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Cardiac Radiology
CA001-EB-X
On-site CT Derived Fractional Flow Reserve: An In-Depth Methodological Background and Practical Tips and
Tricks
All Day Location: CA Community, Learning Center
FDA
Discussions may include off-label uses.
Participants
Adriaan Coenen, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Marisa M. Lubbers, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Raluca G. Saru, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Atsushi K. Kono, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
Admir Dedic, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Marcel L. Dijkshoorn, RT, Rotterdam, Netherlands (Abstract Co-Author) Consultant, Siemens AG
Robert J. Van Geuns, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Gabriel P. Krestin, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Consultant, General Electric Company; Research Grant,
General Electric Company; Research Grant, Bayer AG; Research Grant, Siemens AG; Speakers Bureau, Siemens AG
TEACHING POINTS
Background methodology on how reduced order computational fluid dynamics is applied to the coronary circulation using coronary
CT angiography data. Practical step wise approach, showing the segmentation of the coronary artery three, myocardial mass, and
interpretation of the color coded CT derived FFR map.
TABLE OF CONTENTS/OUTLINE
Computational fluid dynamics in coronary circulation Segmentation of the coronary artery tree Simulation of hyperemic state. Tips
and tricks related to segmentation of the coronary artery lumen in the presence of coronary artery plaque Brief overview of results
with on-site CT derived FFR
CA002-EB-X
Multimodality Imaging Assessment of Takotsubo Cardiomyopathy
All Day Location: CA Community, Learning Center
Participants
Ausami Abbas, MBBS, Edmonton, AB (Presenter) Nothing to Disclose
Emer Sonnex, Edmonton, AB (Abstract Co-Author) Nothing to Disclose
Richard A. Coulden, MD, Edmonton, AB (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Takotsubo cardiomyopathy is a reversible condition, often precipitated by severe emotional and physical stress. It is frequently
difficult to distinguish from acute coronary syndrome (ACS) on the basis of clinical assessment and ECG. Imaging is central to
diagnosis. This educational exhibit will provide the reader with a comprehensive understanding of:1. The diagnostic imaging features
of takotsubo cardiomyopathy and its acute complications.2. How to confidently differentiate takotsubo cardiomyopathy from acute
coronary syndrome.3. The role of different imaging modalities in the diagnosis & follow-up of takotsubo cardiomyopathy.
TABLE OF CONTENTS/OUTLINE
1. Clinical presentation of takotsubo cardiomyopathy and its similarity to ACS.2. Characteristic imaging features of takotsubo
cardiomyopathy, including:• Apical ventricular akinesia and ballooning• Circumferential transmural myocardial oedema in a nonvascular distribution3. Relative role of catheter angiography, echocardiography and MRI in the diagnosis and follow-up of takotsubo
cardiomyopathy.
CA003-EB-X
Hold the Contrast, Please: A Tailored, Non-contrast MR Approach for Evaluation of Thoracic Aortic Disease
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Paul G. Peterson, MD, Bethesda, MD (Presenter) Nothing to Disclose
John Lichtenberger, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Matthew Lutynski, DO, Rockville, MD (Abstract Co-Author) Nothing to Disclose
Michael Huppmann, MD, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Robert A. Liotta, MD, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Vincent B. Ho, MD, MBA, Bethesda, MD (Abstract Co-Author) In-kind support, General Electric Company
TEACHING POINTS
1) Thoracic aortic MR protocols can be streamlined and tailored to the most common indications without sacrificing a
comprehensive evaluation 2) Non-contrast MRI/MRA offers a large amount of information on aortic dimensions and flow as well as
cardiac functional analysis without requiring the use of ionizing radiation or intravenous contrast media
TABLE OF CONTENTS/OUTLINE
BackgroundProtocolsScreening and Surveillance for Thoracic Aortic Disease (aneurysm and/or dissection) - First degree relatives of
patients with thoracic aortic disease - Isolated arch aneurysms less than 4 cm: every 12 months - Isolated arch aneurysms greater
than 4 cm: every 6 months - Marfan Syndrome + Up to 4.4 cm: every 12 month + 4.5 cm or greater: every 6 months - Loeys-Dietz
Syndrome: every 12 months - Turner's: every 5-10 yearsBicuspid Aortic ValveCoarctation of the AortaSurgical thresholds - 5.5 cm
aortic diameter (asymptomatic patients with degenerative thoracic aortic aneurysm, chronic dissection, etc.) - 4-5 cm aortic
diameter + Undergoing bicuspid aortic valve repair/replacement: 4.5 cm + Marfan syndrome female considering pregnancy: greater
than 4 cm + Loeys-Dietz: greater than 4.4 cm + Ratio of maximal aortic area in cm2/height in meters > 10 - Growth rate greater
than 0.5 cm/year even if less than threshold diameter - Pediatrics
CA004-EB-X
Recent Developments in Multimodal Imaging of the Right Ventricle: Toward a Non-invasive Imaging-based
Cardiac Monitoring
All Day Location: CA Community, Learning Center
Participants
Thomas Giraudmaillet, MD, Toulouse, France (Presenter) Nothing to Disclose
Charline Zadro, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Fatima-Zohra Mokrane, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Marie Agnes Marachet, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Herve P. Rousseau, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Laurent Dercle, MD, Villejuif, France (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Recent advances in echocardiography (US), cardiac magnetic resonance imaging (CMR), computed tomography, positron emission
tomography (CT), myocardial perfusion single photon emission computed tomography (MPS) and gated blood pool SPECT (GPBS)
allow an accurate and non-invasive, in vivo assessment of the right ventricle. Medical imaging is determinant for the riskstratification, the management, the treatment (choice and response) and the prognosis of patients. The diagnosis of a right
ventricular dysfunction is thus crucial. However, the modeling and the evaluation of the right ventricle remain challenges, especially
in case of cardiomyopathy.This report describes key facts that the radiologist should know in daily clinical practice. 1. Anatomy,
function and pathology of the right ventricle. 2. Radiologic-pathology correlation in cardiomyopathies. 3. Advantages, limitations
and indications of imaging techniques.
TABLE OF CONTENTS/OUTLINE
I. ANATOMY II. FUNCTION III. PHYSIOPATHOLOGYIV. CARDIOMYOPATHIES: RADIOLOGIC-PATHOLOGY CORRELATION 1. RVEF 2.
HEART FAILURE 3. ARRHYTHMOGENIC DISEASE 4. CONGENITAL DISEASEV. IMAGING MODALITIES 1. ULTRASOUND 2. CT-SCAN 3.
MRI 4. MYOCARDIAL PERFUSION SPECT 5. FDG-PET 6. RADIONUCLIDE VENTRICULOGRAPHY
CA006-EB-X
Common Artifacts in MRI Viability Imaging and How to Avoid Them
All Day Location: CA Community, Learning Center
Participants
El-Sayed H. Ibrahim, PhD, MSc, Ann Arbor, MI (Presenter) Nothing to Disclose
Nancy Dudek, RT, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Dejan Jakimovski, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Jadranka Stojanovska, MD, MS, Northville, MI (Abstract Co-Author) Nothing to Disclose
Mohamed M. Sayyouh, MBBCh, MSc, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
James Wagner, RT, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Mike Braid, RT, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Anil K. Attili, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Review the principles of viability imaging with late gadolinium enhancement (LGE) MRI. 2. Review and illustrate the sources of
common artifacts in LGE imaging. 3. Describe different strategies for optimizing the imaging parameters to eliminate artifacts in LGE
MRI imaging for accurate evaluation of the myocardial scar.
TABLE OF CONTENTS/OUTLINE
Magnetic resonance imaging (MRI) late gadolinium enhancement (LGE) imaging is an effective technique for scar visualization in
both ischemic and non-ischemic heart diseases. When optimally performed, LGE shows bright scar and dark non-scar tissues,
allowing for clear identification of the myocardial scar with high spatial and contrast resolution. Nevertheless, inappropriate settings
of the imaging parameters may lead to inverse or reduced scar-myocardium contrast, with suboptimal scar visualization and
inaccurate measurement of its size, especially in small scars. Therefore, understanding of the sources of these artifacts and
strategies to alleviate them is essential for proper LGE imaging. Herein, we describe and illustrate cases acquired with LGE image
artifacts due to inappropriate setting of the imaging parameters, as well as the imaging protocol modifications needed to alleviate
these artifacts.
CA007-EB-X
Hemodynamic Measurements Using 4D PC-MRI: Quantification of Wall Shear Stress, Helicity and Turbulence of
Blood Flow
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Hojin Ha, Pohang, Korea, Republic Of (Presenter) Nothing to Disclose
Guk-Bae Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jihoon Kweon, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Jung Koo, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young-Hak Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Namkug Kim, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Stockholder, Coreline Soft, Inc
Dong Hyun Yang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
We will review a basic principle of 4D PC-MRI focused on quantifications of hemodynamic parameters. We will provide practical
guidelines of 4D PC-MRI measurements for obtaining successful results. We will introduce applications of 4D PC-MRI for diagnosing
abnormal hemodynamics in-vivo and-in vitro.
TABLE OF CONTENTS/OUTLINE
Introduction of 4D PC-MRI. Procedure for 4D PC-MRI: determination of proper acquisition parameters, reduction source of errors,
compromise of scan time. Quantification method of blood flow: estimation of wall shear stress, helicity and turbulent intensity: invitro and in-vivo results Prospect of 4D PC-MRI: current outcomes, technical obstacles and potentials.
CA008-EB-X
Ejection Fraction is Not as Good as Trusted for the Estimation of Left Ventricular Systolic Function
All Day Location: CA Community, Learning Center
Participants
Jan Malik, Prague, Czech Republic (Presenter) Nothing to Disclose
Jan Kavan, MD, Prague, Czech Republic (Abstract Co-Author) Nothing to Disclose
Lukas Lambert, MD, PhD, Prague, Czech Republic (Abstract Co-Author) Nothing to Disclose
Jiri Weichet, MD, Prague 5, Czech Republic (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Heart disease of ESRD patients is a common complication, frequently leading to death. LVEF is the most frequently use measure.
