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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
01/09/2010 - ASCI 2010 appropiateness 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).
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.
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
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EUROCMR 2010 Florence - online for members
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.
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
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.
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.
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."
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.
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
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.
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 |
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.
Contains useful data (eg number of MRI scans, CMR images with ICD etc)
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
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
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.
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
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
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'
Want to understand CMR from a patients perspective? See this. 'My wild ride in the cardiac MRI'
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
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.
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
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
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
Good debate about CT ionising radiation from the NEJM. Here
Anaesthesia system launched that is safe for MRI. details here.
Horizon scanning by the NHS: the likely future roles of CMR.
Two reports: Viability and perfusion.
New guidelines on the safety of MRI in patients with cardiovascular devices published in circulation.
For full text, see here (endorsed by SCMR)
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
AHA cardiac MR abstracts.
Click on the links below to see all the abstracts in full.
Cardiac MR in Diagnosis and Prognosis
New developments in cardiac MRI
Newborns with congenital heart disease have abnormal braind development. NEJM paper.
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..
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
Pacemakers safe for MRI under certain conditions
See here (also the members only ongoing trials list here)
Siemens announce a new 3T magnet. CNN story.
Siemens story Siemens press release
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
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.
MRI Scans to Be Made Safe for Pacemakers
2006 SCMR Annual Scientific Session Photos - Board Members and Award Ceremony
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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