Cardiovascular interest spans clinics, techniques, modalities

The resurgence of interest in noninvasive imaging of the heart and vasculature with CT and MR was reflected in the record attendance at the October 2004 meeting of the North American Society of Cardiac Imaging. Nearly 500 radiologists and cardiologists-double last year's turnout-learned optimal MR sequences, reviewed CT angiography's benefits, and discussed the importance of collaboration between the two groups.

Physicians from various parts of the world shared their experience in running cardiovascular centers. The challenges are many, but so are the rewards. In this conference reporter, we chronicle the success of Dr. Scott Flamm, a radiologist recruited from the Cleveland Clinic five years ago to start a cardiac MR practice in Houston. The key to success, according to Flamm, is knowing the heart, the modality, and referring physicians' needs.

Much research in CT and MR has focused on imaging atherosclerotic lesions. While the pursuit looks promising, we cannot yet predict which plaque will rupture within a few weeks based on CT and MR data. Dr. Marco Costa, director of the cardiovascular imaging core lab at the University of Florida at Jacksonville, presented a snapshot of current research into alternative imaging modalities that can, for example, measure plaques' fibrous cap up to 20 microns thin, well below the 100-micron vulnerable threshold.

Multislice CTA is such a powerful diagnostic tool that entire practices are springing up around this single technique. CTA is literally revolutionizing the way clinicians diagnose, treat, and manage cardiovascular disease. We focus in this report on interventional cardiologist Dr. David E. Allie in Louisiana, who will not perform a procedure on a patient with peripheral vascular disease without first acquiring a CTA examination.

Finally, we take a look at the ongoing debate among clinicians about which noninvasive imaging modality will reign supreme in the cardiovasculature. At a packed Saturday evening dinner, two luminary radiologists duked it out. Dr. Lawrence Boxt from New York City highlighted the advantages of CT, while Dr. J. Paul Finn from Los Angeles carried the mantle for MR. Each side made a compelling case, which could signal more debate and discovery in the years ahead.