15:243-8.

 

 

20/07/2010 - CMR for predicting successful PCI

Kirschbaum et al studied 71 patients with reduced left ventricular function before and after PCI with CMR and found that CMR can help predict which patients will show improvement in LV function after 6 months. The study demonstrated that low dose-dobutamine CMR and LGE can both help identify which patients will benefit most from intervention. Not only that, it also showed that incomplete or unsuccessful PCIs were associated with a lack of change in global function at 6 months. The results published in JACC Cardiovascular Interventions suggests that the use of CMR before patients undergo PCI can be considered as a new strategy to better select candidates for the procedure.

Kirschbaum SW et al. JACC Cardiovasc Interv 2010;3:392-400.

 

 

12/07/2010 - CMR and prognosis in aortic valve disease

CMR is relatively underused in the assessment of valvular heart disease. Despite that, new prognostic data besides general volume and function indices show that this should change in the near future. In a manuscript published in JACC by Azevedo et al the authors demonstrated that the amount of myocardial fibrosis identified by LGE were independent predictors of all-cause mortality and functional improvement in patients with severe aortic valve disease. This important prognostic information might help identify in the future patients that should undergo surgery earlier than what is now recommended or even contraindicate the procedure on patients whose improvements do not compensate the surgical risk. Azevedo CF et al. JACC 2010;56:278-87. Link here.

 

05/07/2010 - Diffuse fibrosis quantification

While LGE can easily detects small amounts of focal fibrosis, in many diseases the heart is infiltrated diffusely and may be missed by current techniques. However, the detection of diffuse fibrosis might significantly impact the way we diagnose and treat many common chronic conditions. Flett et al describe and validate a new technique to measure this condition using equilibrium contrast CMR. The authors found a very strong correlation between the CMR measurement and biopsy measured fibrosis in patients with aortic stenosis and hypertrophic cardiomyopathy. The new technique opens a broad door for more widespread clinical applicability of CMR once future studies can prove its usability.

Flett AS et al. Circulation published online Jun 28 2010. Link here. 

New video on demand content EUROCMR 2010 Florence - online for members

JUNE 2010

23/06/2010 - More CMR in HCM: tying the knots together

Two papers were released on an online first basis in JACC regarding prognostic information provided by LGE in HCM. The first manuscript by O'Hanlon et al followed 217 patients with HCM and showed a HR of 3.4 for a combined primary end point of cardiovascular events/death in the group with fibrosis (63% of the group). The extent of fibrosis was also associated with a progressive increase in the risk of events. The second paper by Bruder et al followed 220 patients for a mean of close to three years and showed and odds ratio of 5.47 for all-cause mortality and 8.01 for cardiac mortality in the group with LGE present. Most patients in this cohort were either low risk or asymptomatic.

These two papers show definite evidence of the importance of CMR assessment in patients with HCM, especially because in both cohorts the majority of patients would not be classified as high risk according to clinical risk factors, despite a significant percentage of deaths and events observed during follow-up. The next question that certainly follows is whether in the presence of LGE (and at what extent) a patient with HCM deserves an ICD - an interesting clinical trial to watch.

Prognostic Significance of Myocardial Fibrosis in HCM - link to the abstract here

Myocardial Scar Visualized by CMR Imaging Predicts Major Adverse Events in Patients with HCM - link to the abstract here

 

19/06/2010 - LGE visual estimation as good as planimetry on hypertrophic cardiomyopathy

One of the controversial issues in the latest SCMR meetings has been how to correctly identify and quantify LGE in non-ischemic cardiomyopathies. Planimetry is the gold standard but not a practical approach in daily clinical life. Doesch et al deal with this problem in hypertrophic cardiomyopathies in their manuscript published in Magn Resons Imaging 2010;6:812-9. The authors showed that a global index of the size of LGE can be used by visual estimation with close relation to the more time consuming planimetry approach. The time difference was substantially different (2 versus 10 minutes) making this index a useful tool in such patients.

The abstract can be found here.

 

 

12/06/2010 - SCMR Latin American Chapter on Twitter

Adding to the current means of online communication the Latin American Chapter is now offering a Twitter account that will automatically tweet every post that is listed on the chapter's webpage (http://scmrlac.blogspot.com/). For people to receive the updated news it is just a matter of following the new profile at http://twitter.com/scmrlac.

New posts are added at a rate of 1-3 news/week so no spam is expected and the possibility of getting many tweets per day are numb. 

Also, see our latest newsletter here

 

 

07/06/2010 - Molecular imaging with iron oxide microparticles: a review article

A recent publication in Atherosclerosis by McAteer et al reviews how rapidly molecular imaging has entered the field of MRI, at least in experimental research. The authors describe diverse uses for microparticles of iron oxide (MPIO) ligands in the study of atherosclerosis, thrombosis and inflammation. The manuscript also portrays possible clinical translational uses of these new ligands with special consideration for safety and feasibility. The role of molecular imaging in MRI is still in its infancy for human use but this review provides readers with new insights to follow ahead.

The full text of the manuscript can be read free here: McAteer MA et al. Atherosclerosis 2010;209:18-27.

 

03/06/2010 - World Cup warm up: CMR meets professional soccer players

The differentiation between physiological adaptations in the athlete's heart compared to pathological changes in hypertrophic cardiomyopathies is a common indication for the use of CMR. This is especially true among soccer players who have not so infrequently been involved in SCD episodes all over the world. In this manuscript by Scharf et al in Germany the authors compare 29 professional soccer players to nonathelete controls. They found significant higher LV and RV EDV in athletes but no difference in remodeling index. This results should prove useful when submitting soccer players for investigation under CMR. Link to the manuscript here: Scharf M et al. Am Heart J 2010;159:911-8.

MAY 2010

 

26/05/2010 - Three is the charm: CMR in acute ischemic syndromes

In three concomitant publications in JACC this week the use of CMR in the acute setting of coronary syndromes is further advanced. In the manuscript by Larose et al from Canada, investigators showed that LGE volume was the best predictor of late myocardial dysfunction with a cutoff of 23% of LGE ventricular mass giving the best AUC. A second manuscript by Eitel et al from Germany used a myocardial salvage index based on LGE and T2W images to estimate the prognosis at 6 months after reperfusion therapy. Finally, a paper by Raman et al from USA showed that the presence and magnitude of edema measured by T2W imaging also predicts worse outcomes in patients with NSTE-ACS. Taken together, these three papers further demonstrate that the use of CMR in ACS - specially before invasive angiography is chosen to be performed - might allow for better risk stratification and management of these cases. The exact impact of the method, however, remains to be investigated in a randomized study.

