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Systemic to pulmonary collateral flow measurement
A very nice example of effective use of flow imaging in measuring collateral flow.

Systemic-to-pulmonary collateral flow, as measured by cardiac magnetic resonance imaging, is associated with acute post-Fontan clinical outcomes.

Glatz AC, Rome JJ, Small AJ, Gillespie MJ, Dori Y, Harris MA, Keller MS, Fogel MA, Whitehead KK.

Circ Cardiovasc Imaging. 2012 Mar;5(2):218-25. Epub 2012 Jan 6. http://circimaging.ahajournals.org/content/5/2/218.long

BACKGROUND:

Systemic-pulmonary collateral (SPC) flow occurs commonly in single ventricle patients after superior cavo-pulmonary connection, with unclear clinical significance. We sought to evaluate the association between SPC flow and acute post-Fontan clinical outcomes using a novel method of quantifying SPC flow by cardiac magnetic resonance (CMR) imaging.
METHODS AND RESULTS:

All patients who had SPC flow quantified by CMR imaging before Fontan were retrospectively reviewed to assess for acute clinical outcomes after Fontan completion. Forty-four subjects were included who had Fontan completion between May 2008 and September 2010. SPC flow prior to Fontan measured 1.5±0.9 L/min/m(2), accounting for 31±11% of total aortic flow and 44±15% of total pulmonary venous flow. There was a significant linear association between natural log-transformed duration of hospitalization and SPC flow as a proportion of total aortic (rho=0.31, P=0.04) and total pulmonary venous flow (rho=0.29, P=0.05). After adjustment for Fontan type and presence of a fenestration, absolute SPC flow was significantly associated with hospital duration ≥7 days (odds ratio [OR]=9.2, P=0.02) and chest tube duration ≥10 days (OR=22.7, P=0.009). Similar associations exist for SPC flow as a percentage of total aortic (OR=1.09, P=0.048 for hospitalization ≥7 days; OR=1.24, P=0.007 for chest tube duration ≥10 days) and total pulmonary venous flow (OR=1.07, P=0.048 for hospitalization ≥7 days; OR=1.18, P=0.006 for chest tube duration ≥10 days).
CONCLUSIONS:

Increasing SPC flow before Fontan, as measured by CMR imaging, is...
On: 05/13/2012 By: jfernandes4125 Read more?

First MR conditional CRT + ICD announced
Yesterday the first MR-conditional ICD, CRT-D and CRT-P was announced. It appears that there is no turning back and we will see in the next years a whole set of patients capable of undergoing MR studies with these and probably similar devices to come.

For the official press release:here ...
On: 05/10/2012 By: jfernandes4125 Read more?

Tales from the crypts
Myocardial crypts were previously regarded as an unknown entity. Now part of the mystery seems to begin to unfold.

Prevalence and Clinical Profile of Myocardial Crypts in Hypertrophic Cardiomyopathy
CIRCIMAGING.112.972760 Published online before print May 4, 2012

Maron MS et al. Link here http://circimaging.ahajournals.org/content/early/2012/05/04/CIRCIMAGING.112.972760.full.pdf+html

Background—In hypertrophic cardiomyopathy (HCM), cardiovascular magnetic resonance (CMR) can detect morphologic abnormalities of the left ventricle (LV) not visualized with echocardiography. Although myocardial crypts (ie., narrow, blood-filled invaginations within the LV wall) have been recognized in HCM, all clinical implications of these structural abnormalities within the broad clinical HCM spectrum are not completely resolved. Therefore, we sought to characterize the prevalence and diagnostic significance of myocardial crypts in patients with HCM.

Methods and Results—Cine and late gadolinium enhancement (LGE) CMR and 2-dimensional echocardiography were obtained in 292 consecutive HCM patients including: 31 genotype positive/phenotype negative (G+ P-) family members without LV hypertrophy (28±16 years; 51% male), and 261 patients with LV hypertrophy (46±18 years; 60% male). 98 subjects without cardiovascular disease were controls. Myocardial crypts (1-6/patient) were identified only by CMR in 19/31 G+ P- patients (61%), compared to only 10/261 (4%) HCM patients with LV hypertrophy (p<0.001), and were absent in controls. 12-lead ECGs were normal in 10 (53%) of the G+ P- patients with crypts. Crypts were confined to the basal LV, most commonly in ventricular septum (n=21) or posterior LV free wall (n=4), and associated with normal LV contractility and absence of LGE in all but one patient.

