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Gohmann RF, Sieren MM, Gutberlet M. [Computed tomography and magnetic resonance imaging in cardiac diagnostics-how to choose the right modality : A guide based on the new guidelines of the European Society of Cardiology (ESC)]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:902-911. [PMID: 36222875 PMCID: PMC9613581 DOI: 10.1007/s00117-022-01066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/05/2022]
Abstract
In the guideline updates of the European Society of Cardiology (ESC), noninvasive radiological cross-sectional imaging is taking an increasingly prominent role, while at the same time invasive diagnostic approaches are becoming less important. Especially for the diagnosis and treatment of chronic and acute coronary syndromes, there are fundamental changes in clinical routine. In addition, cross-sectional imaging also offers an alternative to diagnostic algorithms for other cardiac pathologies, especially echocardiography, which is increasingly used in the differential diagnosis of cardiac diseases. The radiologist should be aware of the recommendations of the current guidelines and encourage their establishment in clinical practice. This paper summarizes the indications of cross-sectional cardiac imaging with focus on new recommendations in the ESC guidelines and addresses specific strengths and weaknesses of each modality.
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Affiliation(s)
- Robin F Gohmann
- Abteilung für Diagnostische und, Interventionelle Radiologie, Herzzentrum Leipzig GmbH, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Malte M Sieren
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Matthias Gutberlet
- Abteilung für Diagnostische und, Interventionelle Radiologie, Herzzentrum Leipzig GmbH, Strümpellstr. 39, 04289, Leipzig, Deutschland
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Abstract
Klinisches Problem Rauchen beeinflusst das kardiovaskuläre System des Körpers. Primär führt es entweder zu atheromatösen Plaques mit potenzieller Gefäßstenosierung oder zu aneurysmatischen Gefäßveränderungen mit potenzieller Rupturgefahr. Radiologische Standardverfahren Je nach Lokalisation ermöglicht die Sonographie eine initiale Einschätzung der Veränderungen. Eine Angiographie in Kombination mit Computertomographie (CT) oder Magnetresonanztomographie (MRT) ermöglicht die weiterführende Beurteilung und ggf. Therapieplanung. Ohne klinische Symptomatik wird bei Rauchern ohne sonstige Risikofaktoren oder Komorbiditäten keine bildgebende Diagnostik lediglich aufgrund des Rauchens empfohlen. Methodische Innovationen Aktuelle Leitlinien der entsprechenden Pathologien erkennen das Rauchen einstimmig als modifizierbaren Risikofaktor für kardiovaskuläre Erkrankungen an, weshalb stets eine Raucherentwöhnung als erster Schritt zur Prävention sekundärer Akutereignisse empfohlen wird. Bei Verdacht auf ein chronisches Koronarsyndrom erhöht das Rauchen die klinische Wahrscheinlichkeit, wodurch eher eine bildgebende Diagnostik indiziert werden sollte. Leistungsfähigkeit Obwohl das Rauchen weitreichende Folgen am gesamten kardiovaskulären System zeigt, bleibt zu klären, ob Raucher durch eine Modifikation aktueller Leitlinien zur Vorsorge und Diagnose hinsichtlich harter klinischer Endpunkte profitieren würden. Empfehlung für die Praxis Raucher sollten aufgrund des deutlich erhöhten kardiovaskulären Risikos zu einer Raucherentwöhnung beraten werden. Hinsichtlich konkreter Krankheitsbilder bedingt das Rauchen keine prinzipielle Modifikation der bildgebenden Abklärung, bei intermediärem Risiko kann aber tendenziell früher zur Bildgebung geraten werden.
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Affiliation(s)
- Mathias Pamminger
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Agnes Mayr
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Sieren MM, Maintz D, Gutberlet M, Krombach GA, Bamberg F, Hunold P, Lehmkuhl L, Fischbach K, Reinartz S, Antoch G, Barkhausen J, Sandstede J, Völker M, Naehle C. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. ROFO-FORTSCHR RONTG 2021; 194:181-191. [PMID: 34384112 DOI: 10.1055/a-1554-9236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany. MATERIALS AND METHODS Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry. RESULTS 71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants. CONCLUSION This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future. KEY POINTS · High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the dissemination & deepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI.. CITATION FORMAT · Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1554-9236.
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Affiliation(s)
- Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - David Maintz
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
| | - Matthias Gutberlet
- Department for Diagnostic and Interventional Radiology, Heart Center Leipzig - University Leipzig, Germany.,Steering Committee Chair MRCT-Registry of the ESCR, ESCR, Vienna, Austria
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University-Hospital Gießen, Germany
| | - Fabian Bamberg
- Department for Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Peter Hunold
- n/a, FOKUS Radiologie & Nuklearmedizin, Göttingen, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - Katharina Fischbach
- Diagnostische Radiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.,Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Sebastian Reinartz
- Department for Diagnostic and Interventional Radiology, University Hospital Aachen, Germany
| | - Gerald Antoch
- Department for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jörn Sandstede
- Hamburg Wördemanns Weg, Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e.V. (BDR), Munich, Germany
| | - Martin Völker
- Bereich Wissenschaft, Nachwuchsförderung, Zertifizierung, German Roentgen Society "Deutsche Röntgengesellschaft", Berlin, Germany
| | - Claas Naehle
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
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