MRI & CT 2000-2001

Links

• CT is us
  http://www.ctisus.org/index.html 
  CT is us is a web site created and maintained by The Advanced Medical Imaging Laboratory (AMIL). AMIL is a multidisciplinary team dedicated to research, education, and the advancement of patient care using medical imaging with a focus on spiral CT and 3D imaging. The AMIL is headed by Elliot K. Fishman, M.D., and includes several radiologists, a computer scientist, multimedia developer (Melissa Garland), and a medical illustrator (Frank Corl). The AMIL is part of the Department of Radiology at the Johns Hopkins Medical Institutions in Baltimore, MD. There is a new section on multidetector CT, the newest advance in CT technology. This section is in development, but you can already have excitement by viewing some of our newest capabilities in 3D imaging and CT angiography. 
  Clich here for a brief overview of this technique
• International Society for Magnetic Resonance in Medicine (ISMRM).
  Includes a great list of links. (British Chapter here.)
• Society for Cardiovascular Magnetic Resonance (SCMR)
• The Adelaide MRI Website, by Greg Brown
• www.mrieducation.com 
  A one-stop website that intends to keeps up-to-date with learning resources in the field of Magnetic Resonance Imaging.

CT ANGIOGRAPHY REVIEW
Applied Radiology 29(12):24-29, 2000.
http://cardiology.medscape.com/33259.rhtml?srcmp=card-020201
New advancements in technology, such as multidetector scanners and more powerful computer processors, may allow CTA to replace conventional angiography.

Education in Heart
IMAGING TECHNIQUES: Cardiovascular magnetic resonance
Dudley Pennell
Heart 2001;85 581-589
http://www.heartjnl.com/cgi/content/full/85/5/581

Bracco - Clinical Cases
- MR Angiography

ESC 2001 Meeting Coverage

• Clinical Cardiovascular Magnetic Resonance Today

TCT 2001 Session: Advances in Noninvasive Imaging

• Electron Beam CT: A Valid Screening Option?
• Multiple Cardiac Risk Factors and Atypical Chest Pain: A Case Presentation
• The Asymptomatic Patient: A Case Presentation
• The Case for MRI
• The Case for Nuclear Scintigraphy

TCT 2001 Abstracts

TCTMD - Slide Sets

Cardiovascular Magnetic Resonance	W. Manning
Direct and Indirect Imaging of Vulnerable Plaque: From IVUS to Plaque Characterization to Optical Cohenrence Tomography	P. J. Fitzgerald
The Case for MRI	S. Wolff
Electon Beam CT For the Early Detection of Coronary Artery Disease	A. Guerci

TCTMD - Factoids

Review
Coronary magnetic resonance angiography
Botnar RM, et al.
Cardiol Rev 2001;9:77-87
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11209146 
Free Full Text: http://www.cardiologyinreview.com/article.asp?ISSN=1061-5377&VOL=9&ISS=2&PAGE=77

Coronary Magnetic Resonance Angiography for the Detection of Coronary Stenoses
Kim WY, et al.
N Engl J Med 2001;345:1863-1869
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11756576 

EDITORIALS
Noninvasive Coronary Angiography -- An Acceptable Alternative?
Achenbach S, et al.
N Engl J Med 2001;345:1909-1910
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11756583 

Magnetic resonance angiography accurately assesses integrity of the coronary lumen
http://www.theheart.org/index.cfm?doc_id=27610 
Noninvasive coronary MRA accurately identifies - or rules out - CAD, paticularly left main or three-vessel disease, researchers say. 

Coronary angiography with multi-slice computed tomography
Nieman K, et al.
Lancet 2001;357:599-603
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11558487 

Usefulness of multislice spiral computed tomography angiography for determination of coronary artery stenoses
Knez A, et al.
Am J Cardiol 2001;88:1191-4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11703970 

Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography
Achenbach S, et al.
Circulation 2001;103:2535-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11382719 

Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography (MSCT)
Schroeder S, et al.
J Am Coll Cardiol 2001;37:1430-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11300457
This study indicates that coronary lesion configuration might be correctly differentiated by MSCT. Since also rupture-prone soft plaques can be detected by MSCT, this noninvasive method might become an important diagnostic tool for risk stratification in the near future.

