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Instertitial Volume in Health and Amyloidosis
Radiology. 2013 May 14. [Epub ahead of print]
Measurement of Tissue Interstitial Volume in Healthy Patients and Those with Amyloidosis with Equilibrium Contrast-enhanced MR Imaging.
Bandula S, Banypersad SM, Sado D, Flett AS, Punwani S, Taylor SA, Hawkins PN, Moon JC.
Centre for Medical Imaging, Institute of Cardiovascular Science, and Centre for Amyloidosis and Acute Phase Proteins, University College London, London, England
Purpose:To investigate equilibrium contrast material-enhanced magnetic resonance (MR) imaging measurement of extracellular volume (ECV) fraction within healthy abdominal tissues and to test the hypotheses that tissue ECV in systemic amyloid light-chain (AL) amyloidosis is greater than in healthy patients and show that this increase correlates with organ amyloid burden.Materials and Methods:A local ethics committee approved the study and all patients gave written informed consent. Forty healthy volunteers (18 men, 22 women; median age, 43 years; age range, 24-88 years) and 67 patients with AL amyloidosis (43 men, 24 women; median age, 65 years; age range, 38-81 years) underwent equilibrium MR imaging of the upper abdomen. ECV was measured in the liver, spleen, and paravertebral muscle. Patients with amyloidosis also underwent serum amyloid P (SAP) component scintigraphy so that specific organ involvement by amyloid could be scored. Variation in ECV between tissues was assessed by using a Friedman Test. Tissue ECV in healthy and amyloidosis groups were compared by using a Mann-Whitney U test. Spearman correlation was used to test for an association between the organ SAP score and ECV.Results:ECV measured at equilibrium MR imaging varied significantly between organs in healthy volunteers (χ2 = 31.0; P < .001). ECV was highest in the spleen (0.34), followed by liver (0.29) and muscle (0.09). ECVs measured within the spleen (0.39; P< .001), liver (0.31; P = .005), and...
On: 05/20/2013 By: jfernandes4125 Read more?
Standardized Post Processing by SCMR
Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Post Processing
Jeanette Schulz-Menger, David A Bluemke, Jens Bremerich, Scott D Flamm, Mark A Fogel, Matthias G Friedrich, Raymond J Kim, Florian von Knobelsdorff-Brenkenhoff, Christopher M Kramer, Dudley J Pennell, Sven Plein and Eike Nagel
Journal of Cardiovascular Magnetic Resonance 2013, 15:35 doi:10.1186/1532-429X-15-35
Published: 1 May 2013
On: 05/06/2013 By: jfernandes4125 Read more?
2013 JACC Year in Cardiac Imaging
Year In Cardiac Imaging ONLINE FIRST
Raymond J. Gibbons, M.D.; Philip A. Araoz, M.D.; Thomas C. Gerber, M.D., Ph. D.
J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.02.080 ...
On: 04/28/2013 By: jfernandes4125 Read more?
Perfusion: making it easier for the clinician
Colorful images always attracts more referrals and also increases the ease of interpretation especially by clinicians. Despite the many advantages of CMR perfusion, it is still deeply underused worldwide. Maybe this solution will help out.
Invest Radiol. 2013 Apr 4. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/23563196
Detection of Myocardial Ischemia by Automated, Motion-Corrected, Color-Encoded Perfusion Maps Compared With Visual Analysis of Adenosine Stress Cardiovascular Magnetic Resonance Imaging at 3 T: A Pilot Study.
Doesch C, Papavassiliu T, Michaely HJ, Attenberger UI, Glielmi C, Süselbeck T, Fink C, Borggrefe M, Schoenberg SO.
The purpose of this study was to compare automated, motion-corrected, color-encoded (AMC) perfusion maps with qualitative visual analysis of adenosine stress cardiovascular magnetic resonance imaging for detection of flow-limiting stenoses.
