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a) SCMR official document standardized acquisition guidelines – relevant extract
b) SCMR official document reporting recommendations – relevant extract
As described in the non-imaging findings component of the reported list above, parameters such as vital signs, medications, and contrast agent administration should be reported.The SCMR recommends the reporting of LV myocardial information in the format of a 17-segment model through the use of a chart, table, or bipolar maps (so called “Bullseye” plot)
Existing literature regarding the prognostic significance of qualitative perfusion defects is unavailable at this time; nevertheless, SCMR suggests that perfusion in each of the 17 segments (Figure 1) be defined according to the transmurality, and persistence of the defect. The committee recommends that stress induced (vasodilator or inotropic) perfusion defects be compared with co-registered rest perfusion or late enhancement segments in order to identify ischemic, infarcted, or non-ischemic areas. The SCMR also recognizes that observed defects may be characterized as artifacts. These should be described.
c) Standardized web based images
Perfusion case full dataset
Case notes: Case from the Heart Hospital, London. Here, stress has been done first with the LV volumes module between stress and rest perfusion. There are extensive stress induced perfusion defects (series_12_1-3) not present at rest (series_23_1-3). There is a small circumflex subendocardial infarct (seen series_30)
d) Case of the Week example(s)
Number 10-17: Clinical role of perfusion CMR *** CASE WINNER
History: **best case of the week in 2011. A patient with chest pain had echocardiography suspicious for HCM - CMR resolved the true diagnosis of multivessel CAD.
Number 10-08: Perfusion Abnormalities in Cardiac Amyloidosis
History: A 68 year-old hypertensive male patient presented with typical chest pain. The ECG showed new characteristic ischemic changes and troponin dosage was positive. An urgent coronary angiogram revealed unobstructed epicardial coronary arteries. The echo showed a significant degree of septal wall thickening, out of proportion with his well-controlled blood pressure profile, suggesting possible hypertrophic cardiomyopathy.
Number 07-06: Microvascular Obstruction by CMR
History: A 41 year-old man admitted with 3 hours of chest pain with initial thrombolysis (tenecteplase) and salvage angioplasty one hour later.
Number 08-05: Acute MI, normal coronaries
History: A 44 yr old lady transferred for primary PCI for chest pain with lateral ST elevation. Troponin I 26, CK 1233. Normal lipids (TC:HDL 3.17). Only risk factor for IHD was hypertension: non-smoker.
e) Expert opinion – ‘How we do’
"How we do Perfusion CMR" (Robert Manka, Rolf Gebker, Eike Nagel)
f) Relevant Online Talks
Free talks CMR Myocardial perfusion in ischaemic heart disease
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By Juerg Schwitter
Recorded at Advanced Cardiac Imaging Course for the Interventional Cardiologist, 2008, London
By Juerg Shwitter
Recorded at EuroCMR 2008
By Sven Plein
Recorded at EuroCMR 2008
Members only talks - general
Members only talks - cutting edge
CMR Myocardial perfusion in ischaemic heart disease
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g) Useful Documents for a CMR service
DOBUTAMINE & ADENOSINE ADMINISTRATION FOR STRESS MRI from Southampton General Hospital, Uk
h) Relevant papers (starting point):
Bodi V, Sanchis J, Lopez-Lereu MP et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007;50:1174-9
Pilz G, Jeske A, Klos M, Ali E, Hoefling B, Scheck R, Bernhardt P. Prognostic value of normal adenosine-stress cardiac magnetic resonance imaging. Am J Cardiol. 2008 15;101:1408-12
Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, Dill T, Larsson HB, Flamm SD, Marquardt M, Johansson L. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial.Eur Heart J. 2008 Feb;29(4):480-9.
Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art
Bernhard L Gerber, Subha V Raman, Krishna Nayak, Frederick H Epstein, Pedro Ferreira, Leon Axel, Dara L Kraitchman
Journal of Cardiovascular Magnetic Resonance 2008, 10:18 (28 April 2008)
[Abstract] [Full Text] [PDF]