The abstract for each article can be read here:

Larose et al. JACC Volume 55, Issue 22, 1 June 2010, Pages 2459-2469

Eitel et al. JACC Volume 55, Issue 22, 1 June 2010, Pages 2470-2479

Raman et al. JACC Volume 55, Issue 22, 1 June 2010, Pages 2480-2488

 

 

 

19/05/2010 - NEW: ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance

Expedited publication in JACC - read the full text here.

 

 

17/05/2010 - Perfusion kinetics in CABG patients

Kelle et al published a recent paper in JCMR to assess whether the kinetics of firs pass perfusion was different in native vessels compared to grafts. This is a very important question since in some labs more than 10-20% of the patients that come in for stress studies have already had bypass surgery. The authors found that despite a short delay (measured by the time to 50% and 100% maximal intensity) no significant differences were found once the contrast reached the myocardium. Read the full manuscript here.

10/05/2010 - Myocardium at risk

As the concept of myocardium at risk is more understood by clinicians its use in CMR is certain to increase substantially. In this paper by Sorensson et al from Sweden the authors describe a simple yet very comprehensive and accurate methodology to use CMR in the acute/subacute phase of a myocardial infarction in patients with total occlusions. In a thorough exam that depicts both myocardium at risk and infarct size CMR is compared to SPECT. The full clinical utility of this concept remains to be proven but is certainly a step in the right direction. The full paper can be read freely at JCMR 2010;12:25.

05/05/2010 - CMR as a clinical endpoint 2 - using it more...

Just after mentioning in the last news piece why don't we use CMR more as an endpoint it was nice to read this paper by Gao et al in JACC. The authors used volumes and LVEF measured by CMR to assess the role of a recombinant human neuregulin-1 (rhNRG-1) in chronic heart failure. Only 44 patients were used in the study but the high accuracy provided by CMR made it possible for the authors to reduce sample size significantly if compared to other modalities that measure the same endpoints. A very up to date example of intelligent use of resources in this tight economic year.

The link to the manuscript follows here.

 

APRIL 2010

25/04/2010 - CMR as a clinical endpoint: why don't we use it more???

 

A recent paper by Sliwa et al (Circulation. 2010;121:1465-73) demonstrated the beneficial effects of bromocriptine on the treatment of peripartum cardiomyopathy.  Despite using CMR for assessment of LV thrombi, echo was used as the endpoint for volume and ejection fraction improvement over 6 months. The quality of the paper is undisputable but one wonders why CMR was not adopted as the method for evaluation of this improvement in light of the recent data on its clinical utility as a stricter endpoint? This is just one example of a very important paper relegating the use of CMR to a secondary position and not using it, in a rather simple design, with its full capabilities. There is definite a task for all the CMR community to provide for more education of clinical cardiologists in the role played by the method in many settings. (This is a personal position of the news editor on this paper and does not represent an official position of SCMR).

21/04/2010 - EuroCMR Registry: Lessons Learned

 

In a review paper by Bruder et al the authors summarize the main lessons learned from the pilot phase of the EuroCMR registry which studied over 11.000 patients in 20 German centers. The main lessons presented in the paper include: (1) CMR is mainly used for the work-up of heart failure, CAD and viability; (2) the procedure is both safe and provides excellent image quality; (3) it changed patient treatment in 45% of the cases with 16% new, unsuspected diagnosis; (4) it may allow for less orders of subsequent tests since 86% of the patients did not require any further studies.

 

The full link with free access to the manuscript can be found here.

The EuroCMR Registry homepage can be found in www.eurocmr-registry.com. The original manuscript with the results can be found at J Am Coll Cardiol. 2009 Oct 6;54(15):1457-66 with definitions of what is included in J Cardiovasc Magn Reson. 2009 Nov 5;11(1):43.

 

 

18/04/2010 - Functional Ischemia versus anatomy

On this topic, an older paper on the subject is a must read for anyone doing CAD imaging: Gould KL. JACC Cardiovasc Imaging. 2009;2:1009-23. A manuscript to be read and re-read as many times possible with concepts that seem to have been forgotten by most of the cardiology community over time.

 18/04/2010 - Ischemia, as real as it can get

A great portion of CMR exams are performed for the investigation of CAD. Despite improvements on perfusion sequences, there is still a lot of room for improvement/new techniques. The manuscript by Jahnke C et al (J Am Coll Cardiol Img 2010;3:375-84) with an editorial by Matthias Friedrich describes a high resolution 3D BOLD sequence on 3.0-T scanners that advances the field significantly. While the debate on anatomy versus functional  ischemia continues, CMR advances on the latter (more on the topic above).

 

11/04/2010 - Quantitative LGE analysis in HCM: a new approach

 

Quantitative analysis of LGE in non-ischemic cardiomyopathies has always been a challenge. In the last two SCMR scientific sessions, many talks were devoted to this subject without a clear definition of where to set the cut bar. A new proposal has been added by Giovanni Aquaro from Pisa, Italy, who used a Rayleigh distribution curve to define normal vs disease myocardial with more accuracy than either 2SD or 6SD cutoffs. The full PDF of this paper can be read here in JCMR.

 

05/04/2010

 

PIOPED III partially nags CMR for pulmonary embolism. The study found that reasonable accuracy could only be obtained in large experienced centers and in patients without access to other techniques. The conclusions were based on an overall sensitivity of only 57% and inadequate technique in 25% of patients. In patients who underwent appropriately done scans, the sensitivity rose to 78% with a specificity of 99%. So the problem seems to be not the method itself but in how it is performed. However, the negative message seems to have shadowed the other data in the manuscript. Ann Intern Med April 6, 2010 152:434-443

 

MARCH 2010

 

28/03/2010

Quantitatite flow analysis by CMR is a key application rather underutilized. However, the accuracy of these measures cannot be taken for granted and background correction for phase offsets should always be accounted for. In this multicenter study, Gatehouse et al found that this was not always the case in 12 scanners studied. Full text available in JCMR.

 

 

22/03/2010

CMR assessment of valve disease previous to surgery has become an important new role for the method. This has been the case in aortic valve disease (e.g. prognostic information based on LGE) but is certainly even more true in cases where the right ventricle is involved. This is acknowledged by Kim et al in cases of sever tricuspid regurgitation. Eur Heart J. 2010 Mar 16. [Epub ahead of print].

 

12/03/2010

Despite coronary imaging being in the CT ballpark for now, MR has still some tricks to teach. The use of isosorbide administred before the acquisition of coronary images has been investigated by Hu et al that showed that a 5mg dose should be chosen with an increase of 10% in SNR. A link to the abstract is provided here.