MATERIALS AND METHODS:
Myocardial perfusion measurements applying the standard adenosine stress imaging protocol and a saturation-recovery temporal generalized autocalibrating partially parallel acquisition (t-GRAPPA) turbo fast low angle shot (Turbo FLASH) magnetic resonance imaging sequence were performed in 25 patients using a 3.0-T MAGNETOM Skyra (Siemens Healthcare Sector, Erlangen, Germany). Perfusion studies were analyzed using AMC perfusion maps and qualitative visual analysis. Angiographically detected coronary artery (CA) stenoses greater than 75% or 50% or more with a myocardial perfusion reserve index less than 1.5 were considered as hemodynamically relevant. Diagnostic performance and time requirement for both methods were compared. Interobserver and intraobserver reliability were also assessed.
A total of 29 CA stenoses were included in the analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of ischemia on a per-patient basis were comparable using the AMC perfusion maps compared to visual analysis. On a per-CA territory basis, the attribution of an ischemia to the respective vessel was facilitated using the AMC perfusion maps. Interobserver...
On: 04/15/2013 By: jfernandes4125 Read more?
Native T1 - can we skip the contrast?
Native T1 Mapping in Differentiation of Normal Myocardium From Diffuse Disease in Hypertrophic and Dilated Cardiomyopathy
Valentina O. Puntmann, MD, PhD; Tobias Voigt, PhD; Zhong Chen, MD; Manuel Mayr, MD, PhD; Rashed Karim, PhD; Kawal Rhode, PhD; Ana Pastor, MD; Gerald Carr-White, MBBS, PhD; Reza Razavi, MD; Tobias Schaeffter, PhD; Eike Nagel, MD, PhD
J Am Coll Cardiol Img. 2013;6(4):475-484. doi:10.1016/j.jcmg.2012.08.019
Objectives The aim of this study was to examine the value of native and post-contrast T1 relaxation in the differentiation between healthy and diffusely diseased myocardium in 2 model conditions, hypertrophic cardiomyopathy and nonischemic dilated cardiomyopathy.
Background T1 mapping has been proposed as potentially valuable in the quantitative assessment of diffuse myocardial fibrosis, but no studies to date have systematically evaluated its role in the differentiation of healthy myocardium from diffuse disease in a clinical setting.
Methods Consecutive subjects undergoing routine clinical cardiac magnetic resonance at King's College London were invited to participate in this study. Groups were based on cardiac magnetic resonance findings and consisted of subjects with known hypertrophic cardiomyopathy (n = 25) and nonischemic dilated cardiomyopathy (n = 27). Thirty normotensive subjects with low pre-test likelihood of cardiomyopathy, not taking any regular medications and with normal cardiac magnetic resonance findings including normal left ventricular mass indexes, served as controls. Single equatorial short-axis slice T1 mapping was performed using a 3-T scanner before and at 10, 20, and 30 minutes after the administration of 0.2 mmol/kg of gadobutrol. T1 values were quantified within the septal myocardium (T1native), and extracellular volume fractions (ECV) were calculated.
Results T1native was significantly longer in patients with cardiomyopathy compared with control subjects (p < 0.01). Conversely, post-contrast T1 values were significantly shorter in patients with cardiomyopathy at all time...
On: 04/09/2013 By: jfernandes4125 Read more?
Practical determination of Mitral Regurgitation Severity
Visual assessment by cine-MRI compared to echo and invasive angiography.
Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040491
PLoS One. 2012;7(7):e40491. doi: 10.1371/journal.pone.0040491.
Clinical application of cine-MRI in the visual assessment of mitral regurgitation compared to echocardiography and cardiac catheterization.
Heitner J, Bhumireddy GP, Crowley AL, Weinsaft J, Haq SA, Klem I, Kim RJ, Jollis JG.
Detecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography.
The study population consisted of 68 patients who underwent a cardiac MRI followed by an echocardiogram within a median time of 2.0 days and 49 of these patients who had a cardiac catheterization, median time of 2.0 days. The inter-rater agreement statistic (Kappa) was used to evaluate the agreement.
There was moderate agreement between cine MRI and Doppler echocardiography in assessing mitral regurgitation severity, with a kappa value of 0.47, confidence interval (CI) 0.29-0.65. There was also fair agreement between cine MRI and cardiac catheterization with a kappa value of 0.36, CI of 0.17-0.55.
