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MARCH 2010

05/03/2010

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

FEBRUARY 2010

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

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

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

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

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

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

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

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

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

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

December 2009

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

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

November 2009

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

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

2009 abstracts available for download here.

Fat Collections Linked to Decreased Heart Function

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

October 2009

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

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

 

September 2009

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

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

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

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

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

August 2009

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

See EuroCMR presentation on the study

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

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

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

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

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

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

Table 1. Additional Diagnostic Procedures Avoided Due to CMR

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

 

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

 US Lags Behind Europe in Documenting CMR's Value

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

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

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

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

Study Details

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

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

 

Cardiosource CMR: ICDs and PPMs and MRI:

Upon completion of this module, the user should:

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

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

June 2009

Pumped for marathon - CMR study

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

June 2009: JCMR impact factor increased to 2.15 from 1.87

May 2009

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

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

April 2009

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

January 2009

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

January 2009

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

November 2008

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

October 2008

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

September 2008

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

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

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

August 2008

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

July 2008

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

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

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

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

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

May 2008

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

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

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

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

Philips releases new version of Xcelera cardiology system

March 2008

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

February 2008

Good debate about CT ionising radiation from the NEJM. Here

January 2008

2008 SCMR Award Ceremony Photos

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

December 2007

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

Two reports: Viability and perfusion.

December 2007

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

For full text, see here (endorsed by SCMR)

November 2007

Generic gd contrast agent launched in Europe for cardiac MRI

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

See DettaglioNews

RSNA 2007

See the draft cardiac program

November 2007

AHA cardiac MR abstracts. 

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

cardiac MRI

Cardiac MR in Diagnosis and Prognosis

Clinical cardaic MRI

Young investigator award

New developments in cardiac MRI

November 2007

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

November 2007

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

November 2007

Major tagging MRI study presented at AHA

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

Novenber 2007

Pacemakers safe for MRI under certain conditions

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

October 31st 2007

Siemens announce a new 3T magnet. CNN story.

Siemens story  Siemens press release

 

September 2007

Nephrogenic Systemic Fibrosis Predicts Early Mortality in Patients Receiving Hemodialysis  CME

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

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

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

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

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

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

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

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

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

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

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

September 2007

Dipyridamole stress cardiovascular MRI predicts CAD outcomes

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

Pubmed abstract here

September 2007

JCMR - new publishing arangements

JCMR is moving to open access - read here

11th September 2007

Latin American Chapter Meeting:

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

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

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

Gadolinium-containing MRI Contrast Agents for MRI.

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

Cost containment measures in US CVD imaging

- see streamed 'Insider view presentation' here.

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

SCMR 2007 meeting– summary

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

2007 SCMR Award Ceremony Photos

MRI Scans to Be Made Safe for Pacemakers

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

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

2005 SCMR Award Winners for Best Abstract

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

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

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

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

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

MR Laboratories Accredited by ICAMRL

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

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

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

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

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