05/03/2010

Despite great advances in T2W imaging for CMR many limitations must still be considered regarding its qualitative evaluation. A new paper by Giri et al published in JCMR addresses some of these limitations and describes a new method to quantify myocardial T2 for the detection of myocardial edema. Read the full manuscript in JCMR.

FEBRUARY 2010

28/02/2010 - New and unique information that is clinically relevant provided by CMR is the best way to increase the usage of the method. Flynn et al published a manuscript showing that papillary muscle LGE may

guide the indication of mitral regurgitation surgery. This is a very practical issue and, if true, may recommend that CMR should be done previous to all similar cases of MR regurgitation. Link to the manuscript here.

20/02/2010 - CMR provides not only an accurate diagnosis of hypertrophic cardiomyopathy but also the unique finding of LGE with significant prognostic information. Rubinshtein R et al. Circ Heart Fail. 2010 Jan;3(1):51-8. Epub 2009 Oct 22.

15/02/2010 - The latest review manuscript in CMR for the general cardiologist by Dr. Dudley Pennell in Circulation - link here to the journal page.

07/02/2010 - In Education in Heart session of Heart Journal, a review by Dr. Beek and Dr. van Rossum review the use of CMR in acute myocardial settings.

Non-invasive imaging: Cardiovascular magnetic resonance imaging in patients with acute myocardial infarction. Aernout M Beek, Albert C van Rossum. Heart 2010;96:237-243. Link here

Manuscript highlight: The Year in Cardiac Imaging - a review of what happened in 2009 in cardiac imaging by Dr. Raymond J. Gibbons, Philip A. Araoz and Eric E. Williamson in JACC - Link here.

Manuscript highlight: How to use Isosorbide Dinitrate in MR Coronary Imaging (Hu et al. Radiology. 2010 Feb;254(2):401-9.) Link here. 

35 New articles from PubMed (Updated 23/01/2010).

SCMR attendence at preconferences up!
Videos from the presentations from Thursday are online for members here
Watch here for the latest information.

December 2009

New content (from homepage)
Advanced Cardiac Imaging for the Interventionalist.  10 talks (members only)
Mitral valve repair, percutaneous valves, MRI compatible pacemaker,  cardiac CT, CMR perfusion and more.
News: JACC article - German CMR registry shows cardiology transformed by CMR
Upgrade your scanner - disease specific sequences here (members only)
June 2009: JCMR impact factor increased to 2.15 from 1.87

The death of Dr Hanns-Joachim Weinmann, inventor Gd-DTPA as an MRI contrast material and author of the highest cited paper from AJR in 100 years is announced.  "He was a good friend to many of us.  Hundreds of MR physicians and MR researchers knew Hanns. Hanns helped so many in their MR careers. Our thoughs are with his wife and family at this time."

November 2009

AHA Sicentific sessions MRI abstracts 2009.
Cardiac MR Imaging I 
Cardiac MR Imaging II 
Cardiac MR Imaging III 
Cardiac MRI: 3T, Plaque and Pacemakers  
Cardiac MRI: Myocardial Delayed Enhancement 
Cardiac MRI: Prognosis and Risk

JACC article - German CMR registry shows cardiology transformed by CMR
Upgrade your scanner - disease specific sequences here (members only)
SCMR Latin American Newsletter
Important Upcoming Changes in Medicare Coverage/Coding for US CMR
SCMR 3rd quarter newsletter here
Mid year 2009 JCMR Presidents page from Chris Kramer.
SCMR 2009 standardized reporting guidelines and standardized protocols.

2009 abstracts available for download here.

Fat Collections Linked to Decreased Heart Function

ScienceDaily (Nov. 13, 2009) - Researchers from Boston University School of Medicine (BUSM) have shown that fat collection in different body locations, such as around the heart and the aorta and within the liver, are associated with certain decreased heart functions. The study, which appears online in Obesity, also found that measuring a person's body mass index (BMI) does not reliably predict the amount of undesired fat in and around these vital organs.

October 2009

Scanning technique can cut thalassaemia deaths by 70%, finds study

(UK) Times online.  Sufferers of one of the world's most common genetic disorders can have their risk of dying reduced dramatically with the use of a scanning technique developed by British scientists.
Seventy per cent of patients with thalassaemia, a blood disease involving defects in haemoglobin production that causes anaemia, currently die of heart failure.
Researchers at the Royal Brompton Hospital and Imperial College London have made a breakthrough in the monitoring of the disorder. A study of the scanning advance, which allows the identification of patients at risk of imminent heart failure, has been shown to cut mortality rates by 71 per cent.
Scientists told The Times that the same technology, which tracks the dangerous build-up of iron in the heart caused by regular blood transfusions, would help sufferers of other conditions reliant on transfusions, such as leukaemia. 
More here

 

September 2009

Imaging Modality Shows Great Promise in Heart FailureCardiovascular magnetic resonance imaging fast becoming the 'gold standard'  

WEDNESDAY, Sept. 30 (HealthDay News) Cardiovascular magnetic resonance (CMR) imaging is the new "gold standard imaging technique" for the assessment of heart anatomy, function and viability in heart failure patients, according to a report in the Oct. 6 issue of the Journal of the American College of Cardiology.
Theodoros D. Karamitsos, M.D., of John Radcliffe Hospital in Oxford, U.K., and colleagues reviewed the state-of-the-art in CMR and its role in stratifying disease severity in heart failure and contributing conditions. With the ability to image in any plane, CMR offers complete flexibility for evaluating cardiac and extra-cardiac anatomy. Using CMR with late gadolinium enhancement contrast agents has further expanded CMR's role. Another advantage is that CMR does not use ionizing radiation and has no known side effects.
The researchers note that one of CMR's strengths is the ability to assess the etiology of heart failure, making possible targeted management strategies. CMR can assess global left and right ventricular function and diastolic function, differentiate acute and chronic injury and complications in myocardial infarction, and distinguish many forms of cardiomyopathy underlying heart failure.
"It is anticipated that the application of CMR in the evaluation of patients with heart failure will expand substantially in the coming years. We predict that most patients with heart failure will eventually undergo CMR imaging as part of the diagnostic workup and to guide management and stratify risk," the authors write.
Abstract