Cine MRI offers a reasonable alternative to both Doppler echocardiography and, to a lesser extent, cardiac catheterization for visually assessing the severity of mitral regurgitation with specific visual parameters during routine clinical cardiac MRI. ...
On: 03/30/2013 By: jfernandes4125 Read more?
CMR and CCT combined in CAD
Best of two worlds?
Eur Heart J. 2013 Mar 7. [Epub ahead of print] - http://eurheartj.oxfordjournals.org/content/early/2013/03/07/eurheartj.eht077.long
Combined non-invasive functional and anatomical diagnostic work-up in clinical practice: the magnetic resonance and computed tomography in suspected coronary artery disease (MARCC) study.
Groothuis JG, Beek AM, Brinckman SL, Meijerink MR, van den Oever ML, Hofman MB, van Kuijk C, van Rossum AC.
AimsThe combined use of cardiac computed tomography (CT) coronary angiography (CTCA) and myocardial perfusion imaging allows the non-invasive evaluation of coronary morphology and function. Cardiovascular magnetic resonance (CMR) imaging has several advantages: it can simultaneously assess myocardial perfusion, ventricular and valvular function, cardiomyopathy, and aortic disease and does not involve any additional ionizing radiation. We investigated the combined use of cardiac CT and CMR for the diagnostic evaluation of patients with suspected coronary artery disease (CAD) in clinical practice.Methods and resultsA total of 192 patients with low or intermediate pre-test probability of CAD underwent CTCA and CMR. All patients with obstructive CAD on CTCA and/or myocardial ischaemia on CMR were referred for invasive coronary angiography (ICA). Fractional flow reserve was measured in case of intermediate lesions (30-70% diameter stenosis) on ICA. Additional cardiac and extra-cardiac findings by CTCA and CMR were registered. The combination of CTCA and CMR significantly improved specificity and overall accuracy (94 and 91%) for the detection of significant CAD compared with their use as a single technique (CTCA 39 and 57%, P < 0.0001; CMR 82 and 83%, P = 0.016). No events were recorded during follow-up (18 ± 6 months) in 104 patients who did not undergo ICA. Furthermore, the combined strategy provided an alternative diagnosis in 19 patients.ConclusionThe combined use of CTCA and CMR significantly improved specificity and overall diagnostic accuracy for the detection of...
On: 03/18/2013 By: jfernandes4125 Read more?
Two new JAMA papers on CMR (2)
Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy: http://jama.jamanetwork.com/article.aspx?articleid=1660382
JAMA. 2013 Mar 6;309(9):896-908. doi: 10.1001/jama.2013.1363.
Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy.
Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S, Morarji K, Brown TD, Ismail NA, Dweck MR, Di Pietro E, Roughton M, Wage R, Daryani Y, O'Hanlon R, Sheppard MN, Alpendurada F, Lyon AR, Cook SA, Cowie MR, Assomull RG, Pennell DJ, Prasad SK.
Risk stratification of patients with nonischemic dilated cardiomyopathy is primarily based on left ventricular ejection fraction (LVEF). Superior prognostic factors may improve patient selection for implantable cardioverter-defibrillators (ICDs) and other management decisions.
To determine whether myocardial fibrosis (detected by late gadolinium enhancement cardiovascular magnetic resonance [LGE-CMR] imaging) is an independent and incremental predictor of mortality and sudden cardiac death (SCD) in dilated cardiomyopathy.
DESIGN, SETTING, AND PATIENTS:
Prospective, longitudinal study of 472 patients with dilated cardiomyopathy referred to a UK center for CMR imaging between November 2000 and December 2008 after presence and extent of midwall replacement fibrosis were determined. Patients were followed up through December 2011.
MAIN OUTCOME MEASURES:
Primary end point was all-cause mortality. Secondary end points included cardiovascular mortality or cardiac transplantation; an arrhythmic composite of SCD or aborted SCD (appropriate ICD shock, nonfatal ventricular fibrillation, or sustained ventricular tachycardia); and a composite of HF death, HF hospitalization, or cardiac transplantation.
