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Thavendiranathan P, Popović ZB, Flamm SD, Dahiya A, Grimm RA, Marwick TH. Improved Interobserver Variability and Accuracy of Echocardiographic Visual Left Ventricular Ejection Fraction Assessment through a Self-Directed Learning Program Using Cardiac Magnetic Resonance Images. J Am Soc Echocardiogr 2013; 26:1267-73. [DOI: 10.1016/j.echo.2013.07.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 11/27/2022]
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77
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Kwon DH, Hachamovitch R, Adeniyi A, Nutter B, Popovic ZB, Wilkoff BL, Desai MY, Flamm SD, Marwick T. Myocardial scar burden predicts survival benefit with implantable cardioverter defibrillator implantation in patients with severe ischaemic cardiomyopathy: influence of gender. Heart 2013; 100:206-13. [PMID: 24186562 PMCID: PMC3913110 DOI: 10.1136/heartjnl-2013-304261] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective We sought to assess the impact of myocardial scar burden (MSB) on the association between implantable cardioverter defibrillator (ICD) implantation and mortality in patients with ischaemic cardiomyopathy (ICM) and left ventricular EF ≤40%. In addition, we sought to determine the impact of gender on survival benefit with ICD implantation. Design Retrospective observational study. Setting Single US tertiary care centre. Patients Consecutive patients with significant ICM who underwent delayed hyperenhancement-MRI between 2002 and 2006. Interventions ICD implantation. Main outcome measures All-cause mortality and cardiac transplantation. Results Follow-up of 450 consecutive patients, over a mean of 5.8 years, identified 186 deaths. Cox proportional hazard modelling was used to evaluate associations among MSB, gender and ICD with respect to all-cause death as the primary endpoint. ICDs were implanted in 163 (36%) patients. On multivariable analysis, Scar% (χ2 28.21, p<0.001), Gender (χ2 12.39, p=0.015) and ICD (χ2 9.57, p=0.022) were independent predictors of mortality after adjusting for multiple parameters. An interaction between MSB×ICD (χ2 9.47, p=0.009) demonstrated significant differential survival with ICD based on MSB severity. Additionally, Scar%×ICD×Gender (χ2 6.18, p=0.048) suggested that men with larger MSB had significant survival benefit with ICD, but men with smaller MSB derived limited benefit with ICD implantation. However, the inverse relationship was found in women. Conclusions MSB is a powerful independent predictor of mortality in patients with and without ICD implantation. In addition, MSB may predict gender-based significant differences in survival benefit from ICDs in patients with severe ICM.
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78
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Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J Cardiovasc Magn Reson 2013; 15:91. [PMID: 24103764 PMCID: PMC3851953 DOI: 10.1186/1532-429x-15-91] [Citation(s) in RCA: 532] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 09/19/2013] [Indexed: 12/15/2022] Open
Abstract
This document is an update to the 2008 publication of the Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Protocols. Since the time of the original publication, 3 additional task forces (Reporting, Post-Processing, and Congenital Heart Disease) have published documents that should be referred to in conjunction with the present document. The section on general principles and techniques has been expanded as more of the techniques common to CMR have been standardized. There is still a great deal of development in the area of tissue characterization/mapping, so these protocols have been in general left as optional. The authors hope that this document continues to standardize and simplify the patient-based approach to clinical CMR. It will be updated at regular intervals as the field of CMR advances.