 TCT: Silent Stroke Common in Percutaneous Valve Replacement
By Crystal Phend, Senior Staff Writer, MedPage Today
SAN FRANCISCO Percutaneous aortic valve replacement frequently causes cerebral lesions, although typically without functional or neurologic consequences, researchers found.
New lesions appeared on brain MRI in at least 80% of patients treated with either brand of percutaneous device developed for this procedure but in only 48% of those who got the traditional open heart valve surgery, according to Philipp Kahlert, MD, of University Duisburg-Essen and the West German Heart Center in Essen, Germany, and colleagues.
But there were no changes in National Institute of Health Stroke Scale, Mini Mental State Examination, or Modified Rankin Scale scores in the immediate postprocedural period or at three months, they said here at the Transcatheter Cardiovascular Therapeutics meeting.
Emboli created by percutaneous valve implantation have been very much a concern, commented Alain Cribier, MD, of Hôpital Charles Nicolle at the University of Rouen, France, and a pioneer in designing the devices...
...Each step in the percutaneous replacement provides opportunities for thrombus formation, yielding periprocedural stroke rates of 2.9% to 10%, Kahlert said. His group suspected that more clinically-silent cases were occurring, so they conducted clinical and neurological exams and diffusion-weighted MRI on 32 consecutive eligible patients and repeated the battery of tests three months after the procedure as well. All the operative procedures to replace the valve were deemed successful. But MRI showed new lesions in 86% of the 10 patients who received a balloon-expandable prosthesis (Edwards-SAPIEN) and 80% of the 22 who got a self-expanding prosthesis (Medtronic CoreValve). Compared with a rate of 48% in historical controls undergoing open surgical valve replacement at the same center, the rate with transcatheter aortic valve implantation was significantly higher (P=0.016). Time to postprocedural MRI was similar among these groups, although lesion size was smaller in the percutaneous procedure groups (average 81 and 61 versus 224 mm3, P<0.001). Because "these foci were not associated with apparent neurological events or measurable deterioration of neurocognitive function during three-month follow-up," further study is needed to determine their clinical significance and origin, Kahlert concluded.
More here

Why CMR needs outcome data..
The Machine That's Bankrupting America
The $2 million MRI scanner and what's wrong with U.S. health care.
By Mark Gimein Posted Monday, September 21, 2009 - 7:10am

A keystone conflict in the current health care debate centers around the idea of "rationing." Opponents of a government-run insurance program talk darkly of rationing health care, with the government refusing procedures because of their cost. Supporters answer that health care is already effectively rationed by a market that ensures that many people will not be able to afford the care they need. The assumption on both sides, though, is that however we choose to "ration" it, we want all the care we can afford. We shouldn't.
In the United States we spend roughly 16 percent of our national income on health care; almost every other industrialized country gets by with less than 11 percent, for equally good (and usually better) care. What's really striking about this gap is that most of the obvious explanations simply do not begin to account for it. American health care workers get paid a lot, but as New York Times economics writer Catherine Rampell shows, we're in the same ballpark, when it comes to medical pay, as Australia or the Netherlands. We rely more on specialists than, say, Canada or France, but no more so than many other countries.
Notably, while we pay more for health care than countries with national health insurance, the situation is really no different in countries with private insurance systems. The Netherlands also relies mainly on private health insurers, and its health care spending still comes in at 9.8 percent of national income. It's not how you pay for health care that matters most here: It's what you pay for.
One of the main reasons we now have a crisis in health insurance is that we have a crisis in health care costs that has been (as the Times' Rampell beautifully charts) 30-plus years in the making. The proliferation of MRI scanners is an easy-to-quantify and telling example of the bigger trend. Doctors and hospitals turn ever more readily to the latest equipment and technology, performing more procedures at greater cost without a corresponding improvement in care. Patients come to expect to be subjected to a growing battery of tests and operations. And instead of welcoming ideas about how to reverse this cycle, Americans worry about rationing.
Supporters of every variation of health care reform hope that their preferred solution-an unregulated market for health insurance, a government-run program along the lines of Medicare, and everything in between-will not only make care more equitably available, but will rein in the cost. All the proposals focus on how to get folks insured, without ever really grappling with the basic question of why the United States spends 60 percent more on health care then everyone else.
So it is that both patients and policy makers remain locked in the thinking that more expensive care is better, when our experience often shows the opposite to be the case. We pride ourselves on having more and better equipment than anyone in the rest of the world, and carefully avoid asking whether it is worth what we pay for it, or even if it is doing us any good in the first place.

August 2009

JACC paper - Early Data Show Clinical Value of Cardiac MR Imaging

See EuroCMR presentation on the study

TCT press release. CMR represents a safe, noninvasive modality that frequently helps guide patient management, according to early findings from a multicenter registry published online August 12, 2009, ahead of print in the Journal of the American College of Cardiology.

Investigators led by Oliver Bruder, MD, of Elisabeth Hospital (Essen, Germany) and Heiko Mahrholdt, MD, of Robert Bosch Medical Center (Stuttgart, Germany), looked at how CMR imaging was utilized in 11,040 consecutive patients enrolled in the pilot phase of the EuroCMR (European Cardiovascular Magnetic Resonance) registry at 20 participating sites between April 2007 and January 2009. The researchers assessed the indications for CMR as well as its procedural safety, image quality, and clinical value in a routine setting.

The main indications for cardiovascular MR were as a workup for myocarditis and cardiomyopathies (31.9%), risk stratification in patients with suspected CAD/ischemia (30.8%), and assessment of myocardial viability (14.7%).

In more than 90% of patients, image quality was rated as good, which means CMR answered all the questions for which the imaging was ordered. In 8.1% of patients, image quality was graded as moderate, although still considered diagnostic. Image quality did not vary by gender or race. It did decline with age, although paradoxically the therapeutic consequences remained high, perhaps because older patients carried more comorbidities.

CMR demonstrated clinical usefulness in two-thirds of all patients, directly impacting management, for example, by leading to an unsuspected new diagnosis (16.4%), suggesting a different medication (23.5%), or indicating an intervention (8.7%).

In 23.1% of patients, CMR was the first imaging modality ordered, and 80% of the time no further noninvasive imaging was required. Specifically, in patients undergoing CMR stress testing for workup of suspected CAD, analysis showed that almost half of patients could avoid invasive angiography, while use of noninvasive procedures involving ionizing radiation could be substantially reduced (table 1).

Table 1. Additional Diagnostic Procedures Avoided Due to CMR

	Stress Test (n = 3,351)	P Value
Invasive Angiography	45%	<0.0001
Nuclear (SPECT/CT)	18.2%	<0.0001
Coronary CT	2.2%	0.32

 

 "Our data demonstrate that CMR was capable of answering the relevant clinical questions in more than 98% of cases. This indicates that current CMR utilization yields a high number of valuable studies," the authors write. "Importantly, this was shown in a clinical routine setting, since patients with dyspnea at rest, atrial fibrillation, obesity... or other frequent cardiac conditions affecting image quality were not excluded."

