Cardiac MRI

Radiologists must embrace cardiac imaging, especially coronary CT angiography, but many are hesitant to do so, according to Dr. Kerry M. Link, a professor of radiology, cardiology, regenerative medicine, and biomedical engineering at Wake Forest University Health Science Center in Winston-Salem, NC.

As a practicing radiologist for 28 years, I was happy to see the Point/Counterpoint repartee between Dr. Carter Newton and Dr. David Dowe in Diagnostic Imaging (September 2006, pages 24 and 25) regarding cardiac CT angiography. It's time the radiology community and the medical community at large understand the difference between real imaging professionals and doctors who believe that cardiac imaging is some type of divine entitlement.

GE Healthcare's latest invention, SnapShot Cine, is a multislice CT software enhancement that borrows its method from the days of axial scanning. The big difference is that it cuts the x-ray dose for cardiac scans by 70% or more compared with conventional CT.

I have been performing CT angiography of the coronary arteries since 1993, mainly at the University of Erlangen-Nuremberg. Collaboration with radiologists has been good from the start. I know of several other hospitals in Germany where cardiac CTA works similarly well, but I also know of many where it does not. Why the difference?

Cardiologists impressed by the diagnostic power of PET/CT are beginning to recognize its clinical importance. In sites where the transition from PET to PET/CT has been made, rising cardiac PET imaging volumes have followed.

Studies presented at the RSNA meeting suggest that the promise of dual-source CT will be fulfilled by a big boost in temporal resolution and a corresponding increase in its sensitivity to coronary artery disease.

Software upgrades introduced by GE Healthcare this week for the company's LightSpeed VCT scanner promise to cut patient x-ray dose for coronary CT angiography by 70% or more and double the area covered during dynamic angiography and perfusion.

Sixty-four-slice cardiac CT may be the most disruptive technology to hit coronary artery imaging since the introduction of SPECT. And its influence does not end at the diagnosis of atherosclerotic coronary artery disease.

Officials from the American College of Radiology and the American College of Cardiology, along with other interested stakeholders, have published a consensus report defining quality for all cardiovascular imaging modalities. They say that the focus on quality in cardiovascular imaging has been less intense than in other areas of cardiovascular medicine.

Advances in spatial, temporal resolution should help CT provide better functional, anatomic information

Advances in multislice CT, particularly the improved spatial and temporal resolution of 64-slice scanners, have changed the dynamics of cardiac imaging, seemingly overnight.

In a move calculated to open doors for CT as a cardiac screening tool, GE Healthcare will market a software upgrade for its LightSpeed VCT that will dramatically reduce the radiation dose patients receive during cardiac CT.

Calcium scores not only reveal calcified plaque, they also show noncalcified plaque with a good positive predictive value, according to a study presented at the North American Society for Cardiac Imaging meeting in Las Vegas this week.

A high number of extracardiac findings in patients who undergo CT scans are clinically important, according to a study of 963 patients presented at the North American Society for Cardiac Imaging meeting in Las Vegas this week.

Docs stuck trying to manipulate pull-down menus, adjusting windows, and leveling cardiac images can take heart. A new start-up firm in Durham, NC, has designed a cardiovascular image management system to help.

Focal renal mass procedure has few complications, shows high PPV for diagnosis of renal malignancy

Fusion SPECT/CT images may be better than multislice CT alone for evaluating patients with suspected myocardial infarction.

Junior high school student with proper training could read certain cardiac CT studies

Cardiovascular imaging demands new skills and a new focus from imaging technologists. While technologists evince plenty of interest in cardiovascular imaging, training opportunities remain in the early stages.

In this issue, legal columnist Thomas Greeson wades squarely into one of radiology's hottest topics today: cardiac CT overreads by radiologists. Under such scenarios, cardiologists interpret images of the heart and related vessels and leave the rest of the chest to radiologists. These marriages of convenience are strongly promoted in some quarters as avoiding destructive turf battles and assuring that patients get the best possible care following a chest CT scan.

Stress echocardiography can accurately predict the onset of cardiovascular disease in patients waiting for kidney transplants, according to a study presented in June at the American Society of Echocardiography meeting.

The third phase of clinical PET adoption appears imminent and Integrated Cardiac Solutions intends to be ahead of the curve.

Echocardiography has unearthed links among morbid pediatric obesity, sleep disorders, and potentially fatal -- often hidden -- pulmonary hypertension, according to a study presented in June at the American Society of Echocardiography meeting.

Figuring out how to treat postinfarction left ventricular remodeling using delayed-enhancement cardiac MR is not so cut and dried as it seems. Bright signal may signify dead myocardial tissue during DE-MR viability studies, but bright and dark myocardium both have stories to tell when dealing with remodeling.

Adenosine rest-stress perfusion may represent nearly half the imaging volume at some clinics, but due to safety questions some physicians are sticking with dobutamine for pharmacological stress testing.

In cardiac catheterization, it's known as the money shot: coronaries floating in space with the shadow of the heart behind them. It is also the hardest shot to get, because of the amount of tissue that x-rays must penetrate. As patients get larger, the going gets tougher. But for MRI, capturing this shot has become a piece of cake.

Figuring out how to treat postinfarction left ventricular remodeling using delayed-enhancement cardiac MR is not so cut and dried as it seems. Bright signal may signify dead myocardial tissue during DE-MR viability studies, but bright and dark myocardium both have stories to tell when dealing with remodeling.

New research conducted in Europe may guide strategies that determine the best time and optimal tools for coronary interventions. Results from one multicenter trial indicate that early intervention is better than a wait-and-watch policy for patients with partial vessel occlusion. Meanwhile, a Swiss team has published data questioning the cost-effectiveness of drug-eluting stents for revascularization.

Philips Medical Systems was the undisputed global provider of cardiac cath imaging systems in 2005, a crown the company has worn for more than a few years. But being king of cardiovascular imaging is no longer enough.