Conclusions—LV myocardial crypts represent a distinctive morphologic expression of HCM, occurring with different frequency in HCM patients with or without LV hypertrophy. Crypts are a novel CMR imaging marker, which may identify individual HCM family members who should also be considered for diagnostic genetic testing. These...
On: 05/05/2012 By: jfernandes4125 Read more?

Ischemia Meta-analysis: CMR vs SPECT vs PET
CMR showed greater accuracy compared to SPECT, similar to PET in a pooled analysis of 166 studies (37 from CMR):

Diagnostic Performance of Noninvasive Myocardial Perfusion Imaging Using Single-Photon Emission Computed Tomography, Cardiac Magnetic Resonance, and Positron Emission Tomography Imaging for the Detection of Obstructive Coronary Artery Disease. A meta-analysis.

Jaarsma C et al. J Am Coll Cardiol, 2012; 59:1719-1728, doi:10.1016/j.jacc.2011.12.040.

Link here http://content.onlinejacc.org/cgi/content/abstract/59/19/1719

Objectives: This study aimed to determine the diagnostic accuracy of the 3 most commonly used noninvasive myocardial perfusion imaging modalities, single-photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) perfusion imaging for the diagnosis of obstructive coronary artery disease (CAD). Additionally, the effect of test and study characteristics was explored.

Background: Accurate detection of obstructive CAD is important for effective therapy. Noninvasive myocardial perfusion imaging is increasingly being applied to gauge the severity of CAD.

Methods: Studies published between 1990 and 2010 identified by PubMed search and citation tracking were examined. A study was included if a perfusion imaging modality was used as a diagnostic test for the detection of obstructive CAD and coronary angiography as the reference standard (≥50% diameter stenosis).

Results: Of the 3,635 citations, 166 articles (n = 17,901) met the inclusion criteria: 114 SPECT, 37 CMR, and 15 PET articles. There were not enough publications on other perfusion techniques such as perfusion echocardiography and computed tomography to include these modalities into the study. The patient-based analysis per imaging modality demonstrated a pooled sensitivity of 88% (95% confidence interval [CI]: 88% to 89%), 89% (95% CI: 88% to 91%), and 84% (95% CI: 81% to 87%) for SPECT, CMR, and PET, respectively; with a pooled specificity of 61% (95% CI: 59% to 62%), 76% (95% CI: 73%...
On: 05/02/2012 By: jfernandes4125 Read more?

LGE in RV and LV in ARVC
Although less scar is detected with CMR compared to electroanatomical mapping, the presence of LGE in both RV and LV is rather frequent.

Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltage mapping and contrast-enhanced cardiac magnetic resonance.
Marra MP, Leoni L, Bauce B, Corbetti F, Zorzi A, Migliore F, Silvano M, Rigato I, Tona F, Tarantini G, Cacciavillani L, Basso C, Buja G, Thiene G, Iliceto S, Corrado D.

Circ Arrhythm Electrophysiol. 2012 Feb 1;5(1):91-100. Epub 2011 Dec 2. http://circep.ahajournals.org/content/5/1/91.long

BACKGROUND:

The hallmark lesion of arrhythmogenic right ventricular cardiomyopathy (ARVC) is fibrofatty scar replacement. We compared endocardial voltage mapping (EVM) and contrast-enhanced cardiac magnetic resonance (CE-CMR) for imaging scar lesions in ARVC patients.
METHODS AND RESULTS:

We studied 23 consecutive ARVC patients (16 males; mean age, 38±12 years) who underwent RV EVM and CE-CMR and 37 control subjects. In 21 (91%) of 23 ARVC patients, RV EVM was abnormal, with a total of 45 electroanatomical scars (EAS): 17 (38%) in the inferobasal region, 12 (26.6%) in the anterolateral region, 8 (17.7%) in the RV outflow tract (RVOT), and 8 (17.7%) in the apex. RV delayed contrast enhancement (DCE) was found in 9 (39%) of 23 patients, with a total of 23 RV DCE scars: 4 (17.4%) in the inferobasal region, 9 (39.1%) in the anterolateral region, 4 (17.4%) in the RVOT, and 6 (26.1%) in the apex. There was a mismatch in 24 RV scars, with 22 EAS not confirmed by DCE and 2 DCE scars (both in the RVOT) undetected by EVM. In 9 (75%) of 12 patients with abnormal RV EVM/normal RV DCE, ≥1 DCEs were identified in the left ventricle (LV). Overall, ventricular DCE was detected in 78%...
On: 04/22/2012 By: jfernandes4125 Read more?

Quantitative T2 and BOLD
Link here

Ghugre, N. R., Ramanan, V., Pop, M., Yang, Y., Barry, J., Qiang, B., Connelly, K. A., Dick, A. J. and Wright, G. A. (2011), Myocardial BOLD imaging at 3 T using quantitative T2: Application in a myocardial infarct model. Magn. Reson. Med., 66: 1739–1747. doi: 10.1002/mrm.22972

Left ventricular remodeling as a result of acute myocardial infarction (AMI) is associated with significant morbidity, leading to cardiovascular dysfunction, disability, and death. Despite successful revascularization, coronary vasodilatory dysfunction has been shown in infarcted and remote myocardium of patients following AMI. Our study explored the utility of a T2-based blood-oxygen-level-dependent approach in probing regional and longitudinal fluctuations in vasodilatory function in a porcine model of AMI at 3 T. Ten pigs underwent MRI in control state and at day 2, weeks 1–6 following 90 min occlusion followed by reperfusion. The remote myocardium exhibited vasodilatory dysfunction at weeks 1 and 2 that gradually recovered, whereas the infarct zone showed no vasodilatory alterations. Our study suggests that microvascular alterations occurring in infarcted and remote myocardium after AMI might serve as an indicator of adverse left ventricular remodeling. The blood-oxygen-level-dependent technique using quantitative T2 could potentially be a useful noninvasive tool to evaluate novel therapeutic strategies aimed at limiting vasoconstriction and improving coronary flow reserve after AMI ...
On: 04/08/2012 By: jfernandes4125 Read more?

Optmizing First Pass Perfusion - size of the dark rim
Of the most common problems in stress perfusion imaging: high temporal and spatial resolution could help.

Link here: here

Magn Reson Med. 2011 Dec;66(6):1731-8. doi: 10.1002/mrm.22969. Epub 2011 Jun 23.

Myocardial first-pass perfusion: influence of spatial resolution and heart rate on the dark rim artifact.

Meloni A, Al-Saadi N, Torheim G, Hoebel N, Reynolds HG, De Marchi D, Positano V, Burchielli S, Lombardi M.

Fondazione G Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, Pisa, Italy.

Myocardial perfusion images can be affected by the dark rim artifact. This study aimed to evaluate the effects of the spatial resolution and heart rate on the transmural extent of the artifact. Six pigs under anesthesia were scanned at 1.5T using an echo-planar imaging/fast gradient echo sequence with a nonselective saturation preparation pulse. Three short-axis slices were acquired every heart beat during the first pass of a contrast agent bolus. Two different in-plane spatial resolutions (2.65 and 3.75 mm) and two different heart rates (normal and tachycardia) were used, generating a set of four perfusion scans. The percentage drop of signal in the subendocardium compared to the epicardium and the transmural extent of the artifact were extracted. Additionally, the signal-to-noise and the contrast-to-noise ratios were evaluated. The signal drop as well as the width of the dark rim artifact increased with decreased spatial resolution and with increased heart rates. No significant slice-to-slice variability was detected for signal drop and width of the rim within the four considered groups. signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) ratios decreased with increasing spatial resolution. In conclusion, low spatial and temporal resolution could be correlated with increased extent of the dark-rim artifact and with lower SNR and CNR. ...
On: 04/08/2012 By: jfernandes4125 Read more?