Contrast-Enhanced MR Angiography Effective For Evaluating Cervical Vessels
Contrast-enhanced magnetic resonance angiography (CEMRA) is effective in assessing patients with suspected carotid or vertebral disease and can avoid the potential complications of standard angiography, according to a report in the October issue of Stroke.
http://www.medscape.com/43636.rhtml?srcmp=Card-101201

Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis
Boudewijn G, et al.
Ann Intern Med 2001;135:401-11
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11560453 
Gadolinium enhanced MRA or contrast CT are the best ways to detect renal artery stenosis In unselected hypertensives, 1–5% will have renovascular hypertension. The gold standard for detection is considered to be invasive angiography. A survey of the literature on computed tomography (CT), magnetic resonance angiography (MRA), captopril enhanced scintigraphy, and ultrasonography concludes that gadolinium enhanced MRA and contrast enhanced CT are probably the best non-invasive ways to detect renal artery stenosis.

Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography
Schwitter J, et al.
Circulation 2001;103:2230-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11342469
The presented MR approach reliably identifies patients with coronary artery stenoses and provides information on the amount of compromised myocardium, even when perfusion abnormalities are confined to the subendocardial layer. This modality may qualify for its clinical application in the management of coronary artery disease.

Magnetic resonance imaging demonstrates improved regional systolic wall motion and thickening and myocardial perfusion of myocardial territories treated by laser myocardial revascularization
Laham RJ, et al.
J Am Coll Cardiol 2002;39:1-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11755279 

CLINICAL COMMENTARY - RADIOLOGY 2002: NEAR TERM ADVANCES IN MEDICAL IMAGING
Dr. William G. Bradley, who has been at the epicenter of innovations in radiology for decades, highlights advances in imaging that will have a profound effect on health care in 2002.
Medscape Radiology, 2001
http://cardiology.medscape.com/46340.rhtml?srcmp=card-122101

CT SCANS HELP DIFFERENTIATE SYNDROME X AND CORONARY ARTERY DISEASE
Coronary calcification detected by electron-beam computed tomography (EBCT) may be helpful in distinguishing between syndrome X and coronary artery disease (CAD) in certain patients, according to Taiwanese researchers.
http://cardiology.medscape.com/46197.rhtml?srcmp=card-122101

RSNA News - December 2000
New technology brings long-awaited cardiac applications of CT and MR to reality 
  Radiology Gets a Fresh Look at Cardiac Imaging
  Reprinted with permission from the American College of Radiology
  ACR Bulletin, February 2000, Volume 56, Issue 2. ©2000 
  Click here to view the full article
"If you had a time machine and went forward 10 years, I think you would find it [cardiac MR imaging] to be commonplace," Jeffrey C. Weinreb, M.D. (Professor and co-chair of radiology at New York University School of Medicine and chair of the ACR MRI Accreditation program) says. "It is a huge growth area."

RSNA News - December 2000
Multislice spiral CT promises to offer speed, safety, and superior images
  Click here to view the full article
Multidetector row CT promises to have a major impact on the practice of radiology in the 21st century, with its potential for an array of clinical innovations, from angiography and surgical planning to the diagnosis of trauma and stroke, and, particularly, cardiac imaging. 
At the annual scientific program of the Radiological Society of North America held here, radiologists explored applications of multislice spiral CT in the chest during a special focus session. 
Session chair Dr Pablo R Ros (Harvard Medical School, Boston, MA) outlined the advantages and limitations of the technology that he characterized as an "exciting new tool." He said it will have the biggest impact in the chest, although there are a spectrum of clinical applications.

Review 
Electron Beam (Ultrafast) CT for the Evaluation of Cardiac Disease and Function
  JA Rumberger PhD MD Clinical Professor of Medicine Ohio State University
  [UpToDate © 2000]
  Click here to view the full article
EBCT functions as a body scanner performing high resolution imaging of the thorax in much the same fashion as standard and spiral CT devices. Review of the current status of the use of EBCT for these purposes. 

Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT
  Carr JJ et al.
  AJR 2000;174:915-921
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010749222  
A general purpose, current generation helical CT scanner equipped for retrospective cardiac gating can accurately quantify coronary calcium, and the results are highly correlated to scores obtained with electron beam CT.