 US Lags Behind Europe in Documenting CMR's Value

In a telephone interview with TCTMD, Steven D. Wolff, MD, PhD, of Advanced Cardiovascular Imaging (New York, NY), said CMR registries like this are important because they not only "show the value of cardiac MR in real bread-and-butter cardiology" but also in the future will provide the efficacy and cost-effectiveness data needed to justify use of relatively new imaging modalities like CMR. "Unfortunately, the US lags behind Europe in this regard," he said, noting that no such registries exist in this country.

Because many physicians in the US are not familiar with CMR's diagnostic strong points, Dr. Wolff said, the technology is underutilized here. Most cardiology patients today routinely receive 2 or 3 imaging modalities, yet for the proper indications "our experience is that when patients get an MRI, it's pretty definitive-it doesn't lead to a lot of other imaging tests or invasive procedures," he observed.

Another difference compared with Europe is that in the US, less stress testing is performed, Dr. Wolff said. Overall, however, there are a number of areas where CMR imaging is attracting the attention of interventional cardiologists, such as in assessing obstructive coronary disease and the viability and function of myocardial tissue. And as interventionalists move into the field of valve repair and replacement, they will also appreciate its ability to evaluate and quantify valvular disease, he suggested.

For the time being, Europe remains at the forefront of adopting CMR, Dr. Wolff reiterated, noting that many of the sites enrolled in the EuroCMR registry are cardiology centers, whereas in the US most MR scanners are owned by radiologists. One possible explanation for the difference is that "in the US, cardiologists are often tied to their current imaging modalities, such as nuclear perfusion, echo, and cath, while radiologists have the equipment but not necessarily the training and experience [in cardiology]," he commented. "Cardiac MR is one of those technologies that can change the way medicine is practiced, but the problem is that it is falling between 2 specialties."

Study Details

Fully 88% of patients received a gadolinium-based contrast agent during the imaging procedure, with a median contrast dose of 1.28 mmol/kg (1.16-1.56 mmol/kg) bodyweight. The vast majority of MR procedures were performed without complications. Mild complications, which occurred in 1.1% of patients (n = 124), were associated with butamine or adenosine infusion during stress testing, and included dyspnea, chest pain, and extra systoles. All 5 severe complications were related to stress testing; there were no deaths. Moreover, the safety of the procedure did not depend on age, gender, or race.

Source: Bruder O, Schneider S, Nothnagel D, et al. EuroCMR (European Cardiovascular Magnetic Resonance) registry. J Am Coll Cardiol. 2009;Epub ahead of print.

 

Cardiosource CMR: ICDs and PPMs and MRI:

Upon completion of this module, the user should:

• Understand the magnitude of the problem and possible hazards of magnetic resonance imaging scanning of patients with pacemakers and implantable cardioverter defibrillators.
• Understand the possible options to reduce the risk and what is needed for a safe scan.

Contains useful data (eg number of MRI scans, CMR images with ICD etc) 

June 2009

Pumped for marathon - CMR study

Dr. Davinder Jassal has a message for those out there slaving away on the treadmill or pounding the pavement in preparation for the Manitoba Marathon next month: your heart is in the right place.
A study on marathons and the impact they have on the heart shows that while running the 26.2-mile distance does cause a short-term cardiac injury, it does not result in permanent heart muscle damage.
"Marathons are not dangerous as long as you train appropriately," Jassal, a cardiologist at St. Boniface General Hospital, said Friday.
Funded by the St. Boniface Hospital and Research Foundation, the study took 14 runners who participated in the 2008 Manitoba Marathon, ranging in age from 18 to 45 years old.
All participants were in good health and considered amateur runners, involved in moderate to heavy training schedules.
Jassal said researchers knew some of the characteristics of a marathoner's heart before the 2008 study.
Images of the heart through ultrasounds and results of elevated blood biomarker chemicals initial signs of cardiac stress were already available following a 2006 Boston Marathon study.
For this latest study, researchers added a more detailed look at the heart to the investigation with a cardiac MRI scan immediately following the race the first time researchers have used advanced cardiac imaging for a study like this.
"The MRI can actually tell you if there is true damage to the heart," Jassal said.
One of the unique things found was how large the heart grows post-marathon. In all cases, the right side of the heart responsible for delivering blood to the lungs doubled in size. Jassal found that while all participants had noticeable stress, all came back with healthy, normal functioning hearts when scanned a week later.
Jennifer Goldenberg, a first-time marathon runner in 2008, felt some anxiety participating in the study but was pleased to hear the results.
"When I got to the hospital after the race, I was interested to see that my heart rate was still very high," the 33-year-old said. "It's unsettling to hear that your heart isn't functioning properly, so it's a relief to know that one week later that it was back to normal."
The study will focus on half-marathon runners this year and will then look at multiple full marathon runners in 2010, searching for any long-term heart conditions associated with running.

June 2009: JCMR impact factor increased to 2.15 from 1.87

May 2009

CALL FOR RESEARCHERS: Determining the Risks of MRI in the Presence of Pacemakers and ICDs
The MagnaSafe multicentre Registry registry study, details here

Latest Pacing and MRI news: 
No complications, no overheating with MRI-compatible pacemaker/leads. Report from Heart Rhythm Society 2009

April 2009

Silent Heart attacks more common than previously thought.
CNN article on Duke University CMR article.  Full text here
Story Highlights Silent heart attacks affect nearly 200,000 people in the United States annually.
Researchers studied 185 people at risk of coronary artery disease
Treatment for "silent" heart attacks is similar to that for regular attacks
More research is necessary to determine whether screening is useful.