MR-IMPACT II
Following the successful first trial and in addition to CE-MARK data on the use of CMR for ischemia detection:

Juerg Schwitter, Christian M. Wacker, Norbert Wilke, Nidal Al-Saadi, Ekkehart Sauer,
Kalman Huettle, Stefan O. Schönberg, Andreas Luchner, Oliver Strohm, Hakan Ahlstrom,
Thorsten Dill, Nadja Hoebel, and Tamas Simor

MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial

Aims Perfusion-cardiac magnetic resonance (CMR) has emerged as a potential alternative to single-photon emission computed tomography (SPECT) to assess myocardial ischaemia non-invasively. The goal was to compare the diagnostic performance of perfusion-CMR and SPECT for the detection of coronary artery disease (CAD) using conventional X-ray coronary angiography (CXA) as the reference standard.

Methods and results In this multivendor trial, 533 patients, eligible for CXA or SPECT, were enrolled in 33 centres (USA and Europe) with 515 patients receiving MR contrast medium. Single-photon emission computed tomography and CXA were performed within 4 weeks before or after CMR in all patients. The prevalence of CAD in the sample was 49%. Drop-out rates for CMR and SPECT were 5.6 and 3.7%, respectively (P = 0.21). The primary endpoint was non-inferiority of CMR vs. SPECT for both sensitivity and specificity for the detection of CAD. Readers were blinded vs. clinical data, CXA, and imaging results. As a secondary endpoint, the safety profile of the CMR examination was evaluated. For CMR and SPECT, the sensitivity scores were 0.67 and 0.59, respectively, with the lower confidence level for the difference of +0.02, indicating superiority of CMR over SPECT. The specificity scores for CMR and SPECT were 0.61 and 0.72, respectively (lower confidence level for...
On: 04/01/2012 By: jfernandes4125 Read more?

Re: Manuscript Highlights
Hi Juliano could you use the url like this?
this
they render better on the homepage feeds this way. ...
On: 03/27/2012 By: moon Read more?

T2 mapping
Is T2 mapping the solution to the T2W imaging debates? Link here http://circimaging.ahajournals.org/content/5/1/102.long

Circ Cardiovasc Imaging. 2012 Jan;5(1):102-10. Epub 2011 Oct 28.
Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping.

Thavendiranathan P, Walls M, Giri S, Verhaert D, Rajagopalan S, Moore S, Simonetti OP, Raman SV.
Source

The Ohio State University, Columbus, OH 43210, USA.

BACKGROUND:

T2-weighted cardiac magnetic resonance imaging is useful in diagnosing acute inflammatory myocardial diseases, such as myocarditis and tako-tsubo cardiomyopathy (TTCM). We hypothesized that quantitative T2 mapping could better delineate myocardial involvement in these disorders versus T2-weighted imaging.
METHODS AND RESULTS:

Thirty patients with suspected myocarditis or TTCM, referred for cardiac magnetic resonance imaging, who met established diagnostic criteria underwent myocardial T2 mapping. T2 values were averaged in involved and remote myocardial segments, both defined by a reviewer blinded to T2 data. In myocarditis, T2 was 65.2±3.2 ms in the involved myocardium versus 53.5±2.1 ms in the remote myocardium (P<0.001). In TTCM, T2 was 65.6±4.0 ms in the involved myocardium versus 53.6±2.7 ms in the remote segments (P<0.001). T2 values were similar across remote myocardial segments in patients and all myocardial segments in controls (P>0.05 for all). T2 maps provided diagnostic data even in patients with difficulty breath holding. A T2 cutoff of 59 ms identified areas of myocardial involvement, with sensitivity and specificity of 94% and 97%, respectively. T2 mapping revealed regions of abnormal T2 beyond those identified by wall motion abnormalities or late gadolinium-enhancement positivity. Conventional T2-weighted short tau inversion recovery images were uninterpretable in 7 patients because of artifact and unremarkable in 2 patients who had elevated T2 values. T2-prepared steady-state-free precession images showed areas of signal hyperintensity in only 17 of 30 patients.
CONCLUSIONS:

Quantitative T2...
On: 03/24/2012 By: jfernandes4125 Read more?

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