Interscan Variation in Coronary Artery Calcium Quantification in a Large Asymptomatic Patient Population
  Yoon HC et al.
  AJR 2000;174:803-809 
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010701629 
Interscan variation remains an important limitation of electron beam CT in the examination of asymptomatic patients.

American College of Cardiology/ American Heart Association Expert Consensus Document on Electron Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease
  O'Rourke RA Brundage BH Froelicher VF et al.
  Circulation 2000; 102:126-140
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010880426 
Although preliminary data are intriguing with respect to risk prediction in the asymptomatic patient, available data are insufficient to support recommending EBCT to asymptomatic members of the general public or for routine clinical use. Further studies are enthusiastically recommended for determining the additive predictive effect of the calcium score in patients with intermediate risk, particularly in the elderly. The use of EBCT in selected asymptomatic patients can be justified when performed in the context of a medical assessment only after the more standard cardiac risk assessment is considered insufficient by the physician to direct further therapy plans.

• a negative EBCT makes the presence of atherosclerotic plaque, including unstable plaque, very unlikely.
• a negative test is highly unlikely in the presence of significant luminal obstructive disease.
• negative tests occur in the majority of patients who have angiographically normal coronary arteries.
• a negative test may be consistent with a low risk of a cardiovascular event in the next 2 to 5 years.
• a positive EBCT confirms the presence of a coronary atherosclerotic plaque.
• the greater the amount of calcium, the greater the likelihood of occlusive CAD, but there is not a 1- to -1 relationship, and findings may not be site specific.
• the total amount of calcium correlates best with the total amount of atherosclerotic plaque, although the true "plaque burden" is underestimated.
• a high calcium score may be consistent with moderate to high risk of a cardiovascular event within the next 2 to 5 years.
  

Prediction of coronary events with electron beam computed tomography
  Arad Y et al.
  J Am Coll Cardiol 2000;36:1253-60
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011028480 
In asymptomatic adults, EBCT of the coronary arteries predicts coronary death and nonfatal MI and the need for revascularization procedures. Click here to view the Synopsis

MRI in the diagnosis of Ischemic Heart Disease
  David A Bluemke MD PhD E.A. Zerhouni MD
  http://www.mri.jhu.edu/~dbluemke/Cardiac_MRI.html 
Investigators at the Johns Hopkins Hospital are conducting extensive research in the diagnosis of coronary artery disease using MRI. MRI has excellent potential to become the noninvasive test of choice to diagnose disease of the coronary arteries. In this article,  the background of coronary MR angiography and ongoing research efforts are discussed. 

Magnetic resonance-based assessment of global coronary flow and flow reserve and its relation to left ventricular functional parameters: a comparison with positron emission tomography
  Schwitter J et al.
  Circulation 2000;101:2696-702
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010851206 
A novel application for MRI technology may provide some clues to the altered coronary hemodynamics seen in a range of left ventricular diseases. This research suggests that phase-contrast MRI can quantify myocardial blood flow in normal hearts, yielding measurements that match those obtained using positron emission tomography. Add this data to MRI-derived information of contractility and loading, and things start to look interesting.... 
  See additional comments at heartwire > News Click here

Assessment of coronary arterial restenosis with phase-contrast magnetic resonance imaging measurements of coronary flow reserve
  Hundley WG et al.
  Circulation 2000;101:2375-81
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010821813  
Assessments of coronary flow reserve with PC- MRI can be used to identify flow-limiting stenoses (luminal diameter narrowings >70%) in patients with recurrent chest pain in the months after a successful percutaneous intervention.

From TCTMD 

• Improvement of Myocardial Perfusion Reserve Early After Coronary Intervention: Assessment With Cardiac MRI
    by N. Al-Saadi Click here
• Contractile Reserve and Contrast Uptake Pattern by MRI and Functional Recovery After Reperfused MI
    by C. Kramer Click here

Case Report - Cardiovascular Magnetic Resonance
http://www.escardio.org/wg26/case_study/006/description.htm
This case deals with the detection of myocardial ischaemia with adenosine perfusion. Discover the description of this case, including two short movies showing perfusion images at rest and with adenosine stimulation