January 2009

FIRE trial legacy: Cardiac MRI best to assess reperfusion agents
Read about the first multicenter trial of a therapeutic reperfusion agent that uses cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE) to quantify the primary end point. "This technique allows the direct quantification of myocardial salvage, which is a better indicator of therapeutic efficacy in MI trials, given the strong influences of collateral flow and area on final infarct size. Furthermore, serial imaging to assess changes in T2 region, MVO, necrotic core, and total infarct size could be quite powerful to better understand the pathophysiology and document the extent and time course of human reperfusion injury," she stresses. CMR-LGE will be a prerequisite for future trials

January 2009

Ionizing radiation in cardiac imaging. Ionizing Radiation in Cardiac Imaging.
A Science Advisory From the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention

November 2008

Medtronic Receives European Approval for World's First Pacing System Designed, Tested and Approved for MRI. 'EnRhythm MRI SureScan Pacemaker System Now Commercially Available in Europe'

October 2008

Want to understand CMR from a patients perspective? See this. 'My wild ride in the cardiac MRI'

September 2008

See all ESC 2008 CMR abstracts
3 pages of CMR abstract titles

A Revolution in non-invasive cardiac imaging ESC talk
As a result of the very rapid development in imaging techniques over the past few years, it seems likely that non-invasive imaging will gain more importance in clinical cardiology. It is also likely that in the following years new, more accurate diagnostic tests will become available and revolutionise the diagnostics of cardiac diseases.
Topics: Non-invasive imaging: Echocardiography, MR/CT, Nuclear

New Pacemaker System Safe for Use With MRI: Presented at ESC
MUNICH, Germany September 1, 2008 A new pacemaker system designed for use with magnetic resonance imaging (MRI) is both efficacious and safe for patients with pacemaker implants, according to the results of an international, prospective, nonblinded, randomised, controlled trial. Article here

August 2008

Cardiac MR can screen for ACS in the emergency room
Harvard researchers say
Abstract: Cury RC et al. CMR with T2-weighted imaging improves detection of patients with ACS in the emergency department. Circulation 2008.

July 2008

CMR detects the protective effects of cyclosporine in acute MI reperfusion
NEJM paper

Cardiovascular MR stress testing can detect CAD in women
Cardiovascular magnetic resonance (CMR) stress perfusion testing is of great utility in the detection of coronary artery disease (CAD) in women, says JACC imaging

Systemic right ventricle: from the physiopathology to treatment
Le ventricule droit systémique : de la physiopathologie au traitement Author(s) : Magalie Ladouceur, Laurence Iserin, Mourad Bensalah, Marc Sirol, Younes Boudjemline, Antonio Fereira, Elie Mousseaux
Summary : The right ventricle in sub-aortic position called “systemic” is an anatomical feature that is found mainly in two types of heart defect: transposition of the great arteries operated by atrial switch, which is to direct the venous return to the contralateral atrioventricular valve and ventricle, and corrected transposition of the great arteries. The right ventricle is then exposed to systemic afterload and adapts initially by myocardial hypertrophy. But in over half of cases, it progresses to a dilation and irreversible heart failure. The mechanisms that lead to this evolution are still poorly understood and it is difficult to identify patients at risk for heart failure. After describing the heart disease and its evolution, the authors describe the failure mechanisms of systemic right ventricle proposed in the literature. Finally, the authors describe the two techniques currently used to study systemic right ventricular function, which are echocardiography and cardiac MRI. Sang Thrombose Vaisseaux
This article is in French Full text and English resume present.

"All-stars" convene to discuss CV imaging research priorities.
Bethesda, MD - Leading clinicians, trialists, and scientists have wrapped up a two-day meeting in Bethesda, MD, convened to figure out what clinical trials are needed to establish a role for emerging cardiovascular imaging modalities. The National Institute of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI), which hosted the meeting, hopes the ideas generated will help them prioritize the NIH research agenda. "One of the big questions that are being asked right now by many people outside of cardiology—by policy-makers, by payers, by people in other areas of medicine—is: what is the value of CV imaging?" Dr Michael Lauer, one of the NIH leads for the meeting, told heartwire. "There has been a dramatic increase in the utilization of imaging over the past 10 to 15 years, but we don't know to what extent CV imaging results in improvement in patient outcomes. The reason we went into medicine was because we wanted to help people, and therefore everything we do in medicine should be because we want to help people, because we want to make a difference. The imaging technology today is amazing, it's amazing how quickly it's advanced, yet we haven't answered the fundamental question of whether we're actually helping people by doing this." Heartwire

June 2008
Cardiac magnetic resonance may predict adverse events after MI
Source: Medicexchange, Author: Paola Accalai. Date: 09 June 2008 CMR may allow physicians to discern which patients are at highest risk for complications following MI, according to US researchers [1]. The technique allows for differentiation between viable and nonviable myocardial tissue to evaluate infarct size. The study group looked at CMR images from 122 patients who had had an STEMI followed by PCI. The findings showed a correlation between the size of the acute infarct and the initial end-systolic and end-diastolic volume indices and ejection fraction. Over two years of follow-up, the researchers reported one death, one recurrent MI and 14 admissions with heart failure. The acute infarct size was significantly greater in all these patients, and was the strongest predictor of major cardiac events after multivariate analysis. Using a cut-off infarct size of 18.5 per cent gave a sensitivity of 88 per cent and a negative predictive value of 96 per cent for adverse clinical events. The authors concluded: "The negative predictive value [of infarct size] for both predicting which patients following STEMI will not develop [major cardiac events] or adverse LV remodelling were both high at over 90 per cent." They added: "This high negative predictive value would suggest that quantifying the amount of infarcted myocardium can be a good negative screening test in patients. Therefore, CMR can prospectively discern which patients warrant close monitoring." [1] Infarct size by contrast enhanced cardiac magnetic resonance is a stronger predictor of outcomes than LV EFor ESV index: prospective cohort study Heart 2008;94:730-736
Press article here

May 2008

2nd Latin American Chapter Meeting
The second SCMR Latin American Chapter Meeting took place in Buenos Aires in May 20th, 2008. This year we had 32 specialists coming from Brazil, Mexico, Argentina, Uruguay and England. The four hours meeting was very ambitious and succesfull, and allowed everyone to see the cummulated experience in various important centers practicing CMR in Latinamerica. There was a lot of enthusiasm and hope for having the 3rd meeting next year. We were pleased to invite Dr. James Moon, from London who had active participation in discussion and in recording the lectures, online here. (6 talks in either Spanish or Portugese). After the talks, the group discussed future projects towards a better integration of Latin American countries involve in CMR and submitted a project of a multicenter trial related with normalized ventricular function in our countries. It was also agreed to continue the publication of its newsletter with increased participation of everyone, and to determine the place and date of the next meeting.

MRI staff to be examined for cancer risk Health Protection Agency will set up a working group to investigate the long-term effects on those who operate MRI scanners.

St. Jude Medical Announces Start of Landmark DETERMINE ICD Study 1550 patients to be enrolled, all with CMR

ONTARGET CMR Substudy Shows No Benefits for Combination Therapy for Prevention of Vascular Events in High-Risk Patients: Presented at ASH(HYP)

Philips releases new version of Xcelera cardiology system

March 2008

Yale certified in CMR.  Here
NIH laptop containing medical data on cardiac MRI study of nearly 2,500 patients was stolen.  Here
Integrated PET-MRI Scanner Developed Here

February 2008

Good debate about CT ionising radiation from the NEJM. Here

January 2008

2008 SCMR Award Ceremony Photos

Anaesthesia system launched that is safe for MRI. details here.

