New MR software supports functional analysis of heart

Cardiac MR could get a boost from the commercial release of a software package designed to support the functional analysis of multislice, multiphase images of the heart. The new CAAS MRV (cardiovascular angiography analysis system MR ventricular) imports cine MR data sets of the heart from MR scanners, then analyzes the inner and outer walls of the ventricles to calculate ventricular volume, ejection fraction, and other parameters.

CAAS MRV, which cleared the FDA on July 27, can support routine clinical, as well as academic, studies of the heart. Quantitative analyses of the heart may be used not only in the diagnosis of ischemic heart disease but also to measure patient response to medical or interventional therapy.

The software tool is the latest in a string of analytical programs developed by Pie Medical Imaging of Maastricht, the Netherlands. Earlier products, the first of which was launched 20 years ago, have become staples in the practice of cardiac cath.

Other companies have produced analytical packages for cardiac MR, but CAAS MRV offers advantages. CAAS MRV software is more reliable and easier to use, according to Casper Bouman, Pie Medical sales manager. Processing is typically completed in less than 10 minutes, although the actual time depends on the quality and number of cine images.

"We try to get the results as fast and as easily as possible," he said.

Two university hospitals, one in Antwerp, Belgium, the other in Rotterdam, the Netherlands, are already using the package. Now, with FDA clearance in hand, Pie Medical Imaging will actively seek U.S. customers. CAAS MRV is priced under $50,000-less than competing products, according to Bouman.

The development of CAAS MRV, however, is part of a broader strategy that involves creating an intravascular contrast agent for MR. The agent, being developed by Bracco, parent of Pie Medical Imaging, might enhance the MR signal enough to allow myocardial perfusion and, ultimately, MR coronary angiography. In concert with CAAS MRV, the agent might allow the definitive diagnosis of ischemic heart disease without invasive procedures such as cardiac cath. A perfusion algorithm to evaluate myocardial viability is the next step in the evolution of the software, according to Bouman.

The company is also planning to extend its product portfolio to include analytical software for CT. A CAAS product designed specifically for CT coronary angiography could be on the market next year, Bouman said. Pie Medical has already created a version of CAAS for intravascular ultrasound.

Over the past two decades, the company has forged a global reputation as a developer of medical software with the release of quantitative analysis tools for cardiology. Its first CAAS product, released in 1984, has grown through regular upgrades to become a standard for accurately and reproducibly measuring the dimensions of coronary arteries and other blood vessels, as well as analyzing left and right ventricular function.

Early but powerful versions of CAAS software are typically applied at teaching hospitals to establish their utility. The software may then evolve into a package optimized for general use. CAAS quantitative coronary analysis, for example, is available in two versions: one for general use, which typically is bundled with cardiac cath equipment sold by OEMs including Siemens and Philips; the other incorporating advanced features more suited for university hospitals, which is sold directly by Pie Medical Imaging.

So far, the company has developed only one version of CAAS MRV. This fully featured product is aimed at advanced users.

"But we will probably develop two versions, a clinical one for OEMs and the other for direct sale," Bouman said.

The company, a sister to Pie Medical Equipment, which makes diagnostic ultrasound equipment, is a member of the Bracco Group. Its software engineers seek feedback from users to refine capabilities while evolving the software to work with new computing platforms, most recently desktop systems.

CAAS MRV automatically segments the inner and outer left ventricular wall of the heart on all short-axis images in both time and space. Heart wall contours allow functional parameters to be calculated. These include ventricular volume, stroke volume, ejection fraction, wall motion, and wall thickening.

Functional data are presented numerically and graphically with interactive 3D visualization of the heart. PACS compatibility is an option.

CT-based software to assess the coronaries is now in development. With the coming release of 40- and 64-slice scanners, Bouman believes CT holds more promise than MR, when it comes to the coronaries.

"The general expectation in the market is that the analysis of big shapes, like the heart, will be done mostly with MR," Bouman said. "And coronary arteries will probably be done with CT."