Variables describing the left ventricular structure and function, obtained by various imaging methods, significantly affect the choice
of treatment and its invasiveness, choice of dialysis access etc. The major limitations include: Stroke volume is the main parameter
and when multiplied by the heart rate, it gives cardiac output. Dilated left ventricle could produce sufficient stroke volume even in
low LVEF. LVEF overestimates the systolic function in case of aortic or mitral regurgitation. Regurgitation volume should be
subtracted LVEF could be temporarily reduced by stunning as a result of dialysis or of coronary artery disease LVEF depends on
actual preload (hydration status, time interval since the last hemodialysis) and afterload (~systemic blood pressure) Left ventricular
filling depends both on the diastolic function and on the length of diastolic phase; the latter shortens in tachycardia, when LVEF
underestimates the systolic function In arrhythmias, mostly in atrial fibrillation, LVEF differs from one cycle to another
TABLE OF CONTENTS/OUTLINE
The aforementioned limitations will be discussed in detail and the mechanisms will be explained LVEF is much more dynamic
parameter than is generally known
CA009-EB-X
Excess Ectopic Fat Depots and Association with Coronary Atherosclerosis: Lessons from ROMICAT I/II and
the Framingham Heart Study
All Day Location: CA Community, Learning Center
Participants
Travis R. Hallett, BA, Boston, MA (Presenter) Nothing to Disclose
Jakob Park, Boston, MA (Abstract Co-Author) Nothing to Disclose
Khristine Ghemigian, BA, Boston, MA (Abstract Co-Author) Nothing to Disclose
Maros Ferencik, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael T. Lu, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Learn how to measure pericardial, liver, visceral, and subcutaneous fat on CT2) Review the association with coronary
atherosclerosis for these fat depots
TABLE OF CONTENTS/OUTLINE
1) Ectopic fat depots can be measured on CT2) Pericardial fat can be quantified with many different software packages Pericardial: defined as fat surrounding the heart -Epicardial: defined as fat within the pericardium3) Liver can be assessed for
steatosis (fatty infiltration) -Steatosis defined as lower liver attenuation than spleen attenuation4) Subcutaneous and visceral
adipose tissue volumes can be calculated using many different software packages5) These fat depots are associated with coronary
atherosclerosis in the Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography (ROMICAT I/II) trials and the
Framingham Heart Study
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
CA010-EB-X
Gateway to the Arch: 3D-printed Models in Repair of Interrupted Aortic Arch
All Day Location: CA Community, Learning Center
Participants
Wilson T. King, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Michael Moritz, MD, Saint Louis, MO (Presenter) Nothing to Disclose
Sridhar Condoor, PhD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Nadeem Parkar, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To explain how modern 3D printing technology allows conversion DICOM data into detailed 3D models.2. To discuss how these
models are useful in preoperative planning and resident/student education.
TABLE OF CONTENTS/OUTLINE
Introduction: • Preoperative planning in complex congenital heart surgery. • Current 2D and 3D image display techniques. •
Converting DICOM data into physical models.Cases:1. BC• 2 week old girl with VACTERL.• 3D-printed model of the type B IAA,
aortic stenosis, and VSD.• Complete repair of arch and VSD closure.2. RA• 7 day old boy with complex congenital heart disease.•
3D-printed model of type 1 truncus arteriosis, hypoplastic ascending aorta with anomalous single coronary artery, type B IAA, ASD,
and VSD. • Truncus and IAA repair with RV to PA conduit, ASD and VSD closure.Summary: • Discuss why surgeons may prefer 3D
printed models.• Discuss future directions of 3D printing in both everyday practice and education.
CA100-ED-X
Artifacts in Cardiac CT- Physics and Solutions
All Day Location: CA Community, Learning Center
Awards
Identified for RadioGraphics
Participants
Ji Y. Buethe, MD, Cleveland, OH (Abstract Co-Author) Research Grant, Galil Medical Ltd
Robert C. Gilkeson, MD, Cleveland, OH (Abstract Co-Author) Research Consultant, Riverain Technologies, LLC Research support,
Koninklijke Philips NV Research support, Siemens AG
Sandra S. Halliburton, PhD, Highland Heights, OH (Abstract Co-Author) Employee, Koninklijke Philips NV
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Presenter) Institutional Research Grant, Koninklijke Philips NV
TEACHING POINTS
Despite advances in CT technology, imaging artifacts are frequently encountered in cardiac CT and remain a major cause of
impaired diagnostic confidence. The purpose of this exhibit is To illustrate the appearance of common and uncommon cardiac CT
artifacts. To review the cause and physics of these artifacts To explain how these artifacts may mimic lesions or lead to
misinterpretation. To propose effective approach to correct or reduce each artifact.
TABLE OF CONTENTS/OUTLINE
The appearance, causes and physics of following cardiac CT artifacts are illustrated in detail along with sample cases.
Subsequently, the most effective methods for improving or avoiding each artifact are described. Cardiac motion artifact(Blurring,
winging, double image, dark shadowing) Respiratory motion artifact Partial volume averaging Calcium blooming Beam hardening
Streak artifact- Rotational beam width asymmetry/ high density structures Quantum mottle Misregistration Stair step artifact Ring
artifact Helical/windmill artifact Poor contrast enhancement Incomplete anatomic coverage Reconstruction and post processing
error
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
CA101-ED-X
Cardiothoracic Applications of Spectral CT- Physics, Principles and Clinical Applications
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Bahar Mansoori, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Hamid Chalian, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Luis A. Landeras, MD, Cleveland, OH (Abstract Co-Author) Institutional Grant support, Koninklijke Philips NV
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Presenter) Institutional Research Grant, Koninklijke Philips NV
TEACHING POINTS
There are several implementations of spectral CT Spectral CT using a single-source dual-layer technology is a recent introduction
to this technology. Retrospective availability of spectral data enables several cardiothoracic applications using this novel
technology. Spatial and temporal registration and improved beam hardening offers advantages in cardiothoracic imaging.
TABLE OF CONTENTS/OUTLINE
-Implementations of dual energy technology-Spectral CT using dual layer CT technology- Physics-Phantom studies-Advantages and
disadvantages compared to other implementations-Limitations and pitfalls-Cardiothoracic applications of spectral CT with
illustrationsCardiac applications1.Myocardial perfusion2.Plaque characterization3.Metal artifact reduction4.Calcium blooming
reduction5.Contrast boosting with low monoenergetic images- Low contrast dose, salvage suboptimal studies, angio from regular
studies6.Virtual non contrast images- Radiation dose saving7.Virtual calcium score Thoracic applications1.Chronic PE, perfusion
detects with iodine mapping, effective atomic number2.Low contrast PE studies3.Lung lesion characterization4.Lymph nodal
characterization5.Tumor response, Perfusion6.Artifact reduction- Metallic, beam hardening
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
CA103-ED-X
Congenital Heart Diseases in Pediatric Age Group: Decoding of Embryology and Situs Anomalies, Spectrum of
Extracardiac Manifestations and Optimization of ECG Gated Imaging Techniques Using Bisegmental Protocol
All Day Location: CA Community, Learning Center
Participants
Gaurav V. Watane, MBBS, MD, Amravati, India (Presenter) Nothing to Disclose
Isha D. Atre, MBBS, Mumbai, India (Abstract Co-Author) Nothing to Disclose
Deepak Y. Kamble, MD, MBBS, Mumbai, India (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: To review the embryology of heart and classification of situs anomalies associated with congenital
heart diseases. To study the spectrum of intracardiac and extracardiac anomalies of heart for a tailored pre surgical planning.
Discuss the optimum MDCT imaging technique using modified biphasic ECG gated protocol in the evaluation of congenital heart
diseases.
TABLE OF CONTENTS/OUTLINE
Embryology of heart and cardiovascular systemNormal CT Anatomy of heart -Atria -Ventricles -Cardiac Valves -Great arteries and
connections -Great veinsImaging technique -Patient preparation -Equipment and scanning parameters -Image
reconstructionClassification of congenital heart diseases5 step approach to CT diagnosis of CHD with illustrative cases: -Step 1 Step 2 -Step 3 -Step 4 -Step 5
CA105-ED-X
Pump Up the Heart: Imaging Review of Entities that Result in Ballooning of the Left Ventricle
All Day Location: CA Community, Learning Center
Participants
Monica D. Ocampo, MD, Floridablanca, Colombia (Presenter) Nothing to Disclose
Daniel Vargas, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
Carlos S. Restrepo, MD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
Jennifer Leon, MD, Floridablanca, Colombia (Abstract Co-Author) Nothing to Disclose
Carlos F. Guerro, MD, Floridablanca, Colombia (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:To review the clinical and imaging findings of the different entities that result in global and focal
ballooning of the left ventricle.To discuss the utility different imaging modalities in the evaluation of patients with left ventricular
ballooning.To revisit the differentiation of ventricular aneurysm from pseudoaneurysm and diverticulum.
TABLE OF CONTENTS/OUTLINE
Ventricular aneurysm, pseudoaneurysm and diverticulum. Dilated cardiomyopathy (ischemic and non-ischemic) Hypertrophic
cardiomyopathy with associated apical aneurysm Focal and diffuse non-compaction cardiomyopathy Takotsubo cardiomyopathy
Chagas disease
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Carlos S. Restrepo, MD - 2012 Honored Educator
Carlos S. Restrepo, MD - 2014 Honored Educator
CA106-ED-X
Fat Is Where It's At: Ventricular Myocardial Fat
All Day Location: CA Community, Learning Center
Participants
Anna S. Bader, MD, Bronx, NY (Presenter) Nothing to Disclose
Jeffrey M. Levsky, MD, PhD, Bronx, NY (Abstract Co-Author) Nothing to Disclose
Linda B. Haramati, MD, MS, Bronx, NY (Abstract Co-Author) Investor, OrthoSpace Ltd Investor, Kryon Systems Ltd Spouse, Board
Member, Bio Protect Ltd Spouse, Board Member, OrthoSpace Ltd Spouse, Board Member, Kryon Systems Ltd
TEACHING POINTS
Identify entities associated with right and left ventricular myocardial fat Describe the radiologic findings of myocardial fat Discuss
the clinical implications
TABLE OF CONTENTS/OUTLINE
Ventricular myocardial fat is associated with: Normal aging - most commonly found in the right ventricle Age-related changes,
association with gender and obesity disputed Imaging findings Most common locations Superior RV wall, RVOT Stable or increased
thickening of the RV myocardium Histological features Healed myocardial infarct High prevalence among patients with known prior MI
- 22-62% Pathogenesis, possible transdifferentiation of cells Association with current methods of revascularization, medical
management Imaging findings Primarily subendocardial in the distribution of a coronary artery Transmural appearance when
infarction is more extensive Most commonly in the LV, but can occur within the right ventricle also Arrhythmogenic right ventricular
dysplasia/cardiomyopathy Clinical and imaging features and pathogenesis 2010 Task Force Criteria Additional conditions associated
with ventricular myocardial fat Tuberous sclerosis complex Dilated cardiomyopathy Muscular dystrophy Intracardiac lipoma
CA107-ED-X
Non-ischemic Coronary Artery Abnormalities and Other Cardiovascular Pathology on EKG Gated Cardiac CT
Angiography
All Day Location: CA Community, Learning Center
Participants
Giuseppe Cruciata, MD, Brooklyn, NY (Presenter) Nothing to Disclose
Maryanne Ruggiero, MD, Brooklyn, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. EKG gated coronary artery CT angiograms can not only detect coronary artery disesease, but can decipher other pathology
accounting for the patient's presentation.2. To gain awareness of the variety of cardiovascular pathology that can be diagnosed on
a coronary artery CT angiogram.
TABLE OF CONTENTS/OUTLINE
Importance of EKG gated cardiac CT angiography for the diagnosis and characteriziation of non ischemic coronary artery
abnormalities and other cardiovascular pathology.Sample cases of non ischemic coronary artery disesease related pathology
diagnosed on CT coronary artery angiograms. Examples include sinus of valsalva aneurysm, interarterial coronary artery, coronary
artery fistula, pseudoanerysm of the proximal ascending aorta, left ventricle pseudoaneurysm, and cardiac masses.Future directions
and summary.