December 2007

Horizon scanning by the NHS: the likely future roles of CMR.

Two reports: Viability and perfusion.

December 2007

New guidelines on the safety of MRI in patients with cardiovascular devices published in circulation.

For full text, see here (endorsed by SCMR)

November 2007

Generic gd contrast agent launched in Europe for cardiac MRI

MAGNEGITA(R) 500 (mu)mol/ml (Gadopentetate Dimeglumine) is about to be introduced for MRI in 22 European countries

See DettaglioNews

RSNA 2007

See the draft cardiac program

November 2007

AHA cardiac MR abstracts. 

Click on the links below to see all the abstracts in full.

cardiac MRI

Cardiac MR in Diagnosis and Prognosis

Clinical cardaic MRI

Young investigator award

New developments in cardiac MRI

November 2007

Newborns with congenital heart disease have abnormal braind development.  NEJM paper. 

November 2007

Orlando, AHA.  The Sanofi-aventis comprehensive program evaluating the acute and long-term effects of insulin glargine on cardiovascular outcomes will be using cardiac MRI in the INTENSIVE study. As part of this broad effort, the INTENSIVE (Intensive Insulin Therapy and Size of Infarct as a Validated Endpoint by Cardiac MRI) trial will use magnetic resonance imaging to compare the effects of tight glycemic control using insulin glargine and insulin glulisine to usual care on cardiac function (infarction size) in patients with ST-Elevation MI. Results are anticipated in 2009..

November 2007

Major tagging MRI study presented at AHA

aging and its effects on cardiac function were explored by the researchers led by Joao Lima, Johns Hopkins

Novenber 2007

Pacemakers safe for MRI under certain conditions

See here  (also the members only ongoing trials list here)

October 31st 2007

Siemens announce a new 3T magnet. CNN story.

Siemens story  Siemens press release

 

September 2007

Nephrogenic Systemic Fibrosis Predicts Early Mortality in Patients Receiving Hemodialysis  CME

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
Release Date: September 27, 2007; 
September 27, 2007 — In patients receiving hemodialysis, nephrogenic systemic fibrosis (NSF) is a predictor of early mortality, and exposure to gadolinium-containing contrast material is a significant risk factor for development of NSF, according to the results of a study published in the October issue of Arthritis & Rheumatism.

"NSF is a rapidly progressive, debilitating condition that causes cutaneous and visceral fibrosis in patients with renal failure," write Derrick J. Todd, MD, PhD, from the Massachusetts General Hospital in Boston, and colleagues. "Little is known about its prevalence or etiology."

At 6 outpatient centers in the Boston area, 186 patients treated with dialysis underwent a simple 3-part skin examination to detect the 3 skin changes associated with NSF: hyperpigmentation, hardening, and tethering of the skin on the extremities. Positive examination for NSF was defined as having at least 2 of these 3 findings. Mortality was followed for 2 years after the skin examination. Using electronic medical records, the investigators identified patients who had undergone scans with gadolinium-containing contrast agents, as well as the dates of exposure to these agents.

Of 186 patients, 25 (13%) had cutaneous changes consistent with NSF. Within 2 years of the skin examination, 45 (24%) patients died. Mortality rate was 48% for those with NSF vs 20% for those with a negative cutaneous examination (adjusted hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4 - 5.9). Increased risk for death in patients with skin changes of NSF occurred primarily within the first 6 months after the skin examination, suggesting an increased risk for early mortality.

In the subgroup of 90 patients for whom electronic records were available, 54 had been exposed to gadopentetate dimeglumine contrast during imaging studies, and 16 (30%) of these developed cutaneous changes of NSF. In contrast, only 1% of the 36 patients who had not been exposed to gadolinium developed NSF. Compared with patients who had not been exposed to gadolinium, those with such exposure were almost 15 times as likely to develop cutaneous changes of NSF (odds ratio [OR], 14.7; 95% CI, 1.9 - 117.0).

Because NSF is a recently reported condition, only 5 patients had skin biopsies. For each of these patients, the results of the biopsies confirmed the diagnosis of NSF.

"The paucity of available skin biopsy specimens highlights that NSF is likely underrecognized by many practicing physicians," the study authors write. "The identification of larger numbers of patients with NSF will allow further investigations into the pathogenesis, treatment, and prevention of this recently described debilitating, and potentially fatal, condition."

In an accompanying editorial, Shawn E. Cowper, MD, from Yale University School of Medicine in New Haven, Connecticut, and colleagues note that reported cases of NSF have prompted a Public Health Advisory urging caution when using magnetic resonance imaging scans for patients with renal disease, as well as prompt dialysis in those who have undergone gadolinium-enhanced imaging procedures.

The early cutaneous changes reported in this study suggest that such changes may occur more frequently than was previously believed. These changes may reflect an early or less severe form of NSF. Unanswered questions about the cause and pathogenesis of NSF include why some patients exposed to gadolinium develop the disease, whereas others do not. Studying the response of cells to gadolinium exposure may help resolve these issues.

"Such information also could facilitate the development of MR [magnetic resonance] contrast agents that have a less toxic response profile, and preserve the high clinical utility of contrast-enhanced MR as an imaging modality in patients with renal insufficiency," Dr. Cowper and colleagues write.

Arthritis Rheum. 2007;56:3173-3175, 3433-3441.

September 2007

Dipyridamole stress cardiovascular MRI predicts CAD outcomes

Source: Reuters; Author: Will Boggs, MD
Date: Thu, 11 October 2007 Dipyridamole stress cardiovascular magnetic resonance imaging (CMR) is useful for predicting major coronary events in patients with known or suspected coronary artery disease (CAD), according to a report in the September 18th issue of the Journal of the American College of Cardiology.
"Taking into account its high accuracy and reliability, the fact that it is less dependent on operator's expertise than other imaging techniques, and the possibility of simultaneously assessing a wide variety of indexes, stress CMR is becoming a gold standard in the evaluation of patients with known or suspected ischemic heart disease," Dr. Vicente Bodi from the University of Valencia, Spain told Reuters Health.
Dr. Bodi and colleagues investigated the prognostic value of dipyridamole stress CMR in 420 consecutive patients with chest pain of possible coronary origin.
All CMR indexes predicted major adverse coronary events (MACE), the authors report, but only the extent of abnormal wall motion (AWM) with dipyridamole was independently related to MACE in the multivariate analysis.
Patients who experienced major events had a larger extent of AWM at rest and with dipyridamole, a greater perfusion deficit, and delayed enhancement, compared with patients who did not have major events.
Results were similar when only the non-revascularized patients were studied.
"We believe that stress CMR is a very good option in those patients in whom more traditional and available techniques, such as exercise ECG, are inconclusive," Dr. Bodi said. "Currently this population represents up to 50 per cent of patients with chest pain."

