scholarly journals 106 The effective study: development and application of a question-driven, time-effective cardiac magnetic resonance scanning protocol

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Camilla Torlasco ◽  
Silvia Castelletti ◽  
Davide Soranna ◽  
Valentina Volpato ◽  
Stefano Figliozzi ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ischaemic Heart Disease ◽  
Tissue Characterization ◽  
Extracellular Volume ◽  
Control Group ◽  
Scanning Time ◽  
Magnetic Resonance Scanning ◽  
Stress Cmr

Abstract Aims Long scanning times impede cardiac magnetic resonance (CMR) clinical uptake. A ‘one-size-fits-all’ shortened, focused protocol [e.g. only function and late-gadolinium enhancement (LGE)] reduces scanning time and costs, but provide less information. We developed two question-driven CMR and stress-CMR protocols, including tailored advanced tissue characterization, and tested their effectiveness in reducing scanning time while retaining the diagnostic performances of standard protocols. Methods and results Eighty-three consecutive patients with cardiomyopathy or ischaemic heart disease underwent the tailored CMR. Each scan consisted of standard cines, LGE imaging, native T1-mapping, and extracellular volume. Fat/oedema modules, right ventricle cine, and in-line quantitative perfusion mapping were performed as clinically required. Workflow was optimized to avoid gaps. See Figure 1 for protocol details. Time target was <30 min for a CMR and <35 min for a stress-CMR. CMR was considered impactful when its results drove changes in diagnosis or management. Advanced tissue characterization was considered impactful when it changed the confidence level in the diagnosis. Images’ quality was assessed. A ‘control group’ of 137 patients was identified among scans performed before February 2020. Compared to standard protocols, the average scan duration dropped by > 30% (CMR: from 42 ± 8 to 28 ± 6min; stress-CMR: from 50 ± 10 to 34 ± 6min, both P < 0.0001). Independent on the protocol, CMR was impactful in ∼60% cases, and advanced tissue characterization was impactful in > 45% of cases. Quality grading was similar between the two protocols. Tailored protocols did not require additional staff. Conclusions Tailored CMR and stress-CMR protocols including advanced tissue characterization are accurate and time-effective for cardiomyopathies and ischaemic heart disease.

scholarly journals Effective Study: Development and Application of a Question‐Driven, Time‐Effective Cardiac Magnetic Resonance Scanning Protocol

2021 ◽  
Author(s):  
Camilla Torlasco ◽  
Silvia Castelletti ◽  
Davide Soranna ◽  
Valentina Volpato ◽  
Stefano Figliozzi ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Ischemic Heart Disease ◽  
Tissue Characterization ◽  
Ischemic Heart ◽  
Gadolinium Enhancement ◽  
Scanning Time ◽  
Stress Cmr

Background Long scanning times impede cardiac magnetic resonance (CMR) clinical uptake. A “one‐size‐fits‐all” shortened, focused protocol (eg, only function and late‐gadolinium enhancement) reduces scanning time and costs, but provides less information. We developed 2 question‐driven CMR and stress‐CMR protocols, including tailored advanced tissue characterization, and tested their effectiveness in reducing scanning time while retaining the diagnostic performances of standard protocols. Methods and Results Eighty three consecutive patients with cardiomyopathy or ischemic heart disease underwent the tailored CMR. Each scan consisted of standard cines, late‐gadolinium enhancement imaging, native T1‐mapping, and extracellular volume. Fat/edema modules, right ventricle cine, and in‐line quantitative perfusion mapping were performed as clinically required. Workflow was optimized to avoid gaps. Time target was <30 minutes for a CMR and <35 minutes for a stress‐CMR. CMR was considered impactful when its results drove changes in diagnosis or management. Advanced tissue characterization was considered impactful when it changed the confidence level in the diagnosis. The quality of the images was assessed. A control group of 137 patients was identified among scans performed before February 2020. Compared with standard protocols, the average scan duration dropped by >30% (CMR: from 42±8 to 28±6 minutes; stress‐CMR: from 50±10 to 34±6 minutes, both P <0.0001). Independent on the protocol, CMR was impactful in ≈60% cases, and advanced tissue characterization was impactful in >45% of cases. Quality grading was similar between the 2 protocols. Tailored protocols did not require additional staff. Conclusions Tailored CMR and stress‐CMR protocols including advanced tissue characterization are accurate and time‐effective for cardiomyopathies and ischemic heart disease.