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Hart SA, Devendra GP, Kim YY, Flamm SD, Kalahasti V, Arruda J, Walker E, Boonyasirinant T, Bolen M, Setser R, Krasuski RA. PINOT NOIR: pulmonic insufficiency improvement with nitric oxide inhalational response. J Cardiovasc Magn Reson 2013; 15:75. [PMID: 24006858 PMCID: PMC3844630 DOI: 10.1186/1532-429x-15-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/22/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tetralogy of Fallot (TOF) repair and pulmonary valvotomy for pulmonary stenosis (PS) lead to progressive pulmonary insufficiency (PI), right ventricular enlargement and dysfunction. This study assessed whether pulmonary regurgitant fraction measured by cardiovascular magnetic resonance (CMR) could be reduced with inhaled nitric oxide (iNO). METHODS Patients with at least moderate PI by echocardiography undergoing clinically indicated CMR were prospectively enrolled. Patients with residual hemodynamic lesions were excluded. Ventricular volume and blood flow sequences were obtained at baseline and during administration of 40 ppm iNO. RESULTS Sixteen patients (11 with repaired TOF and 5 with repaired PS) completed the protocol with adequate data for analysis. The median age [range] was 35 [19-46] years, BMI was 26 ± 5 kg/m(2) (mean ± SD), 50% were women and 75% were in NYHA class I. Right ventricular end diastolic volume index for the cohort was 157 ± 33 mL/m(2), end systolic volume index was 93 ± 20 mL/m(2) and right ventricular ejection fraction was 40 ± 6%. Baseline pulmonary regurgitant volume was 45 ± 25 mL/beat and regurgitant fraction was 35 ± 16%. During administration of iNO, regurgitant volume was reduced by an average of 6 ± 9% (p=0.01) and regurgitant fraction was reduced by an average of 5 ± 8% (p=0.02). No significant changes were observed in ventricular indices for either the left or right ventricle. CONCLUSION iNO was successfully administered during CMR acquisition and appears to reduce regurgitant fraction in patients with at least moderate PI suggesting a potential role for selective pulmonary vasodilator therapy in these patients. TRIALS REGISTRATION ClinicalTrials.gov, NCT00543933.
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Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ, Gerhard-Herman MD, Kalva SP, Ashraf Mansour M, Mohler ER, Schenker MP, Weiss C, Dill KE. ACR Appropriateness Criteria ® imaging of mesenteric ischemia. ABDOMINAL IMAGING 2013; 38:714-9. [PMID: 23296712 DOI: 10.1007/s00261-012-9975-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mesenteric ischemia is a rare disease associated with high morbidity and mortality. Acute mesenteric ischemia is most commonly secondary to embolism followed by arterial thrombosis, nonocclusive ischemia, and less commonly venous thrombosis. Chronic mesenteric ischemia is almost always caused by atherosclerotic disease, with rare causes including fibromuscular dysplasia and vasculitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Patients with mesenteric ischemia usually present with nonspecific abdominal symptoms and laboratory findings. This document evaluates and rates the appropriateness of imaging to evaluate patients with clinically suspected mesenteric ischemia. While catheter-based angiography has been considered the reference standard and enables diagnosis and treatment, advances in computed tomography have made it a first-line test in many patients because it is a fast, widely available, and noninvasive study. Abdominal radiographs and ultrasound have a limited role in diagnosing mesenteric ischemia but are commonly the first ordered tests in patients with abdominal pain and may diagnose more common pathologies.
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81
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Moodley S, Schoenhagen P, Gillinov AM, Mihaljevic T, Flamm SD, Griffin BP, Desai MY. Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: Impact on decision making. J Thorac Cardiovasc Surg 2013; 146:262-8.e1. [DOI: 10.1016/j.jtcvs.2012.06.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/31/2012] [Accepted: 06/18/2012] [Indexed: 11/26/2022]
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82
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. 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. J Cardiovasc Magn Reson 2013; 15:35. [PMID: 23634753 PMCID: PMC3695769 DOI: 10.1186/1532-429x-15-35] [Citation(s) in RCA: 828] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/05/2013] [Indexed: 01/29/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post Processing of the Society for Cardiovascular MR (SCMR). The aim of the task force is to recommend requirements and standards for image interpretation and post processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate.
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83
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Kusunose K, Dahiya A, Popović ZB, Motoki H, Alraies MC, Zurick AO, Bolen MA, Kwon DH, Flamm SD, Klein AL. Biventricular Mechanics in Constrictive Pericarditis Comparison With Restrictive Cardiomyopathy and Impact of Pericardiectomy. Circ Cardiovasc Imaging 2013; 6:399-406. [DOI: 10.1161/circimaging.112.000078] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background—
The aim of our study was to compare myocardial mechanics of constrictive pericarditis (CP) with restrictive cardiomyopathy (RCM), or healthy controls; to assess the impact of pericardial thickening detected by cardiac magnetic resonance on regional myocardial mechanics in CP; and to quantitate the effect of pericardiectomy on myocardial mechanics in CP.