CA108-ED-X
Anomalous Coronary Arteries that Need Intervention: Illustrated Review of Pre and Post-operative Imaging
Appearance
All Day Location: CA Community, Learning Center
FDA
Discussions may include off-label uses.
Participants
Prachi P. Agarwal, MD, Ann Arbor, MI (Presenter) Nothing to Disclose
Smita Patel, MBBS, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Troy LaBounty, MD, FACC, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Carole J. Dennie, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Elena Pena Fernandez, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Elsie Nguyen, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Bo Yang, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Purpose is to:1. Review the imaging features and hemodynamics of clinically significant coronary artery anomalies such as
interarterial coronary artery (esp with intramural course), anomalous coronary artery arising from pulmonary artery and coronary
artery fistula2. Understand surgical techniques used to treat coronary artery anomalies3. Recognize normal post operative
appearance and complications
TABLE OF CONTENTS/OUTLINE
A. Introduction to coronary anomalies that need surgical interventionB. Discuss the role of CT and MRI in the diagnosis and postsurgical follow upC. Illustrated review of significant coronary anomalies emphasizing-Preoperative imaging appearanceHemodynamics-Surgical procedures and post-operative complications associated with specific proceduresD. Anomalies and surgical
procedures included are:-Interarterial coronary artery with intramural course. Surgical options include coronary unroofing, creation
of a neo-ostium leaving the intramural segment in situ and bypass grafting-Anomalous coronary artery arising from pulmonary
artery. Aim is to create a two coronary system by coronary translocation, Takeuchi repair and ligation of anomalous artery with
bypass grafting-Coronary artery fistula. Surgical and interventional optionsE. Summary
CA110-ED-X
18F-FDG PET/CT in Prosthetic Valve Endocarditis
All Day Location: CA Community, Learning Center
Participants
Laurens E. Swart, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Asbjorn Scholtens, MD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Wilco Tanis, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
Ad J. Bogers, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Fred J. Verzijlbergen, MD, PhD, Nieuwegein, Netherlands (Abstract Co-Author) Nothing to Disclose
Gabriel P. Krestin, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Consultant, General Electric Company; Research Grant,
General Electric Company; Research Grant, Bayer AG; Research Grant, Siemens AG; Speakers Bureau, Siemens AG
Ricardo P. Budde, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To understand how 18F-FDG PET/CT can play an important role in the early and accurate detection of prosthetic valve
endocarditis. To comprehend which factors positively and negatively affect its diagnostic performance and how the acquisition
methods can be optimized.
TABLE OF CONTENTS/OUTLINE
Prosthetic heart valves What are prosthetic heart valves, which types are there (biological vs mechanical) and how are they
implanted? Prosthetic valve endocarditis (PVE) What is PVE? How big is the problem (morbidity, mortality, clinical relevance)? How is
PVE currently diagnosed (clinical presentation), and where does the current reference standard (echo and blood cultures) fall
short? 18F-FDG PET/CT What is PET/CT (18F-FDG in particular) and how does it work? PET/CT for the detection of PVE How does
PET/CT perform (based on current literature)? Why does it work? Achieving optimal diagnostic performance How can the acquisition
be improved in order to gain better diagnostic accuracy? Pitfalls What are known causes of false positive or false negative PET/CT
results? Future perspectives What can the added value of CTA (fusion between PET and CTA) be? Could PET/CT be the next
reference standard for PVE? And what role can PET/CT fulfill in treatment strategy determination and follow-up of PVE?
CA111-ED-X
Spectrum of Pulmonary Artery Pathology on CT: What the Radiologist Should Know
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Ane Ugarte Nuno, MBBS, San Sebastian, Spain (Presenter) Nothing to Disclose
Amaia Goienetxea Murgiondo, MD, Bergara, Spain (Abstract Co-Author) Nothing to Disclose
Carmen Biurrun Mancisidor, MD, Donostia, Spain (Abstract Co-Author) Nothing to Disclose
Juan Vega Eraso, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Idoia Echegoyen, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To review the spectrum of congenital and adquired anomalies of the pulmonary arteries emphasizing on their CT appearance. To
discuss the pulmonary artery pathology through a comprehensive case based pictorial approach. Help radiologist feel more confident
recognizing these conditions to avoid misinterpretation and reach the correct diagnosis.
TABLE OF CONTENTS/OUTLINE
Imaging spectrum of congenital anomalies presented include: Unilateral pulmonary agenesis Partial pulmonary artery agenesis Patent
ductus arteriosus Pulmonary artery sling Idiopathic dilatation of the pulmonary trunk Congenital pulmonary artery stenosis Coronary
to pulmonary artery fistula ALCAPA syndromeImaging spectrum of adquired anomalies presented include: Diseases affecting the
vessel wall: vasculitis, infected aneurysm and sarcoma. Pulmonary filling defects besides thromboembolism include intraluminal
droplets of fat, bubbles of air or nitrogen, intravascular metastases and foreign bodies. Extrinsic processes affecting the pulmonary
artery causing luminal narrowing: bronchogenic carcinoma and mediastinal fibrosis. Diffuse or focal enlargement of the arteries
(pulmonary hypertension, aneurysm and pseudoaneurysm).Finally, we will include a brief discussion of post repair appearance of the
pulmonary arteries in congenital heart dissease.
CA112-ED-X
Pacemakers and Implantable Cardioverter Defibrillators, Unknown to Chest Radiography: Review,
Complications and Systematic Reading
All Day Location: CA Community, Learning Center
Participants
Salvador Alandete, MD, Valencia, Spain (Presenter) Nothing to Disclose
Maria Luisa Domingo, MD, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
Santiago Isarria, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
Esperanza de la Via, MD, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
Juan Sales, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
David Uceda, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
M Angeles Meseguer Ripolles, Valencia, Spain (Abstract Co-Author) Nothing to Disclose
Jose S. Vilar, MD, Masarrochos- Valencia, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Radiologists have an important function in the evaluation of these devices. We revise their radiological appearances and possible
complications. The knowledge in normal aspects and complications is important for radiologist. To ensure an accurate reading of the
chest x-ray, we present a systematic approach.
TABLE OF CONTENTS/OUTLINE
1. Introduction2. Immediate complications after the insertion of the device a. Myocardial perforation b. Pneumothorax,
hemothorax3. Control and follow up of the device a. Differentiate between a pacemaker and an implantable defibrillator b. Identify
the company's logo c. Review the correct positioning of the generator inside the pocket d. Inspect the electrode's port insertion
sites connecting to the generator e. Check the full length of the electrodes to rule out any damage or breakages f. Verify that the
electrode head is correctly positioned and that it does not present a different state with respect previous studies. g. Ruling out
other associated complications4. Conclusion
CA115-ED-X
How to Evaluate Extent and Severity of Cardiac Sarcoidosis with FDG PET/CT and MRI
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Osamu Manabe, Sapporo, Japan (Presenter) Nothing to Disclose
Noriko Oyama-Manabe, MD, PhD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Hiroshi Ohira, MD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Yuuki Tomiyama, Sappro, Japan (Abstract Co-Author) Nothing to Disclose
Keiichiro Yoshinaga, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Ichizo Tsujino, MD, PhD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Kenji Hirata, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Masaharu Nishimura, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Nagara Tamaki, MD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To review the image characteristics of cardiac sarcoidosis with FDG PET/CT and MRI. 2. To focus the quantitative aspects of
estimating extent and severity of cardiac sarcoidosis.
TABLE OF CONTENTS/OUTLINE
Sarcoidosis is a multisystem granulomatous disease. Since cardiac sarcoidosis (CS) may cause life-threatening arrhythmias,
diagnosis of CS is clinically important. FDG PET/CT plays an important role in the diagnosis of CS and detection of active
inflammatory lesions. Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) is also a useful diagnostic
tool to qualitatively detect myocardial involvement. The quantification of the volume and intensity of FDG uptake helps predict the
clinical outcomes and evaluate the efficiency of steroid treatment. For the precise evaluation of the extent and severity of CS,
recent studies have focused on reducing physiological myocardial FDG uptake. LGE-CMR enables to estimate the extent of LGE in
patients with CS. The quantitative assessment of extent and severity of CS has significant implications for monitoring disease
progression and treatment response. 1) We have reviewed and compared image characteristic of CS with FDG PET/CT and MRI. 2)
We have focused on the quantitative estimation of extent and severity of CS.
CA116-ED-X
The Total Artificial Heart: Historical Perspectives, Current Applications, Future Directions
All Day Location: CA Community, Learning Center
Participants
Kevin Day, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Clinton E. Jokerst, MD, Tucson, AZ (Presenter) Nothing to Disclose
Ryan J. Avery, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Isabel B. Oliva, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Daniel Vargas, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
Toshinobu Kazui, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Zain Khalpey, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Learner should be able to:1) Enumerate the advantages and disadvantages of placing a total artificial heart verses a more
traditional ventricular assist device2) Discuss common complications of total artificial heart placement and associated imaging
findings
TABLE OF CONTENTS/OUTLINE
Historical development of the Syncardia total artificial heart (TAH)Current device and current indications (bridge to
transplant)Surgical techniquesProper appearance on imagingCommon complications and their imaging findings including (but not
limited to): -Venous kinking -Thrombosis -Hematoma -Hemothorax/pneumothorax Future directions -Expanding indications -Newly
approved 50 cc TAH -Preoperative imaging to guide device selection and surgical technique
CA117-ED-X
Post Mortem CT Scan with Contrast Media Injection and Chest Compression in Unexplained Death in ICU
All Day Location: CA Community, Learning Center
Participants
Laurence Monnier-Cholley, MD, Paris, France (Presenter) Nothing to Disclose
Eric Maury, PhD, Paris, France (Abstract Co-Author) Nothing to Disclose
Claire Pichereau, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
Simon Bourcier, Paris, France (Abstract Co-Author) Nothing to Disclose
Mikael Alves, Paris, France (Abstract Co-Author) Nothing to Disclose
Lionel Arrive, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To learn an efficient, easy to perform and minimally invasive procedure for post mortem CT angiographyTo understand the technical
aspects and the interpretation issues of post mortem CT angiographyTo know the different causes of death than can be diagnosed
on a post mortem CT scan
TABLE OF CONTENTS/OUTLINE
A. IntroductionB. Technical aspects1. Family consent2. Injection and compression procedurea. Unenhanced CT scan performed from
head to pelvisb. Injection of contrast media (2ml/Kg) via venous catheter left in place after deathc. Chest CT scan performed after
20 chest compressions to visualize pulmoanry arteriesd. Chest and abdomen CT scan performed after 50 to 100 complementary
chest compressions to obtain aortic and coronary arteries opacificationC. Results1. CT findings on unenhanced CT scan2.
Pulmonary arteries opacificationa.Visualization of pulmonary arteriesb. Diagnosis of pulmonary embolism3. Coronary arteries
opacificationa. Visualization of coronary arteries on post mortem CTb. Results of coronary angiography on post mortem CTD.