scholarly journals Myocardial Involvement Detected Using Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis: A Prospective Observational Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5364
Author(s):  
Milan Hromadka ◽  
Jan Baxa ◽  
Jitka Seidlerova ◽  
Roman Miklik ◽  
Dan Rajdl ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Systemic Sclerosis ◽  
Magnetic Resonance ◽  
Disease Severity ◽  
Myocardial Fibrosis ◽  
Structural Changes ◽  
Extracellular Volume ◽  
Galectin 3

Introduction and objectives: Cardiac involvement in systemic sclerosis (SSc) patients affects mortality. Cardiac magnetic resonance (CMR) is capable of detecting structural changes, including diffuse myocardial fibrosis that may develop over time. Our aim was to evaluate myocardial structure and function changes using CMR in patients with SSc without known cardiac disease during a 5-year follow-up and find possible correlations with selected biomarkers. Methods: A total of 25 patients underwent baseline and follow-up CMR examinations according to a pre-specified protocol. Standard biochemistry, five biomarkers (hsTnI, NT-proBNP, galectin-3, sST2, and GDF-15), and disease-specific functional parameters enabling the classification of disease severity were also measured. Results: After five years, no patient suffered from manifest heart disease. Mean extracellular volume (ECV) and T1 mapping values did not change significantly (p ≥ 0.073). However, individual increases in native T1 time and ECV correlated with increased galectin-3 serum levels (r = 0.56; p = 0.0050, and r = 0.71; p = 0.0001, respectively). The progression of skin involvement assessed using the Rodnan skin score and a decrease in the diffusing capacity of the lungs were associated with increased GDF-15 values (r = 0.63; p = 0.0009, and r = −0.51; p = 0.011, respectively). Conclusions: During the 5-year follow-up, there was no new onset of heart disease observed in patients with SSc. However, in some patients, CMR detected progression of sub-clinical myocardial fibrosis that significantly correlated with elevated galectin-3 levels. GDF-15 values were found to be associated with disease severity progression.

Myocardial Parametric Mapping by Cardiac Magnetic Resonance Imaging in Pediatric Cardiology and Congenital Heart Disease

2022 ◽  
Author(s):  
Sruti Rao ◽  
Stephanie Y. Tseng ◽  
Amol Pednekar ◽  
Saira Siddiqui ◽  
Murat Kocaoglu ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Magnetic Relaxation ◽  
Congenital Heart ◽  
Extracellular Volume ◽  
Parametric Mapping ◽  
Disease States ◽  
Starting Point

Parametric mapping, that is, a pixel-wise map of magnetic relaxation parameters, expands the diagnostic potential of cardiac magnetic resonance by enabling quantification of myocardial tissue-specific magnetic relaxation on an absolute scale. Parametric mapping includes T 1 mapping (native and postcontrast), T 2 and T 2 * mapping, and extracellular volume measurements. The myocardial composition is altered in various disease states affecting its inherent magnetic properties and thus the myocardial relaxation times that can be directly quantified using parametric mapping. Parametric mapping helps in the diagnosis of nonfocal disease states and allows for longitudinal disease monitoring, evaluating therapeutic response (as in Thalassemia patients with iron overload undergoing chelation), and risk-stratification of certain diseases. In this review article, we describe various mapping techniques and their clinical utility in congenital heart disease. We will also review the available literature on normative values in children, the strengths, and weaknesses of these techniques. This review provides a starting point for pediatric cardiologists to understand and implement parametric mapping in their practice.

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