Methods and Results—
Myocardial mechanics were evaluated by 2-dimensional speckle tracking in 52 consecutive patients with CP who underwent cardiac magnetic resonance examination before pericardiectomy, 35 patients with RCM, and 26 control subjects. CP patients had selectively depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS). In a comparison of RCM and normals, CP patients had significantly lower regional longitudinal systolic strain ratios (CP versus RCM and normal; LVLWS/LVSWS: 0.8±0.2 versus 1.1±0.2 and 1.0±0.2; P<0.001, RVFWS/LVSWS: 0.8±0.4 vs. 1.4±0.5 and 1.2±0.2; P<0.001). LVLWS/LVSWS was more robust than the LV lateral wall to LV septal wall ratio of early diastolic velocities at the LV base (LE′/SE′) in differentiating CP from RCM (area under the curve=0.91 versus 0.76;
P
=0.011). There was a significant inverse correlation between pericardial thickness and respective ventricular strains (
P
=0.001). Pericardiectomy resulted in the improvement of the depressed LVLWS/LVSWS (0.83±0.18–0.95±0.12;
P
<0.001).
Conclusions—
Regional longitudinal systolic strain ratios are robust novel diagnostic tools for CP. Regional myocardial mechanics inversely correlates with adjacent pericardial segment thickness detected by cardiac magnetic resonance, and pericardiectomy leads to systolic strain improvement, which is more pronounced in right ventricular and LV free walls.
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84
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Dahiya A, Thavendiranathan P, Thomas JD, Flamm SD. Apical hypertrophic cardiomyopathy with and without aneurysm. J Am Coll Cardiol 2013; 60:1709. [PMID: 23079118 DOI: 10.1016/j.jacc.2012.05.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 10/27/2022]
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85
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Kwon D, Popovic ZB, Desai MY, Flamm SD, Marwick T, Hachamovitch R. Impact of right ventricular end systolic volume and mitral regurgitation on survival in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559948 DOI: 10.1186/1532-429x-15-s1-p252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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86
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Yingchoncharoen T, Flamm SD, Kwon D. Diffuse myocardial fibrosis, but not focal fibrosis identified with delayed enhancement, is an independent predictor of LV reversed remodeling in patients with idiopathic non-ischemic cardiomyopathy. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559662 DOI: 10.1186/1532-429x-15-s1-p109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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87
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Cavalcante JL, Popovic ZB, Hachamovitch R, Desai MY, Flamm SD, Marwick T, Kwon D. Right ventricular systolic dysfunction in patients with severe ischemic cardiomyopathy - CMR insights into an interventricular relationship. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559814 DOI: 10.1186/1532-429x-15-s1-p203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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88
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Cavalcante JL, Popovic ZB, Hachamovitch R, Desai MY, Flamm SD, Marwick T, Kwon D. Going beyond ejection fraction - CMR assessment of ventricular-vascular coupling and LV remodeling predicts diastolic dysfunction in advanced ischemic cardiomyopathy. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559718 DOI: 10.1186/1532-429x-15-s1-p193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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89
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Kwon D, Hachamovitch R, Popovic ZB, Flamm SD, Marwick T. End systolic volume and scar burden are incremental and independent predictors of survival in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305207 DOI: 10.1186/1532-429x-14-s1-o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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90
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Nazir N, Hachamovitch R, Popovic ZB, Flamm SD, Marwick T, Kwon D. Right ventricular volumes vs. right ventricular ejection fraction are more powerful independent predictors of survival in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304886 DOI: 10.1186/1532-429x-14-s1-p3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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91
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Hart S, Devendra G, Kim YY, Flamm SD, Kalahasti S, Arruda J, Walker E, Boonyasiranant T, Bolen M, Setser RM, Krasuski R. PINOT NOIR: Pulmonic INsufficiency imprOvemenT with Nitric Oxide Inhalational Response. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304836 DOI: 10.1186/1532-429x-14-s1-o73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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92
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Thavendiranathan P, Phelan D, Collier P, Thomas JD, Flamm SD, Marwick TH. Quantitative Assessment of Mitral Regurgitation. JACC Cardiovasc Imaging 2012; 5:1161-75. [DOI: 10.1016/j.jcmg.2012.07.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/12/2012] [Accepted: 07/23/2012] [Indexed: 11/28/2022]
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93
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Thavendiranathan P, Phelan D, Thomas JD, Flamm SD, Marwick TH. Quantitative Assessment of Mitral Regurgitation. J Am Coll Cardiol 2012; 60:1470-83. [DOI: 10.1016/j.jacc.2012.05.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/28/2022]
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94
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Armstrong GT, Plana JC, Zhang N, Srivastava D, Green DM, Ness KK, Daniel Donovan F, Metzger ML, Arevalo A, Durand JB, Joshi V, Hudson MM, Robison LL, Flamm SD. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol 2012; 30:2876-84. [PMID: 22802310 DOI: 10.1200/jco.2011.40.3584] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. PATIENTS AND METHODS Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. RESULTS In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as ≥ 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. CONCLUSION CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.
