Cardiac MRI

The U.K. Clinical Advisory Committee on Diagnostic Imaging has found that CT screening of the colon, heart, and lungs is clinically effective and exposes patients to safe levels of radiation.

Questions remain from practitioners, payers, and administrators regarding the economic impact of coronary CT angiography on established diagnostic modalities and the effects on reimbursement within imaging. To address these concerns, we have developed the CCTA Data Registry, which now consists of more than 20,000 cases. Preliminary results indicate that coronary CTA is being utilized appropriately and affects savings for the healthcare system.

The cardiovascular community has witnessed historic changes in the way cardiovascular disease is evaluated. Recently, the greatest growth has been in cardiac CT to noninvasively diagnose coronary (Figure 1) and noncoronary cardiac disease (Figure 2).

Though the latest generation of 64-slice CT scanners often excels, the technology is still not good enough to confidently assess in-stent restenosis, according to Dr. Stephan Achenbach, a professor of medicine at the University of Erlangen in Germany.

Radiation dose from coronary CT angiography can be dramatically reduced by technologies either currently or soon to be on the U.S. market.

Three-D ultrasound designed for cardiac imaging may be just what interventionalists need to improve the administration of nerve blocks, according to researchers at the Mayo Clinic in Jacksonville, FL.

The American College of Cardiology-backed Task Force on Clinical Competence will extend a certification deadline by two years, enabling more physicians to qualify to perform and interpret cardiac CT.

The inaugural CVI Philadelphia dinner symposium on cardiovascular imaging, held in early August, was deemed a success by organizer Dr. Jeffrey Hellinger, director of cardiovascular imaging and the 3D laboratory at Children’s Hospital of Philadelphia.

A study by University of Maryland researchers has found that CT angiography exams performed after coronary artery bypass surgery can help physicians identify unsuspected, clinically relevant cardiac and noncardiac conditions.

The first substantive clinical trials of dual-source CT suggest it will deliver on a promise to improve the detection of coronary artery disease. A Dutch study published in the August 21 issue of the Journal of the American College of Cardiology found it is 95% sensitive and 95% specific on a per-segment basis for diagnosing significant stenoses.

Cardiac CT angiography holds the key to finding diseases outside of the coronary arteries -- if, that is, diagnosticians are willing to look.

One of the promises of dual-source CT coronary angiography is the ability to scan patients without administering beta blockers. It was reported in the March issue of Diagnostic Imaging, however, that some imagers continue to use beta blockers, albeit with an improved workflow because they don't need to check for optimal heart rate. But several studies recently published and presented at conferences attest to the viability of scanning patients without beta blockers in a variety of cardiac situations.

Though the latest generation of 64-slice CT scanners often excels, the technology is still not good enough for practitioners to confidently assess in-stent restenosis, according to Dr. Stephan Achenbach, a professor of medicine at the University of Erlangen in Germany.

Noninvasive cardiac imaging is gaining widespread acceptance. Both CT and MRI can determine the absence or presence of coronary artery disease accurately and reliably. This is done by either assessing the coronary artery morphology or by offering detailed insight into functional aspects and myocardial perfusion.

Not all those who suffer heart attacks have typical symptoms. Many people, including the elderly, those with renal disease, and women, are at risk of having a silent myocardial infarction. People with diabetes, in particular, are among those at highest risk of experiencing a silent MI. Now there is a clinical MRI technique that can identify abnormal myocardium, which signifies a high-risk profile, in diabetic patients.

The American College of Cardiology-backed Task Force on Clinical Competence will extend a certification deadline by two years, enabling more physicians to qualify to perform and interpret cardiac CT.

An analysis of available data on ionizing radiation effects suggests that 64-slice coronary CT angiography scans put young women at a greater risk of developing cancer later in life than any other patient, according to a study in the July 18 issue of the Journal of the American Medical Association.

Though the latest generation of 64-slice CT scanners often excels, the technology is still not good enough to confidently assess in-stent restenosis, according to Dr. Stephan Achenbach, a professor of medicine at the University of Erlangen in Germany.

Echocardiography is already widely accepted as a diagnostic test for infective endocarditis, but now researchers have proven it’s also a cost-effective option. Making decisions about early surgery for patients with significant stroke risk based on echocardiographic findings is ultimately more economical than standard care.

The future of cardiovascular imaging will hinge more on personalized medicine than on technological developments, according to Dr. J. Jeffrey Carr, who spoke Friday at the 2007 Society of Cardiovascular Computed Tomography meeting in Washington, DC.

Multislice CT evaluations of coronary artery stenosis can calculate the risk of heart-related death for patients with recently diagnosed coronary artery disease. Results are at least as reliable as those presented by conventional myocardial perfusion SPECT imaging.

Eighteen months ago, Dr. David Dowe of Atlantic Medical Imaging in New Jersey was attending a lecture by Dr. Jack Ziffer of Miami Baptist on the challenges of chest pain workups in the emergency setting.

Because of the great potential of cardiac CT angiography for the future of cardiovascular disease diagnosis and management, many physicians have shown an interest in developing expertise in cardiac CT. A number of radiologists and cardiologists have received training in cardiac CT, and many more are planning to obtain such training.

The rapid evolution of cardiac CT has created a compelling need for imagers to fully understand cardiac anatomy as well as the best methods for imaging it.

Researchers are still learning from myocardial perfusion misregistration issues with hybrid SPECT and multislice CT systems. But fusing information acquired on separate scanners using special software seems a practical, clinically useful alternative for the diagnosis of coronary artery disease.