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

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.

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

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.053 ◽

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.

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Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-008-9300-x ◽

2008 ◽

Vol 24 (6) ◽

pp. 597-607 ◽

Cited By ~ 59

Author(s):

Steffen Bohl ◽

Ralf Wassmuth ◽

Hassan Abdel-Aty ◽

André Rudolph ◽

Daniel Messroghli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Heart Disease ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ischemic Heart Disease ◽

Cardiac Magnetic Resonance Imaging ◽

Myocardial Injury ◽

Delayed Enhancement ◽

Ischemic Heart ◽

Resonance Imaging

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Abstract 10958: Identification of Right Ventricular Myocardial Infarction With Late Gadolinium Enhancement in Chronic Ischemic Heart Disease: Comparison With Pathological Findings

Circulation ◽

10.1161/circ.132.suppl_3.10958 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yan Chaowu ◽

Li Li ◽

Fang Wei ◽

Li Hua ◽

Wang Yang

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Late Gadolinium Enhancement ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Pathological Findings ◽

Chronic Ischemic Heart Disease ◽

Gadolinium Enhancement ◽

Right Ventricular Myocardial Infarction ◽

Replacement Fibrosis

Introduction: Late gadolinium enhancement (LGE) has the potential to become an excellent technique in the diagnosis of right ventricular myocardial infarction (RVMI). However, the gold standard, pathological findings from patients, is still unavailable to validate the true value of LGE. Hypothesis: We hypothesized that LGE might correspond with histological infarction in RVMI. Methods: 36 transplant candidates (35 M /1F) with chronic ischemic heart disease were studied prospectively with LGE. According to the 12-segment-model, the pathological findings of RV were compared with the previous in vivo LGE after heart transplantation. Results: Histological RVMI was detected in 7 patients, and corresponded with all LGE segments (n=23) and 2 non-LGE segments. A generalize linear mix effect model showed non-significant difference (P=0.152) between the results of LGE and histological infraction. In identifying the RV segments with histological infarction, sensitivity and specificity of LGE was 92.0% (95%CI 74.0% to 99.0%) and 100% (95%CI 99.9% to 100.0%), respectively. Furthermore, RV segments without LGE mainly included two pathological patterns: histologically normal myocardium (n=372) or the admixture of viable myocardium and scattered replacement fibrosis (n=35). In the non-LGE RV segments, wall motion abnormality was associated with volume fraction of collagen (11.4±6.5% vs 4.3±2.2%, P<0.001) and the presence of ischemia (96.4% vs 1.7%, P<0.001). Conclusions: The RV segments with LGE corresponded closely with histological infarction in ischemic heart disease. However, RV segments without LGE might be histologically normal myocardium or intermixed with scattered replacement fibrosis. Further studies are required to evaluate the significance of scattered replacement fibrosis in the non-LGE segments.

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