LimitationsE. Conclusion
CA118-ED-X
Assessment of Coronary Artery Stent Using Current Cardiac CT: What Every Radiologist Should Know
All Day Location: CA Community, Learning Center
Participants
Masahiro Takahashi, MD, Hidaka, Japan (Abstract Co-Author) Nothing to Disclose
Fumiko Kimura, MD, PhD, Hidaka-Shi, Japan (Presenter) Nothing to Disclose
Haruhiko Machida, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Isao Tanaka, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Masao Takahashi, Hidaka-Shi, Japan (Abstract Co-Author) Nothing to Disclose
Shigetoshi Nishimura, MD, PhD, Hidaka, Japan (Abstract Co-Author) Nothing to Disclose
Fumikazu Sakai, MD, PhD, Hidaka, Japan (Abstract Co-Author) Research Consultant, AstraZeneca PLC; Research Consultant,
Boehringer Ingelheim GmbH; Speaker, Eisai Co, Ltd; Speaker, Shionogi & Co, Ltd; Research Grant, Bayer AG; Research Grant, Eisai
Co, Ltd; ; ;
TEACHING POINTS
The purpose of this exhibit is: To review current techniques for evaluation of coronary artery stents, including CT angiography
(CTA) using subtraction, sharp kernel and increased view numbers, and decreased noise with iterative reconstruction and
monochromatic images obtained with dual energy method. To review complications after stent implantation
TABLE OF CONTENTS/OUTLINE
Table of Contents/Outline: CT techniques to improve spatial resolution, reduce artifacts, and reduce radiation dose Capability using
current CTto evaluate stent patency Abnormal CT findings after stent implantation including in-stent restenosis, stent fracture,
aneurysm and incomplete stent apposition (peri-stent staining) The major teaching points of this exhibit are: Current techniques of
cardiac CT have improved identification of in-stent patency and reduced radiation dose. Though the 2010 appropriate use criteria
of cardiac CT do not recommend coronary CTA for evaluation of stents narrower than 3 mm, identification of in-stent lumen of 2.5
mm might be possible using current techniques. Though drug-eluting stents (DES) have better reduced in-stent restenosis than
bare metal stents, late complications after DES implantation, such as stent fracture and malapposition, complications that might be
related to stent thrombosis, have been noticed.
CA119-ED-X
The Forgotten Ventricle: An Anatomic, Pathologic, and Imaging Review of the Right Ventricle and Its
Conditions
All Day Location: CA Community, Learning Center
FDA
Discussions may include off-label uses.
Participants
Sebastian R. McWilliams, MBBCh, Saint Louis, MO (Presenter) Nothing to Disclose
Sanjeev Bhalla, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Adam L. Sipe, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
David Raymer, MD, St Louis, MO (Abstract Co-Author) Nothing to Disclose
Demetrios A. Raptis, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. The anatomy of the right ventricle allows its distinction from the left ventricle2. Echo and cardiac CT/MR are complimentary
modalities for assessment; knowledge of echo parameters and signs can aide CT and MR studies3. Several pathologic conditions of
the right ventricle are reviewed
TABLE OF CONTENTS/OUTLINE
The right ventricle (RV) is defined by an infundibulum separating inflow and outflow, trabeculation, and the presence of the
moderator bandEchocardiography Functional parameters include the Tei index, TAPSI, and TASV. Echo signs - McConnell's sign,
60/60 sign with pulmonary embolismCT and MRI RV end diastolic volume (RV-EDV) and RV ejection fraction (RV-EF) are quantitative
parameters that are important in congenital heart disease and pulmonary disease, respectively The differential diagnosis of right
ventriclar enlargement includes pulmonary hypertension, pulmonary embolism, cardiomyopathies, and congenital lesions Septal
bounce - a systolic bounce in tamponade and a diastolic bounce in constrictive pericarditisPathologic conditions Arrhythmogenic
right ventricular dysplasia Double chamber right ventricle, associated with congenital lesions Right ventricular infarction with its
distinct clinical syndrome Penetrating trauma - the right ventricle is the most commonly injured due to its anterior location
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Sanjeev Bhalla, MD - 2014 Honored Educator
CA120-ED-X
Imaging of Ascending Aorta - Special Emphasis on Post-operative Imaging
All Day Location: CA Community, Learning Center
Participants
Megha Sheth, Ahedabad, India (Abstract Co-Author) Nothing to Disclose
Yashpal Rana, MD, Ahmedabad, India (Abstract Co-Author) Nothing to Disclose
S. Patel, Ahmedabad, India (Abstract Co-Author) Nothing to Disclose
Dinesh Patel, MD, DMRE, Ahmedabad, India (Abstract Co-Author) Nothing to Disclose
Zalak T. Patel, MD, Ahmedabad, India (Presenter) Nothing to Disclose
TEACHING POINTS
Imaging appearances of Ascending Aorta abnormalities and various surgical treatments available MSCT appearances of Postoperative Ascending Aorta - Normal findings and Complications
TABLE OF CONTENTS/OUTLINE
Ascending Aorta - Anatomy, Pathologies and Imaging Findings MSCT technique and Importance of post processing
techniques Discussing various surgical repair techniques MSCT imaging appearances of Post-operative Ascending Aorta Normal findings and Complications Summary
CA121-ED-X
Cardiac Conduction Devices Implantation and Follow-up: What Should Radiologists Know?
All Day Location: CA Community, Learning Center
Participants
Jiajun Xie, Guangzhou, China (Presenter) Nothing to Disclose
Hui Liu, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Yu-Hsiang Juan, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Sachin S. Saboo, MD, FRCR, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Suhny Abbara, MD, Dallas, TX (Abstract Co-Author) Author, Reed Elsevier; Editor, Reed Elsevier; Institutional research agreement,
Koninklijke Philips NV; Institutional research agreement, Siemens AG
Xiao-Mei Zhong, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Hai-Ying Luo, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Chang Hong Liang, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To understand the role of chest X-ray in initial assessment and subsequent follow-up of cardiac conduction devices.2. To
identify the normal findings of existing cardiac conduction devices.3. To review various imaging appearances of malfunctioning and
complicated cardiac conduction devices.
TABLE OF CONTENTS/OUTLINE
1. Briefly review the development history of cardiac conduction devices.2. Understand the main components of cardiac conduction
devices.3. Review categories of cardiac conduction devices:a) Pacemaker and implantable cardio-defibrillators (ICD)b) Singlechamber pacing, dual-chamber pacing, cardiac resynchronization therapy (CRT), etc.c) Endocardial pacing, epicardial pacingc)
Permanent pacing and temporary pacing4. Case based review of cardiac conduction devices with radiographs and CT for
following:.a) Normal radiological appearancesb) Malfunctioning devices appearance on imaging with regards to:i. Electrode head
displacementii. Electrode damage or breakagesiii. Insertion sites: backed out from terminaliv. Incorrect positioning of the generator
inside the pocket: a. Twiddler's syndrome b. Reel's syndromec) Other complications:i. Myocardial perforationii. Pneumothorax,
hemothorax5. Conclusion
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Suhny Abbara, MD - 2014 Honored Educator
CA122-ED-X
Radiologic-pathologic Correlation of Primary and Secondary Cardiomyopathies: Findings of Cardiac Magnetic
Resonance Imaging and Histopathology of the Autopsy Heart
All Day Location: CA Community, Learning Center
Participants
Hiromi Hashimura, MD, Suita, Osaka, Japan (Presenter) Nothing to Disclose
Fumiko Kimura, MD, PhD, Hidaka-Shi, Japan (Abstract Co-Author) Nothing to Disclose
Hatsue Ishibashi-Ueda, MD, PhD, Suita, Osaka, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiaki Morita, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Masahiro Higashi, MD, Suita, Japan (Abstract Co-Author) Research collaborator, Toshiba Corporation
Hiroaki Naito, MD, PhD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Atsushi Iguchi, Hidaka, Saitama, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: To understand histopathological findings that correspond with cardiac MR (CMR) findings, focusing
mainly on late gadolinium enhancement (LGE) images in patients with primary and secondary cardiomyopathies To understand the
drawbacks of LGE To review the current technique of T1 mapping to overcome the drawbacks of LGE
TABLE OF CONTENTS/OUTLINE
Optimal current CMR techniques for cardiomyopathies Comparison of CMR and histopathological findings of the autopsy heart Dilated
cardiomyopathy Dilated phase of hypertrophic cardiomyopathy Cardiac amyloidosis Cardiac sarcoidosis Arrhythmogenic right
ventricular cardiomyopathy Drawbacks of LGE Quantitative evaluation of myocardial fibrosis Quantitative evaluation of amyloid
deposit Introduction of current technique to overcome LGE drawbacks Native T1 mapping Extracellular volume fraction obtained
from contrast-enhanced T1 mapping
CA123-ED-X
Transthoracic Echocardiography Pitfalls and Limitations as Exposed by Cardiac CT and MRI
All Day Location: CA Community, Learning Center
Awards
Cum Laude
Participants
Sachin B. Malik, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Natalie Chen, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Rex A. Parker III, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Joe Y. Hsu, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To review the standard transthoracic echocardiography imaging windows To review common limitations and pitfalls of transthoracic
echocardiography which lead to referrals for cardiac CT and/or MRI To review cardiac CT and MRI cases that highlight and further
characterize transthoracic echocardiography findings
TABLE OF CONTENTS/OUTLINE
Four standard transthoracic echocardiography imaging windows Limitations and pitfalls of transthoracic echocardiography Masses
and mass mimics Hiatal hernia Crista terminalis Prominent eustachian valve Lipoma/Lipomatous hypertrophy of the interatrial septum
Caseous necrosis of the mitral valve Thrombus Right ventricle moderator band Right atrioventricular groove fat as right atrial mass
Poorly visualized apical lesions Apical aneurysm Apical thrombus Apical infarct Apical hypertrophic cardiomyopathy Ascending
Thoracic Aortic Dissection False positive False negative
CA125-ED-X
Myocardial T1 Mapping for the Characterization of Cardiac Diseases
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Seitaro Oda, MD, Kumamoto, Japan (Presenter) Nothing to Disclose
Kosuke Morita, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Daisuke Utsunomiya, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Hideaki Yuki, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Masafumi Kidoh, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yasuyuki Yamashita, MD, Kumamoto, Japan (Abstract Co-Author) Consultant, DAIICHI SANKYO Group
Takeshi Nakaura, MD, Amakusa, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Measurement of the myocardial longitudinal relaxation time (T1 mapping) is a novel and expanding application of cardiac MR
imaging. 2. Myocardial T1 mapping by cardiac MR has emerged as a new approach for the possible noninvasive quantification and
characterization of various cardiac diseases.
TABLE OF CONTENTS/OUTLINE
1. What is myocardial T1 mapping?_Principles of T1 mapping_Myocardial fibrosis_T1 mapping and delayed myocardial enhancement2.
Myocardial T1 mapping techniques_Inversion recovery sequences_Saturation recovery sequences_Accuracy and precision3.