Pubmed abstract here

September 2007

JCMR - new publishing arangements

JCMR is moving to open access - read here

11th September 2007

Latin American Chapter Meeting:

The first SCMR Latin American Chapter Meeting took place in Sao Paulo in September 7th 2007. With the participation of over 30 specialists from Brazil, Mexico, Argentina and United States the meeting was a success and the first of many steps in increasing the participation of Latin America in CMR. The meeting was honored be the presentation of our two invited speakers: Dr. Erasmo de La Pena-Almaguer from Mexico spoke about CMR at 3 Tesla and Dr. Gerald Pohost lectured about New Insights in CMR. After the talks, the group discussed future projects towards a better integration of all Latin American countries in CMR and the result of a recent poll among LAC CMR users was presented. There was a unanimous decision that the chapter should pursue the constant publication of its newsletter, a special meeting coinciding with the official SCMR Scientific Meeting and another one in conjunction with one of the national meetings of the countries it represents. The members present in the meeting also advised the creation of a Latin American registry of CMR exams. After the reunion the group continued to share their thoughts in a delightful dinner looking forward for their next assembly.   

Some interesting CMR review articles from the India Journal of Radiology and Imaging:

Guest Editorial: Cardiac magnetic resonance: From protons to the pulsating heart	p. 84
Gulati Gurpreet S
[ABSTRACT]  [FULL TEXT]  [PDF]
Cardiovascular MRI applications in congenital heart disease	p. 86
Nielsen James C, Powell Andrew J
[ABSTRACT]  [FULL TEXT]  [PDF]
MRI in Ischemic heart disease: From coronaries to myocardium	p. 98
Manna Alessio La, Sutaria Nilesh, Prasad Sanjay K
[ABSTRACT]  [FULL TEXT]  [PDF]
Cardiac magnetic resonance in the assessment of cardiomyopathies	p. 109
Jagia Priya, Gulati Gurpreet S, Sharma Sanjiv
[ABSTRACT]  [FULL TEXT]  [PDF]
Assessment of valvular heart disease with cardiovascular magnetic resonance	p. 120
Gelfand Eli V, Manning Warren J
[ABSTRACT]  [FULL TEXT]  [PDF]
Cardiovascular magnetic resonance for pericardial disease	p. 133
Westwood Mark A, Moon James C
[ABSTRACT]  [FULL TEXT]  [PDF]

Gadolinium-containing MRI Contrast Agents for MRI.

Saftey resources. FDA warning MHRA warning (UK) Omniscan statement Clin Rad article JAMA article Latest UK/European advice (27/6/2007) full text review article from IJRI

Cost containment measures in US CVD imaging

- see streamed 'Insider view presentation' here.

SCMR atlas - further update: movies
Movies here. Introduction here. still atlas here. Old atlas here.

SCMR 2007 meeting– summary

The 10th SCMR meeting this year in Rome served to document the continued growth in CMR.  There were 885 attendees, 10% more than 2006.  Abstract submissions were 18% higher than ever before (546), and 139 invited speakers contributed to the scientific program.  In addition, an introductory physicians’ CMR course, pre-conference workshops on basic and experimental research in CMR and the technologists workshop contributed a solid and practical educational core to the program.  See the award winners and young investigator prize photos below.

2007 SCMR Award Ceremony Photos

MRI Scans to Be Made Safe for Pacemakers

2006 SCMR Annual Scientific Session Photos - Board Members and Award Ceremony

Food and Drug Administration (FDA) Public Health Notification: MRI-Caused Injuries in Patients with Implanted Neurological Stimulators

2005 SCMR Award Winners for Best Abstract

Boston Scientific stent gets new directions
April 5, 2005
Boston Scientific Corp. said Tuesday that the Food and Drug Administration approved new directions for its Taxus Express2 drug-coated coronary stent, allowing doctors to perform magnetic resonance imaging on a patient soon after receiving the device. Its shares rose nearly 3 percent. To see this recommendation, click here.

SCMR 2003 and 2002 Scientific Session DVDs are available for purchase through Educational Symposia, Inc.

35th Bethesda Conference — Cardiology's Workforce Crisis: A Pragmatic Approach

A survey in Germany performed by the working groups of CMR in the German Radiology and Cardiology Societies revealed that about 20000 clinical CMR studies are performed per year in Germany. As Matthias Friedrich pointed out in a small report, each group, Radiologists and Cardiologists, takes care of 50% (10000 studies). In more than 20 centers, the technique has become part of the clinical routine setting.

CMR within 8 weeks after coronary artery stenting is safe
A recent trial confirmed the saftey of coronary stents in 1.5T CMR systems. A group from Jacksonville, FL examined the cardiac adverse events rates of 111 patients who underwent mri within 8 weeks of coronary artery stenting. There were three repeat revascularizations within 30-day follow-up. No other cardiac adverse events were observed. The authors conclude that (i) CMR within 8 weeks after coronary artery stenting is safe, and (ii) that postponing CMR after coronary stenting is not necessary.

MR Laboratories Accredited by ICAMRL

SCMR Upcoming Meetings: SCMR Eleventh Annual Scientific Sessions will take place February 1-3, 2008 in Los Angeles, California. SCMR Twelfth Annual Scientific Sessions will take place January 29 - February 2, 2009 in Orlando, Florida.

JCMR Online: Issues of JCMR from 2001 to the present are now available online in full-text, digital versions. All individual subscriptions now include both the printed journal and online access to the digital version of JCMR. Look for details regarding this important new membership service in the journal and in SCMR News!

"Guidelines for Credentialing in Cardiovascular Magnetic Resonance" developed by the Clinical Practice Committee of the Society of Cardiovascular Magnetic Resonance (SCMR) and approved by the SCMR Board of Trustees is now available online.

JCMR^® Recognized by ISI – The Society's Journal of Cardiovascular Magnetic Resonance^® published by Informa Healthcare is now recognized by the ISI (the Institute for Scientific Information). ISI maintains the most comprehensive, multidisciplinary, bibliographic database of research information in the world. By being recognized by the ISI, the material published in the Journal will now be cited and the original research papers, reviews, editorials, etc will be counted in the citation index. It usually takes two years or more to be listed by the ISI. JCMR^® took a little over one year. This recognition gives JCMR^® the prestige that parallels that of our Society.

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DECEMBER 2010

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