Among the 142 patients with midwall fibrosis, there were 38 deaths (26.8%) vs 35 deaths (10.6%) among the 330 patients without fibrosis (hazard ratio [HR], 2.96 [95% CI, 1.87-4.69]; absolute risk difference, 16.2% [95% CI, 8.2%-24.2%]; P < .001) during a median follow-up of 5.3 years (2557...
On: 03/11/2013 By: jfernandes4125 Read more?
Two new JAMA papers on CMR (1)
Thinning myocardium and LGE: http://jama.jamanetwork.com/article.aspx?articleid=1660383
JAMA. 2013 Mar 6;309(9):909-18. doi: 10.1001/jama.2013.1381.
Prevalence of regional myocardial thinning and relationship with myocardial scarring in patients with coronary artery disease.
Shah DJ, Kim HW, James O, Parker M, Wu E, Bonow RO, Judd RM, Kim RJ.
Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring.
To evaluate patients with regional myocardial wall thinning and to determine scar burden and potential for functional improvement.
DESIGN, SETTING, AND PATIENTS:
Investigator-initiated, prospective, 3-center study conducted from August 2000 through January 2008 in 3 parts to determine (1) in patients with known coronary artery disease (CAD) undergoing CMR viability assessment, the prevalence of regional wall thinning (end-diastolic wall thickness ≤5.5 mm), (2) in patients with thinning, the presence and extent of scar burden, and (3) in patients with thinning undergoing coronary revascularization, any changes in myocardial morphology and contractility. MAIN OUTCOMES AND MEASURES: Scar burden in thinned regions assessed using delayed-enhancement CMR and changes in myocardial morphology and function assessed using cine-CMR after revascularization.
Of 1055 consecutive patients with CAD screened, 201 (19% [95% CI, 17% to 21%]) had regional wall thinning. Wall thinning spanned a mean of 34% (95% CI, 32% to 37% [SD, 15%]) of LV surface area. Within these regions, the extent of scarring was 72% (95% CI, 69% to 76% [SD, 25%]); however, 18% (95% CI, 13% to 24%) of thinned regions had limited scar burden (≤50% of total extent). Among patients with thinning undergoing revascularization and follow-up cine-CMR (n = 42), scar extent within the thinned region...
On: 03/11/2013 By: jfernandes4125 Read more?
LGE and prognosis of ventricular arrhythmias
JACC Cardiovasc Imaging. 2013 Feb 14. pii: S1936-878X(12)01002-9. doi: 10.1016/j.jcmg.2012.09.012. [Epub ahead of print]
Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias.
Dawson DK, Hawlisch K, Prescott G, Roussin I, Di Pietro E, Deac M, Wong J, Frenneaux MP, Pennell DJ, Prasad SK.
The goal of this study was to explore whether fibrosis detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an independent predictor of hard cardiovascular events in patients presenting with ventricular arrhythmia.
In patients at risk of sudden cardiac death, risk stratification for device therapy remains challenging.
A total of 373 consecutive patients with sustained ventricular tachycardia (VT) (n = 204) or nonsustained VT (NSVT) (n = 169) underwent LGE-CMR. The group was prospectively followed up for a median of 2.6 years (range 11 months to 11 years). The predetermined endpoint was a composite of cardiac death/arrest, new episode of sustained VT, or appropriate implantable cardioverter-defibrillator discharge.
Mean left ventricular (LV) ejection fraction (EF) was 60 ± 13%. The presence of fibrosis was a strong and independent predictor of the primary outcome for the whole group (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.8 to 5.8, p < 0.001). In the sustained VT subset, both LV fibrosis and severely impaired systolic function (LVEF <35%) were significant independent predictors in the multivariate model (HR: 3.0, 95% CI: 1.4 to 6.2, p = 0.001; and HR: 2.5, 95% CI: 1.1 to 6.2, p = 0.038, respectively). In the NSVT subset, the presence of fibrosis was the only independent predictor of the endpoint (HR: 4.2, 95% CI: 1.7 to 10.1, p = 0.006).
LGE-CMR-detected fibrosis is an independent predictor of adverse outcomes in patients with ventricular...
On: 03/03/2013 By: jfernandes4125 Read more?
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