Evaluation parameters of myocardial T1 mapping_Native T1 (pre-contrast T1)_Post-contrast T1_Extracellular volume fraction4.
Clinical applications of myocardial T1 mapping_Coronary artery disease_Cardiomyopathy_Other disorders_Potential future
applications
CA126-ED-X
Collaborative Methodology in the Evaluation of Infiltrative Cardiac Disease: Why a Multimodality Approach
Combining Cardiology and Radiology is Necessary
All Day Location: CA Community, Learning Center
Participants
Kimberly Weatherspoon, MD, MPH, Springfield, MA (Presenter) Nothing to Disclose
Alena Kreychman, MD, Springfield, MA (Abstract Co-Author) Nothing to Disclose
Christopher C. Moore, MD, PhD, Springfield, MA (Abstract Co-Author) Nothing to Disclose
Padmanabhan Priyesh, MD, Springfield, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Infiltrative cardiomyopathies cause significant morbidity if left undiagnosed. Nonspecific clinical presentation of infiltrative
cardiomyopathy warrants a collaborative, multimodality imaging approach between cardiologists and radiologists to clinch a specific
diagnosis while excluding other etiologies. Clinical symptoms and specific imaging characteristics can be combined to differentiate
among various infiltrative cardiomyopathies. General radiologists can learn to recognize characteristic findings of infiltrative
cardiomyopathies on multiple imaging modalities.
TABLE OF CONTENTS/OUTLINE
Discuss the rising incidence of infiltrative cardiomyopathy. Given an overview of the 3 most common infiltrative cardiomyopathies:
amyloidosis, myocarditis, and sarcoidosis. Illustrate characteristic imaging findings that help distinguish among the various
infiltrative cardiomyopathies. Describe the workup of infiltrative cardiomyopathies with various imaging modalities including
echocardiography, nuclear and SPECT cardiac imaging, cardiac magnetic resonance imaging (CMRI) and positron emission
tomography (PET)-computed tomography (CT) performed with fluorine-18-fluoro-deoxy-glucose (FDG). Consider an interdisciplinary,
algorithmic imaging approach leveraging the expertise of radiologists and cardiologists as an effective way to optimize efficient
imaging selection.
CA127-ED-X
Radiologic and Clinicopathologic Findings of Eosinophilic Heart Diseases: Assessment with Cardiac MRI and
MDCT
All Day Location: CA Community, Learning Center
Participants
Hyoung-In Choi, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Eun Ju Chun, MD, PhD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jung Hoon Kim, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Eun-Ah Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Whal Lee, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeo Koon Kim, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang Il Choi, MD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Heart can be involved by various etiologies which cause peripheral hypereosinophilia. 2. Eosinophilic heart diseases may show
characteristic cardiac manifestations including myocarditis, apical obliteration with restrictive pathophysiology or intracardiac
thrombus. 3. MDCT is helpful for assessment of multisystemic involvement in eosinophilic heart diseases 4. Cardiac MRI is useful,
non-invasive modalities not only to diagnose eosinophilic heart diseases, but also to assess the disease stages, differential
diagnosis, predict prognosis and monitoring of treatment for the patients.
TABLE OF CONTENTS/OUTLINE
1. Overview of the eosinophilic heart disease 2. Etiology and pathophysiology of cardiac involvement with peripheral eosinophilia 3.
Various findings of eosinophilic heart diseases assessed by cardiac MRI and MDCT including comprehensive review of multisystemic
involvement - Hypereosinophilic syndrome - Churg-Strauss syndrome - Eosinophilic leukemia - Drug reaction with eosinophilia Parasite infection 4. Progression of eosinophilic heart diseases using follow-up cardiac MRI according to eosinophil count 5.
Differential diagnosis for eosinophilic heart diseases from other cardiac involvement of systemic disease 6. The Potential role of
cardiac MRI and MDCT in patients with eosinophilic heart diseases 7. References
CA128-ED-X
Congenital Anomalies of the Aortic Arch
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Kate Hanneman, MD, Toronto, ON (Presenter) Nothing to Disclose
Beverley M. Newman, MD, MBBCh, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Frandics P. Chan, MD, PhD, Stanford, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Congenital aortic arch anomalies result from aberrations in the development of at least one of the six paired embryologic branchial
arches. Vascular rings are characterized by vascular structures that surround and variably compress the trachea and esophagus.
The most common types are double aortic arch and right aortic arch, aberrant left subclavian artery with left ligamentum
arteriosum. Interrupted aortic arch (IAA) is a rare defect characterized by complete anatomic discontinuity between the ascending
and descending aorta with distal aorta supplied by the ductus arteriosus. IAA is classified based on the site of interruption in
relation to the arch vessels. Aortic coarctation typically occurs as a discrete narrowing in a juxtaductal location, and may be
isolated or associated with other lesions such as bicuspid aortic valve. Arch hypoplasia is defined as an external diameter of the
proximal or distal arch measuring <60% or <50% of the ascending aortic diameter, respectively.
TABLE OF CONTENTS/OUTLINE
Imaging modalities and techniques Embryologic development Normal anatomy Classification of arch anomalies Arch sidedness and
variants: left, right, double aortic arches Interrupted aortic arch (IAA) Hypoplastic aortic arch Aortic coarctation Review of key
learning points
CA129-ED-X
Three-dimensional Cine Imaging of Coronary CT Angiography for Diagnosing Mechanical Prosthetic Heart
Valve Disorders
All Day Location: CA Community, Learning Center
Participants
Sung Mok Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Eun Kyung Kim, Seoul, Moldova, Republic Of (Abstract Co-Author) Nothing to Disclose
Seung Woo Park, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Moon Young Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hae Jin Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Hyeon Choe, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
- In patients with mechanical prosthetic heart valve (PHV) disorders, transthoracic echocardiography (TTE) has been used as first
line imaging tool. For further evaluation, relative invasive study such as transesophageal echocardiography (TEE) is needed.
However, poor sonic window and metallic artifacts sometimes disturb accurate diagnosis. - Coronary CT angiography is helpful for
depicting mechanical PHV disorders using three-dimensional (3D) volume-rendering (VR) with or without cine mode. - In this
exhibition, we will present the cases of pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and
thrombus formation using 3D-VR with or without cine mode.
TABLE OF CONTENTS/OUTLINE
1. Introduction of previous studies using cardiac CT for diagnosing mechanical PHV disorders.2. Image reconstruction and CT scan
technique for 3D-VR cine imaging.3. Case review of 3D-VR demonstrating PHV disorders compared with operative findings or TEE. A.
Aortic valve - Prosthetic valve dysfunction - Pannus and thrombus formation - Suture loosening (paravalvular leak) B. Mitral valve Prosthetic valve dysfunction - Pannus and thrombus formation - Suture loosening (paravalvular leak) C. Tricuspid valve - Prosthetic
valve dysfunction - Pannus and thrombus formation
CA130-ED-X
Comprehensive Evaluation of Mechanical Heart Valves with Third Generation Dual Source CT
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Marcel L. Dijkshoorn, RT, Rotterdam, Netherlands (Presenter) Consultant, Siemens AG
Dominika Sucha, MD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
Ad J. Bogers, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Ricardo P. Budde, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To have an understanding of the most common indications for mechanical heart valve implantation. To discuss and understand the
role of Computed Tomography in relation to procedure complications and general indications for diagnostic follow-up of postoperative mechanical valves. To demonstrate the physical and imaging characteristics of the most commonly used mechanical
valves. To provide detailed CT acquisition protocols for third generation dual source CT with their pros and cons including the use
of prospective gating, high pitch acquisition, iterative reconstruction and limited contrast administration. To demonstrate examples
of clinical cases.
TABLE OF CONTENTS/OUTLINE
Background of valvular heart diseaseMechanical valve types Tilting-disc Bileaflet Cage-ballProblems after mechanical valve
implantation Position and fixation Leakage and obstruction InfectionImaging characteristics Systolic and diastolic geometry Leaflet
motion ECG and metal artefactsScan protocol set-up Required scan phases Scan mode selection ECG-phase selection kV and mA
settings Dynamic reconstruction and analysisClinical casesSummary:Third generation dual source CT is able to provide
comprehensive information in the follow-up of mechanical heart valves at acceptable radiation and contrast dose levels.
CA131-ED-X
Novel Coronary CT Angiography Technique: Subtraction Coronary CT Angiography at a 320-detector Row CT
Scanner
All Day Location: CA Community, Learning Center
Participants
Masafumi Kidoh, Kumamoto, Japan (Presenter) Nothing to Disclose
Daisuke Utsunomiya, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Seitaro Oda, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yoshinori Funama, PhD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Takeshi Nakaura, MD, Amakusa, Japan (Abstract Co-Author) Nothing to Disclose
Tomohiro Namimoto, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Hideaki Yuki, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yasuyuki Yamashita, MD, Kumamoto, Japan (Abstract Co-Author) Consultant, DAIICHI SANKYO Group
Kenichiro Hirata, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Subtraction coronary CT angiography (CCTA) that allows calcium to be subtracted from CCTA images, was clinically introduced on a
320-detector row CT scanner.The purpose of this exibit is:1. To demonstrate the principle about subtraction CCTA.2. To introduce
clinical applications of subtraction CCTA.
TABLE OF CONTENTS/OUTLINE
CONTENT ORGANIZATION1. Necessity for subtraction CCTA2. Principles of subtraction CCTA3. Scan protocols for subtraction
CCTA- Two breath-hold method - Single breath-hold method- Minimum breath-holding time method with test-injection technique4.