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95
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Rajiah P, Halliburton SS, Flamm SD. Strategies for dose reduction in cardiovascular computed tomography. APPLIED RADIOLOGY 2012. [DOI: 10.37549/ar1920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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96
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Rajiah P, Schoenhagen P, Mehta D, Ivanc T, Lieber M, Soufan K, Desai M, Flamm SD, Halliburton S. Low-dose, wide-detector array thoracic aortic CT angiography using an iterative reconstruction technique results in improved image quality with lower noise and fewer artifacts. J Cardiovasc Comput Tomogr 2012; 6:205-13. [PMID: 22612906 DOI: 10.1016/j.jcct.2012.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/03/2012] [Accepted: 04/23/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Iterative reconstruction techniques (IRTs) may improve image quality for low-dose imaging compared with filtered back projection (FBP) reconstruction. OBJECTIVES We compared the results of an IRT for low-dose thoracic aortic computed tomography (CT) imaging with those from FBP reconstruction. METHODS Data from 50 patients who underwent 256-slice CT for evaluation of the thoracic aorta were reconstructed with FBP and an IRT (iDose(4)) at 3 noise-reduction strengths (levels 2, 4, and 6). A blinded reader graded image quality (scale, 1-5; 5 = high diagnostic confidence) and the extent of shoulder artifact (scale, 1-5; 5 = no artifact) on all reconstructions. A second reader evaluated a subset of 20 cases to determine interreader and intrareader reproducibility. The mean and SD of attenuation were measured at 5 locations along the thoracic aorta and both subclavian arteries. RESULTS Image noise (SD of attenuation) improved with IRT relative to FBP (aorta: FBP, 31.4 ± 8.6 HU; IRT level 2, 25.1 ± 6.9 HU; level 4, 21.7 ± 6.2 HU; level 6, 17.2 ± 5.4 HU; P < 0.0001; subclavian arteries: FBP, 92.7 ± 34.6 HU; IRT level 2, 50.1 ± 17.1 HU; level 4, 48.9 ± 18.6 HU; level 6, 45.2 ± 19.2 HU; P < 0.0001), whereas mean attenuation was unchanged. Increasing image quality was observed in the aorta and through the shoulders as the contribution from IRT to the final images increased (P < 0.0001). Significant differences were noted between readers in image quality assessment of the aorta but not through the shoulders. CONCLUSION IRT is associated with reduced noise and shoulder artifact and allows for low-dose aortic CT imaging.