Reconstruction techniques for subtraction CCTA- Volumetric CT digital subtraction angiography- Adaptive Iterative Dose Reduction
3D enhanced (AIDR3D enhanced)- Adaptive Motion Correction (AMC)5. Clinical applications of subtraction CCTA- Coronary artery
calcification- Coronary artery stent- Coronary artery plaque characterization
CA132-ED-X
Clinical Applications of Single-source Dual-energy Cardiac Computed Tomography (CT) with Fast kVp
Switching beyond Conventional Cardiac CT: What the Radiologist Needs to Know
All Day Location: CA Community, Learning Center
Participants
Haruhiko Machida, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Isao Tanaka, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Rika Fukui, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Yun Shen, PhD, Beijing, China (Abstract Co-Author) Employee, General Electric Company Researcher, General Electric Company
Takuya Ishikawa, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Eiko Ueno, MD, Chiyoda-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Etsuko Tate, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Xiao Zhu Lin, MD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Heqing Wang, Dalian, China (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To review limitations of conventional cardiac CT (CCT) To describe basic principles and various methods in single-source dualenergy CCT (DECCT) with fast kVp switching to overcome these limitations To illustrate clinical applications and advantages of
these methods with clinical images
TABLE OF CONTENTS/OUTLINE
Limitations of conventional CCT Limited delineation of small coronary vessels/contrast enhancement of coronary vessels Radiation
dose Coronary calcification/stent/beam-hardening (BH) artifact Limited characterization of coronary plaque Limited contrast
resolution in myocardial perfusion/late iodine enhancement (LIE) CCT Basic principles and various methods in DECCT BH correction
Monochromatic imaging (MI) Material density/material subtraction imaging (MDI/MSI) Energy level (keV)-CT value (HU) curve
Effective atomic number (EAN) histogram Clinical applications and advantages Improved delineation of small coronary
vessels/contrast enhancement of coronary vessels: low-keV MI/iodine (water) MDI Radiation dose reduction: virtual noncontrast
CCT by MSI replacing true noncontrast CCT Coronary calcium/stent subtraction: MDI/EAN histogram Calcified/noncalcified coronary
plaque composition analysis: MDI/keV-HU curve/EAN histogram Myocardial perfusion/LIE CCT: iodine (water) MDI
CA133-ED-X
Morphologic Phenotypes of Hypertrophic Cardiomyopathy at Magnetic Resonance Imaging through the Lens
of the Underlying Genetic Mutations
All Day Location: CA Community, Learning Center
Participants
Mohamed M. Sayyouh, MBBCh, MSc, Ann Arbor, MI (Presenter) Nothing to Disclose
Jadranka Stojanovska, MD, MS, Northville, MI (Abstract Co-Author) Nothing to Disclose
Sharlene M. Day, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
El-Sayed H. Ibrahim, PhD, MSc, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Anil K. Attili, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Prachi P. Agarwal, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Dharshan R. Vummidi, MRCP, FRCR, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Maryam Ghadimi Mahani, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Review genetic subtypes and phenotypes of Hypertrophic Cardiomyopathy (HCM). Discuss the impact of magnetic resonance
imaging (MRI) and/or genetic testing on diagnosis of different phenotypes of HCM and emphasize its clinical importance. Illustrate
added value of MRI over other imaging modalities in diagnosis of HCM and point out its limitations; especially in genotype positive
phenotype negative HCM. Discuss conditions that can mimic HCM on MRI.
TABLE OF CONTENTS/OUTLINE
Introduction Genetic background and pathophysiology of HCM. Value and limitations of MRI in diagnosis of HCM phenotypes. Case
presentations illustrating different phenotypes of HCM, correlation with their genetic subtypes including genotype positive and
phenotype negative HCM HCM mimics: Aortic stenosis, Poorly controlled hypertension, Infiltrative processes such as amyloidosis,
Fabry disease Conclusions
CA134-ED-X
The Left Atrial Appendage: Anatomy, Pathologic Conditions and Insights from the Era of Percutaneous
Intervention
All Day Location: CA Community, Learning Center
Participants
Tami J. Bang, MD, Aurora, CO (Presenter) Nothing to Disclose
Carlos S. Restrepo, MD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
Antonio Luna, MD, Jaen, Spain (Abstract Co-Author) Nothing to Disclose
Jordi Broncano, MD, Cordoba, Spain (Abstract Co-Author) Nothing to Disclose
Daniel Ocazionez, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Pamela K. Woodard, MD, Saint Louis, MO (Abstract Co-Author) Research Consultant, Bristol-Myers Squibb Company; Research
Grant, Astellas Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG;
Research Grant, Actelion Ltd; Research Grant, Guerbet SA; ; ;
Daniel Vargas, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Review the left atrial appendage embryology and anatomy. 2. Discuss the role of imaging in the evaluation of pathologic
conditions affecting the left atrial appendage. 3. Review the utility of pre and post procedural imaging studies for patients with
atrial appendage intervention
TABLE OF CONTENTS/OUTLINE
1. Left atrial appendage embryology and anatomy 2. Variant anatomy 3. Left atrial appendage thrombus Differentiation between
thrombus and pseudo-thrombus Optimizing CT technique for evaluation of left atrial appendage thrombus 4. Other left atrial
appendage conditions Inflammatory Neoplastic 5. Atrial appendage exclusion: Overview of procedural approaches (surgical,
thoracoscopic, percutaneous) Review of devices (Lariat device, Amplatzer plug, atrial clip, Watchman device) Role of imaging on
pre-procedural planning and post-procedural complications
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Carlos S. Restrepo, MD - 2012 Honored Educator
Carlos S. Restrepo, MD - 2014 Honored Educator
CA135-ED-X
Comprehensive Assessment of Endomyocardial Fibrosis (EMF) by Cardiac Magnetic Resonance (CMR):
Morphology, Function and Tissue Characterization
All Day Location: CA Community, Learning Center
Participants
Fabio P. Siqueira, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Livia M. de Castro, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Filipe P. Carvalho, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Wilson B. Correa Filho, MD, PhD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Clerio F. Azevedo, MD, PhD, Rio de Janeiro, Brazil (Presenter) Nothing to Disclose
TEACHING POINTS
EMF is the most common form of restrictive cardiomyopathy worldwide affecting primarily young patients. It is associated with high
morbidity and mortality.Patients with EMF typically present with focal or diffuse endocardial thickening of the ventricles and apical
obliteration by a mass of fibrotic tissue, thrombus and/or calcification. CMR represent a unique tool for further evaluating and
characterizing patients with EMF. Besides providing accurate morphological and functional assessment, CMR can be useful in the
differential diagnosis, quantification of fibrotic tissue and identification of the typical "double V" sign.In this presentation we aim to
discuss the role of CMR in the diagnostic and prognostic evaluation of patients with EMF, reviewing typical imaging findings and the
correlation with macro- and microscopic appearance.
TABLE OF CONTENTS/OUTLINE
A quick review of EMF epidemiology and clinical features.Characterization of EMF cardiac structural changes: discuss the most
common and typical CMR findings going through several illustrative cases.Differential diagnosis: other causes of myocardial wall
thickening, apical obliteration, myocardial fibrosis and infiltration.A brief discussion of therapeutic options and how diagnostic
imaging can help guide the process of clinical decision making.
CA136-ED-X
Pericardial Imaging: A Multimodality Pictorial Review
All Day Location: CA Community, Learning Center
Participants
Bijan Bijan, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Jonah S. Hirschbein, MD, Sacramento, CA (Presenter) Nothing to Disclose
TEACHING POINTS
To review the structure and function of the pericardium in relation to pericardial pathophysiology. To compare and contrast the
strengths and limitations of echocardiography, cardiac CT, and cardiac MRI in the evaluation of pericardial pathophysiology. To
demonstrate the imaging features of pericardial disease processes. To discuss recent advances in pericardial imaging and potential
future improvements.
TABLE OF CONTENTS/OUTLINE
Background. Pericardial structure and function will be reviewed. Techniques. Echocardiography, cardiac CT, and cardiac MRI will be
discussed with an emphasis on the strengths and limitations of each modality in evaluating the pericardium. Examples. Examples of
pericardial disease processes from our institution will be presented, including: effusion and tamponade, constriction/constrictive
pericarditis, inflammation, infection, pericardial cysts, and neoplasms. Important differential diagnostic considerations will be
addressed, for example the use of diagnostic imaging in important clinical dilemmas such as differentiating pericardial constriction
from myocardial restriction. Future work. Current advances and potential future improvements in pericardial imaging will be
discussed.
CA137-ED-X
Computational Fluid Dynamics for Assessing the Hemodynamics in Left Ventricular Assist Device Patients
All Day Location: CA Community, Learning Center
Participants
Christof Karmonik, PhD, Houston, TX (Presenter) Nothing to Disclose
Fabian Rengier, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Arjang Ruhparwar, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Nicholas Bhojwani, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
Hendrik Von Tengg-Kobligk, MD, Bern, Switzerland (Abstract Co-Author) Research Grant, W. L. Gore & Associates, Inc
Sasan Partovi, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To understand the analysis approach when visualizing and quantifying blood flow with computational fluid dynamics (CFD) from
CT angiography (CTA) datasets for patients with left ventricular assist devices (LVADs). 2. To become familiar with the workflow.
3. To learn how to interpret the hemodynamics. 4. To discuss potential perspectives of the application of CFD in CTA datasets of
LVAD patients.
TABLE OF CONTENTS/OUTLINE
1. Setup and specific considerations when conducting CFD analysis in CTA datasets of patients with LVADs: a. Segmentation
models, 3D surface reconstructions and 3D mesh creations b. Implementing inflow and outflow boundary conditions c. Conducting
the simulation process with evaluating convergence and correct physical behavior d. Interpretation of simulations results 2. CFD
parameters: a. Pressure b. Wall shear stress c. Velocity 3. Hemodynamics at inflow and at outflow cannulas (including ascending
aorta and aortic arch) 4. Perspectives: a. Surgical position of the outflow cannula for optimization of aortic hemodynamics b.
Potential role of CFD in predicting and assessing aortic insufficiency as LVAD complication c. Potential prediction and assessment of
ischemic events as LVAD complication d. Incorporation of computational simulations in the design process of medical devices
CA138-ED-X
Clinical Approach and Recent Topics at Coronary Artery Calcium Scoring
All Day Location: CA Community, Learning Center
Participants
Fuminari Tatsugami, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Toru Higaki, PhD, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Nobuo Kitera, RT, Hiroshima, Japan (Presenter) Nothing to Disclose
Masao Kiguchi, RT, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Wataru Fukumoto, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Kazuo Awai, MD, Hiroshima, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation; Research Grant, Hitachi, Ltd;
Research Grant, Bayer AG; Reseach Grant, DAIICHI SANKYO Group; Medical Advisor, DAIICHI SANKYO Group; Research Grant, Eisai
Co, Ltd; Research Grant, Nemoto-Kyourindo; ; ; ; ;
Yoko Kaichi, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Quantification of coronary artery calcium with CT has an established role in the identification and risk stratification of coronary
artery disease.2. Iterative reconstruction (IR) techniques have a potential of a radiation dose reduction for coronary calcium
scoring.3. Novel technique of calcium subtraction has been developed on a 320-detector CT scanner.
TABLE OF CONTENTS/OUTLINE
1. Quantification of coronary artery calcium using multi-slice CT. - scanning method / radiation dose - Agatston-, volume-, and
mass scores - reproducibility 2. Role of coronary calcium scoring in clinical practice - coronary calcium scoring for risk assessment influence of coronary calcium on diagnostic accuracy of coronary CT angiography - usefulness for detection of small calcium with a
thinner slice thickness data (Fig. 1) 3. Application of hybrid iterative reconstruction (IR) techniques - effect of hybrid IR on
coronary calcium scoring - possibility of a radiation dose reduction using IR techniques (Fig. 2, 3) 4. How to deal with patients with
high coronary calcium score - novel technique for calcium subtraction using a 320-detector CT scanner (Fig. 4) - scanning method
of calcium subtraction - improvement in diagnostic accuracy for coronary CT angiography (Fig. 5)
CA139-ED-X
Cardiovascular Manifestations of Turner Syndrome
All Day Location: CA Community, Learning Center
Participants
Ryan T. Pruente, MD, Aurora, CO (Presenter) Nothing to Disclose
Lorna Browne, MD, FRCR, Denver, CO (Abstract Co-Author) Nothing to Disclose
Cylen Javidan-Nejad, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Carlos S. Restrepo, MD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
Daniel Vargas, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
o Briefly review Turner syndrome: its major clinical and imaging presentations.o Familiarize the radiologist with Turner syndrome's
most common cardiovascular imaging findings.o Provide an imaged based approach of important cardiovascular findings that should
be assessed in every Turner syndrome patient.o Review the current imaging recommendations used to diagnose and monitor
potential cardiovascular complications.
TABLE OF CONTENTS/OUTLINE
• Vascular manifestationso Premature coronary artery diseaseo Partial anomalous pulmonary venous returno Left sided SVCo
Elongation of the transverse aortic archo Aortic root dilation, dissection, and rupture o Aortic coarctation • Cardiac Manifestationso
Biscupid aortic valveo Septal defects: atrial and ventricularo Hypoplastic left heart syndrome
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Carlos S. Restrepo, MD - 2012 Honored Educator
Carlos S. Restrepo, MD - 2014 Honored Educator
CA140-ED-X
Cardiac Imaging Applications for Electrophysiology
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Kimberly G. Kallianos, MD, San Franicsco, CA (Presenter) Nothing to Disclose
Karen G. Ordovas, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: 1. To review the current role of cardiac MRI and CT to guide treatment strategies in
electrophysiology. 2. To illustrate the cardiac CT/MRI techniques and indications applicable to cardiac electrophysiology diagnosis.
TABLE OF CONTENTS/OUTLINE
Cardiac CT Techniques:1. Coronary venous mapping - with emphasis on important variants that would influence pacemaker lead
placement.Cardiac MRI Techniques:2. Assessment of cardiac dyssynchrony with cardiac MRI - including visualization tools.3. Scar
mapping techniques for planning ventricular ablation procedures.4. Cardiac MRI in patients with cardiac pacemakers and recurrent
ventricular tachycardia - for assessment of scar substrate for ablation.Cardiac CT/MRI Techniques: 5. Cardiac CT and MRI
techniques and post-processing tools for modeling and informing modern left atrial appendage ligation procedures.
CA141-ED-X
Cardiac MRI of Restrictive Cardiomyopathies: Beyond the Basics
All Day Location: CA Community, Learning Center
Participants
Michael J. King, MD, New York, NY (Presenter) Nothing to Disclose
Javier Sanz, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Adam Jacobi, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Matthew D. Cham, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Although restrictive physiology is traditionally diagnosed by echocardiography, restrictive cardiomyopathy is frequently encountered
on cardiac MRI. Many prognostic indicators that are invisible on echocardiography can be readily seen on MRI. Radiologists should
be familiar with the unique imaging features of restrictive cardiomyopathies. Incorrect sequences, scan parameters, or scan timing
can reduce diagnostic accuracy. Effective diagnostic strategies should utilize patient medical records including blood tests, EKG
tracings, and patient history. Restrictive cardiomyopathy should never be confused with constrictive pericarditis which is a
completely different disease.
TABLE OF CONTENTS/OUTLINE
Sarcoidosis Spectrum of imaging features Diagnostic pitfalls Clinical pearls Amyloidosis Spectrum of imaging features Diagnostic
pitfalls Clinical pearls Iron deposition disease Spectrum of imaging features Diagnostic pitfalls Clinical pearls Churg Strauss
cardiomyopathy Spectrum of imaging features Diagnostic pitfalls Clinical pearls Loeffler's endocarditis Spectrum of imaging features
Diagnostic pitfalls Clinical pearls Anderson Fabry disease Spectrum of imaging features Diagnostic pitfalls Clinical pearls
CA142-ED-X
Cardiac DWI: A New Kid on the Block
All Day Location: CA Community, Learning Center
Awards
Certificate of Merit
Participants
Jordi Broncano, MD, Cordoba, Spain (Presenter) Nothing to Disclose
Antonio Luna, MD, Jaen, Spain (Abstract Co-Author) Nothing to Disclose
Teodoro Martin, MD, Jaen, Spain (Abstract Co-Author) Nothing to Disclose
Javier Sanchez, MD, PhD, Madrid, Spain (Abstract Co-Author) Research Consultant, Koninklijke Philips NV
Pilar Caro Mateo, Cadiz, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To analyze the technical adjustments to perform diffusion-weighted imaging of the heart. To review the potential clinical
applications of cardiac DWI.
TABLE OF CONTENTS/OUTLINE
1. Introduction 2. Technical basis 2.a. Diffusion-weighted MRI 2.b. DWI analysis 2.c DWI artifacts con cardiac imaging 3. Clinical
applications 3.a. Ischemic cardiomyopathy 3.b. Acute myocarditis and pericarditis 3.c. Cardiac trauma: cardiac contusion 3.d.
Cardiac masses 3.e. Follow up and treatment monitoring 4. Conclusions
CA143-ED-X
Secrets to Accurately Diagnosing Cardiac Amyloidosis with Cardiac Magnetic Resonance Imaging: Avoid
Common Pitfalls
All Day Location: CA Community, Learning Center
Participants
Chiara Pozzessere, MD, Siena, Italy (Presenter) Nothing to Disclose
Celia P. Corona-Villalobos, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Linda C. Chu, MD, Lutherville, MD (Abstract Co-Author) Nothing to Disclose
Ihab R. Kamel, MD, PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Stefan L. Zimmerman, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Kristin Porter, MD, PhD, Baltimore, MD (Abstract Co-Author) Stockholder, Pfizer Inc
TEACHING POINTS
Illustrate the spectrum of magnetic resonance imaging findings in patients with biopsy-proven cardiac amyloidosis with emphasis on
distinguishing cardiac amyloidosis from common imaging pitfalls and improving imaging techniques and interpretation.
TABLE OF CONTENTS/OUTLINE
1. Review the most common imaging findings in patients with biopsy-proven cardiac amyloidosis, including: Subendocardial and/or
patchy late gadolinium enhancement Abnormal T1 and inversion times Pericardial and pleural effusions Concentric myocardial
hypertrophy Biatrial enlargement Thickened atrioventricular valves2. Discuss the distinguishing imaging features of cardiac
amyloidosis from the most frequent mimickers, including hypertrophic cardiomyopathy and other infiltrative cardiomyopathies, with
pathological correlation.3. Review imaging protocols and techniques optimization for evaluation of cardiac amyloidosis, including T1
mapping.Summary:Cardiac magnetic resonance imaging is commonly utilized in the diagnosis of cardiac amyloidosis. This exhibit
provides an up-to-date review of the imaging features and pitfalls associated with recognizing and accurately diagnosing cardiac
amyloidosis with pathological correlation.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ihab R. Kamel, MD, PhD - 2015 Honored Educator
Stefan L. Zimmerman, MD - 2012 Honored Educator
Stefan L. Zimmerman, MD - 2015 Honored Educator
CA144-ED-X
Update on Cardiovascular Devices
All Day Location: CA Community, Learning Center
FDA
Discussions may include off-label uses.
Participants
Francisca Furnaro Lobos, MD, Santiago de Chile, Chile (Abstract Co-Author) Nothing to Disclose
Cesar N. Cristancho Rojas, MD, Mexico City, Mexico (Abstract Co-Author) Nothing to Disclose
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Abstract Co-Author) Institutional Research Grant, Koninklijke Philips NV
Luis A. Landeras, MD, Cleveland, OH (Presenter) Institutional Grant support, Koninklijke Philips NV
TEACHING POINTS
Review of new cardiovascular devices and relevant radiographic anatomy. Understand clinical indications for the use of the different
devices. Identify pertinent preoperative findings on cross-sectional imaging Evaluate correct positioning of cardiac and vascular
devices. Recognize possible complications.
TABLE OF CONTENTS/OUTLINE
Introduction.Cardiac monitoring and conductions devices Loop recorder Leadless pacemaker. Subcutaneous implantable defibrillator.
Life VestCardiac valves Transcatheter Heart Valves: CoreValve and Sapiens. MitraClipLeft ventricular assist devices Impella.
HeartMate. HeartWare.Other miscellaneous devices AtriClips. LV Parachute.Conclusions
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
CA145-ED-X
The Clinical Application of Optimization Contrast Medium Injection Protocol Tailored to Body Surface Area in
Coronary CT Angiography
All Day Location: CA Community, Learning Center
Participants
Eriko Sato, Fukui, Japan (Presenter) Nothing to Disclose
Tomokazu Ishida, RT, Yoshida-Gun, Japan (Abstract Co-Author) Nothing to Disclose
Toshiki Adachi, RT, Yoshidagun, Japan (Abstract Co-Author) Nothing to Disclose
Hirohiko Kimura, MD, PhD, Fukui, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:1.To review the contrast injection protocol in Coronary CT. 2.To provide the factors that affect the
degree of arterial enhancement at CT angiography include body size parameters such as body weight and body surface area.
3.Review the effect on coronary artery enhancement of contrast material volumes adjusted for a patient's body surface area in
cardiac CT.
TABLE OF CONTENTS/OUTLINE
1) Optimization Method of contrast material volume in CT Angiography a. adjust for body weight b. adjust for body surface area c.
administer to a 60kg in the body weight group to match the contrast dose in the body surface area group2) Quantitative
assessment Cardiac artery attenuation determine on both enhanced and unenhanced images a. Right coronary artery b. Left
circumflex artery c. Left anterior descending artery3) Statistical Analysis Coronary artery enhancement was plotted against the
below content in each group a. body weight b. iodine dose c. body mass index
PDF UPLOAD
http://abstract.rsna.org/uploads/2015/15015858/15015858_xwfo.pdf
CA146-ED-X
Abnormal Motion of the Interventricular Septum as a Reflection of Underlying Cardiac Disease
All Day Location: CA Community, Learning Center
Participants
Rami Eldaya, MD, Galveston, TX (Presenter) Nothing to Disclose
Fernando Cesani, MD, Galveston, TX (Abstract Co-Author) Nothing to Disclose
Omar S. Eissa, MD, Galveston, TX (Abstract Co-Author) Nothing to Disclose
Matthew Ditzler, MD, Galveston, TX (Abstract Co-Author) Nothing to Disclose
Sanjay Jain, MD, Galveston, TX (Abstract Co-Author) Nothing to Disclose
Luba Frank, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Introduce the anatomy and normal function of the interventricular septumReview pathologic conditions associated with
interventricular septal motion abnomalities with MR correlation Reinforce pathologicconditions through case by case presentation
TABLE OF CONTENTS/OUTLINE
The interventricular septum (IVS) is an important structure that not only plays a direct role in bi-ventricular function, but can also
reflect changes in the function of either ventricle, exhibiting abnormal configurations and motions that have physiologic and
diagnostic value. Anatomy and normal function of interventricular septum with MR correlation Pathophysiology of abnormal motion of
the interventricular septum and correlation with imaging Chart summarizing pathologies resulting in interventricular septal
abnormality Summarize and highlight the prior points through multiple cases
CA147-ED-X
Role of 4D MR Flow Imaging in Corrected Transposition of the Great Arteries
All Day Location: CA Community, Learning Center
Participants
Raluca G. Saru, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Albert Hsiao, MD, PhD, San Diego, CA (Abstract Co-Author) Founder, Arterys, Inc; Consultant, Arterys, Inc; Research Grant,
General Electric Company
Ricardo P. Budde, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Andrea Pezzato, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Shreyas S. Vasanawala, MD, PhD, Palo Alto, CA (Abstract Co-Author) Research collaboration, General Electric Company;
Consultant, Arterys; Research Grant, Bayer AG;
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
TEACHING POINTS
-To understand how 4D MR Flow imaging can play an important role in imaging of congenitally and surgically corrected transposition
of the great arteries (TGA) -To learn how to acquire the images and how to obtain the relevant planes and measurements from the
4D MR data.-To learn how to write a comprehensive radiological report for corrected TGA using 4D MR Flow
TABLE OF CONTENTS/OUTLINE
1. Transposition of great arteries (TGA) . Defining TGA. Pathophysiology. Congenital corrected TGA 2. Different types of surgical
procedures for TGA Atrial switch procedure. Follow-up and possible complications. Arterial switch procedure. Follow-up. 3. 4D MR
Flow Acquisition protocol. Advantages and disadvantages over the standard cardiac MR techniques. 4. Radiological reporting Step
by step, what should be reported and how to obtain the relevant planes from the 4D MR data. 5. Future perspectives What is the
added value of 4D MR Flow in imaging patients with congenital heart disease?