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97
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Bolen MA, Setser RM, Gabriel RS, Renapurkar RD, Tandon Y, Lieber ML, Desai MY, Flamm SD. Effect of protocol choice on phase contrast cardiac magnetic resonance flow measurement in the ascending aorta: breath-hold and non-breath-hold. Int J Cardiovasc Imaging 2012; 29:113-20. [PMID: 22527258 DOI: 10.1007/s10554-012-0047-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
Flow assessment with phase contrast magnetic resonance imaging (PC-MRI) protocols is an important component of a comprehensive cardiovascular MR (CMR) assessment. Breath-hold (BH) and non-breath-hold (NBH) PC-MRI protocols are widely available for this imaging modality. Because flow in the great vessels is known to vary with the respiratory cycle, we hypothesized that these 2 approaches might yield different results in the clinical assessment of forward and regurgitant flow in the ascending aorta. Further, given renewed awareness of the possible effect of velocity offsets in PC-MRI, we also sought to evaluate the impact of BH and NBH protocols on this potential source of error. A prospective observational study was performed in 55 consecutive patients referred for clinical CMR of the thoracic aorta. Both BH and NBH protocols were performed at the sinotubular junction and at the mid ascending aorta. Ten additional patients underwent repeated scanning at the mid ascending aorta with both BH and NBH protocols so that protocol variability could be assessed. Finally, ten patients were scanned with both BH and NBH protocols, and phantoms were then imaged with identical imaging parameters so that offset errors associated with each protocol could be evaluated. Forward flow was generally greater with the NBH protocol than with the BH protocol (mean values 102.1 mL vs. 97.9 mL; P = 0.0004). The Bland-Altman limits of agreement were quite wide for all indices (e.g, forward flow, -26.7 mL, +18.2 mL), which suggests that results from BH and NBH protocols cannot be interchanged with confidence. Estimated phase offset errors were similar for both protocols and were generally within acceptable ranges at the mid ascending level, with slightly higher values observed at the sinotubular junction for the BH technique. We observed differences in flow values with BH and NBH protocols for PC-MRI. This finding is relevant to patients imaged serially for the evaluation of cardiac output or valve (aortic or mitral) insufficiency, for whom adherence to one PC-MRI breathing protocol is likely most effective.
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98
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Zurick AO, Bolen MA, Kwon DH, Tan CD, Popovic ZB, Rajeswaran J, Rodriguez ER, Flamm SD, Klein AL. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging 2012; 4:1180-91. [PMID: 22093269 DOI: 10.1016/j.jcmg.2011.08.011] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 08/17/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the prevalence and histopathologic correlates of pericardial delayed hyperenhancement (DHE) seen with cardiac magnetic resonance imaging (CMR) among patients with constrictive pericarditis (CP) undergoing pericardiectomy. BACKGROUND Constrictive pericarditis patients studied by CMR will occasionally demonstrate pericardial DHE following gadolinium contrast administration. METHODS We identified 25 CP patients who underwent pericardiectomy following CMR-gadolinium study. We also assessed 10 control subjects with no evidence of pericardial disease referred for cardiac viability imaging. A novel 14-segment pericardial model was used to determine pericardial DHE score and thickness score. Histopathology of pericardial specimens was reviewed and evaluated semiquantitatively on a 4-point scale for the extent of calcification, fibrosis, inflammation, and neovascularization. RESULTS DHE was present in 12 (48%) CP patients (DHE+ group), and absent in 13 CP patients (DHE- group) and all control patients. The DHE+ group had greater fibroblastic proliferation and neovascularization, as well as more prominent chronic inflammation and granulation tissue. Fibroblastic proliferation and chronic inflammation correlated with DHE presence quantitated by DHE score (Spearman r = 0.578, p < 0.002, and r = 0.590, p < 0.002, respectively), but not with pericardial thickness. Segmental analysis demonstrated no significant difference in the percentage of patients with different pericardial segmental thickness; however, overall, in each segment, the DHE+ group tended to have greater pericardial thickness. CONCLUSIONS The presence of pericardial DHE on CMR is common in patients with CP, and its presence is associated with histological features of organizing pericarditis, which may be a target for future focused pharmacological interventions. Patients with CP without pericardial DHE had more pericardial fibrosis and calcification, as well as lesser degrees of pericardial thickening.
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99
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Kwon DH, Popovic ZB, Rodriguez ER, Halley CM, Starling RC, Desai MY, Marwick T, Flamm SD. Implantable cardioverter defibrillator implantation and degree of left ventricular scarring predict survival in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106733 DOI: 10.1186/1532-429x-13-s1-o91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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100
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To ACY, Karuppasamy K, Roselli EE, Flamm SD. Comprehensive post-operative assessment of apico-aortic conduit for aortic stenosis with cardiac magnetic resonance imaging. J Am Coll Cardiol 2011; 58:1637. [PMID: 21958893 DOI: 10.1016/j.jacc.2011.03.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 03/24/2011] [Indexed: 10/17/2022]
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