CA149-ED-X
Viewing Lumen of Coronary Stent by CT: A Future of the Coronary Depiction by Super-High-Resolution CT?SHRCT?
All Day Location: CA Community, Learning Center
FDA
Discussions may include off-label uses.
Participants
Hirobumi Nagasawa, RT, Tokyo, Japan (Presenter) Nothing to Disclose
Masahiro Suzuki, Chuo-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Tomohiko Aso, RT, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Toshihiro Ishihara, RT, Wako, Japan (Abstract Co-Author) Nothing to Disclose
Shinsuke Tsukagoshi, MS, Otawara, Japan (Abstract Co-Author) Employee, Toshiba Corporation
Ryutaro Kakinuma, MD, PhD, Chuo-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Noriyuki Moriyama, MD, PhD, Chuo-Ku, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
This education shows that precision of coronary analysis improves drastically by using S-HRCT (spatial resolution 0.12mm).With a
use of S-HRCT, an evaluation of coronary arteries with the extensive calcification and the 2.5mm φ stent lumen is possible where it
was impractical with a Conventional High-Resolution CT (C-HRCT).A stent image scanned by S-HRCT and utility of the coronary
analysis with such images are introduced.
CA151-ED-X
Perivalvular Abscess Associated with Infective Endocarditis: The Role of Multimodality Imaging
All Day Location: CA Community, Learning Center
Participants
Weitao Ye, MD, Guangzhou, China (Presenter) Nothing to Disclose
Hui Liu, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Qiongwen Lin, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Changhong Liang, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To illustrate the clinical significance and possible mechanisms of perivalvular abscess 2. To review the major imaging findings of
perivalvular abscess associated with preoperative planning
TABLE OF CONTENTS/OUTLINE
1.Overview of the epidemiology, possible mechanisms and clinical significance of perivalvular abscess associated with infective
endocarditis 2.Demonstration of what information a radiologist should provide in preoperative planning 3.Comparison of the role of
different imaging modalities in the detection of perivalvular abscesses 4.Case based illustration of the major imaging findings of
perivalvular abscesses, with regards to their location, extension and fistulization into adjacent chambers
CA152-ED-X
Clinical Benefits of Cardiac Computed Tomography (CT) before and after Surgery for Evaluating Mitral Valve
All Day Location: CA Community, Learning Center
Awards
Cum Laude
Participants
Eun Young Kim, Jeonju-si, Korea, Republic Of (Presenter) Nothing to Disclose
Gong Yong Jin, MD, PhD, Jeonju, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jong Bum Choi, Jeonju-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young Min Han, Jeonju, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ji Soo Song, MD, Chon-Ju, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: 1. To show various morphologic findings of mitral valvular disease being considered for mitral valve
repair using preoperative cardiac CT with demonstration of intraoperative finding 2. To identify the clinical utility of the cardiac CT
by showing mitral valve coaptation geometry on postoperative cardiac CT
TABLE OF CONTENTS/OUTLINE
Message to chairman: This abstract is for General Review with Study Data to Support Educational Emphasis1. Illustration of CT
findings of each mitral valvular disease being considered for mitral valve repair with intraoperative finding2. Postoperative findings of
mitral valve coaptation geometry on cardiac CT A. Mitral valve annular and leaflet geometric parameters based on 4D volume
rendering image on cardiac CT i. septo-lateral distance ii. inter-commisural distance iii. tenting height iv. coaptation length v. lateral
displacement of coaptation3. Comparison CT measurements with echocardiography results4. Summary: Cardiac computed
tomography allows detailed assessment of mitral valve anatomy and geometry. Cardiac CT may be used as alternative imaging
modality for mitral valve apparatus measurement after mitral valve repair. In other words, CT measurement may be an important
indicator in predicting surgical prognosis.
CA153-ED-X
Cardiac Amyloidosis: Classic MRI Signs and Emphasis on T1 Mapping Technique with Pathologic Correlation
All Day Location: CA Community, Learning Center
Participants
Jose Gutierrez Chacoff, MD, Santiago, Chile (Presenter) Nothing to Disclose
Rosario J. Perea, MD, PhD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Diego Navarrete, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Teresa M. de Caralt, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Susana Prat-Gonzalez, MD, PhD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The interstitial deposition of amyloid material within the heart leads to restrictive cardiomyopathy, which is responsible for 50% of
mortality of diseaseConcentric left ventricular hypertrophy (with or without right ventricle hypertrophy), atrial enlargement,
interarterial septal thickening are most important morphologic changes of the disease. High, diffuse and heterogeneous myocardial
early enhancement, and subendocardial late enhancement without coronary distribution is the most common pattern of
enhancement after gadolinium injection.T1 mapping CMR technique enable the quantification of diffuse myocardial fibrosis, and
allows measurement of the extracelullar volume fraction (interstitial space).Levels diffuse myocardial fibrosis of amyloidosis, are
higher than any other myocardial disease. Therefore, T1 mapping gives quantitative parameters for diagnosis of myocardial
amyloidosis, and could avoid a biopsy
TABLE OF CONTENTS/OUTLINE
Aims Introduction Pathophysiology and pathology Clinical manifestations MRI Technique and protocols T1 mapping adquisition
Classics signs of amiloidosis T1 mapping interpretation Clues in differential diagnosis Schematic Diagnostic approach Messages to
take home
ED002-SU
Cardiac Sunday Case of the Day
Sunday, Nov. 29 8:00AM - 11:59PM Location: Case of Day, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Alexander M. Tassopoulos, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Cesar A. Lam, MD, Menomonee Falls, WI (Abstract Co-Author) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Presenter) Nothing to Disclose
TEACHING POINTS
1) Identify pertinent findings and generate differential diagnosis for cardiac imaging studies. 2) Develop differential diagnoses based
on the clinical information and imaging findings. 3) Recommend appropriate management for patients based on imaging findings.
SSA02
Cardiac (Dual-energy Cardiac CT)
Sunday, Nov. 29 10:45AM - 12:15PM Location: S502AB
CA
CT
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Gautham P. Reddy, MD, Seattle, WA (Moderator) Nothing to Disclose
Harold I. Litt, MD, PhD, Philadelphia, PA (Moderator) Research Grant, Siemens AG ; Research Grant, Heartflow, Inc;
Johan H. Reiber, PhD, Leiden, Netherlands (Moderator) Stockholder, Medis Medical Imaging Systems bv
Sub-Events
SSA02-01
One-Stop-Shop Cardiac Dual-Energy CT: A Gatekeeper for Invasive Coronary Angiography Early
after Acute Myocardial Infarction?
Sunday, Nov. 29 10:45AM - 10:55AM Location: S502AB
Participants
Wenhuan Li, MD, Beijing, China (Presenter) Nothing to Disclose
Kuncheng Li, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Xiaolian Zhu, Beijing, China (Abstract Co-Author) Nothing to Disclose
Nan Chen, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Qi Yang, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the gatekeeper function of one-stop-shop cardiac dual-energy CT (DECT) in acute myocardial infarction (AMI) patients
to avoid unnecessary invasive coronary angiography (ICA), by evaluating its diagnostic performance to detect coronary stenoses,
myocardial perfusion defects, and myocardial infarction, using ICA plus 13N-ammonia/18F-deoxyglucose (FDG) PET as the gold
standard.
METHOD AND MATERIALS
Consecutive AMI patients scheduled for ICA who have not undergone primary or rescue angioplasty were prospectively recruited.
One-stop-shop DECT and 13N-ammonia/18F-FDG PET were underwent before ICA. The one-stop-shop DECT needed a dual-phase
scan. First phase was scanned in arterial phase, used to reconstruct images of DECT angiography (DE-CTA) and DECT myocardial
perfusion (DE-CTP). Second phase was delayed phase DECT which was scanned 10 seconds after first phase scan, used to detect
myocardial infarction. Image analysis was as follow: firstly, identify the area of myocardial perfusion defects and myocardial
infarction by DE-CTP and delayed phase DECT using 13N-ammonia/18F-FDG PET as the gold standard. A concordant reduction in
13N-ammonia perfusion PET and 18F-FDG metabolic PET (matching defects) indicates myocardial infarction. Then assess the
presence or severity of stenoses on coronary artery supplying area of myocardial perfusion defects or myocardial infarction by DECTA, using ICA as the gold standard. If there were multiple plaques in coronary, the lesion with larger plaque area was considered
as the culprit lesion. Significant stenosis was defined as a luminal diameter reduction of ≥50% on coronary artery.
RESULTS
A total of 25 patients were successfully completed one-stop-shop DECT, 13N-ammonia/18F-FDG PET and ICA. Intervals between
examinations were no more than 1 week. ICA plus 13N-ammonia/18F-FDG PET showed 20 AMI patients with significant stenoses on
infarct-related artery (IRA) and 5 AMI patients without significant stenoses on IRA. One-stop-shop DECT correctly identified 20 AMI
patients with significant stenoses on IRA (sensitivity 100%) and correctly ruled out 5 patients AMI (specificity 100%).
CONCLUSION
One-stop-shop cardiac DECT has a gatekeeper function to avoid unnecessary ICA in patients early after AMI without significant
stenosis.
CLINICAL RELEVANCE/APPLICATION
One-stop-shop cardiac DECT has a gatekeeper function to avoid unnecessary ICA in patients early after AMI without significant
stenosis.
SSA02-02
Extracellular Volume Fraction from Iodine Density Image Using Single Source Dual-energy CT:
Comparison with Manual Measurement and Non-rigid Registration Approach
Sunday, Nov. 29 10:55AM - 11:05AM Location: S502AB
Participants
Yasutoshi Ohta, MD, Yonago, Japan (Presenter) Nothing to Disclose
Shinichiro Kitao, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Junichi Kishimoto, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Tomomi Watanabe, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Natsuko Mukai, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Kazuhiro Yamamoto, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Toshihide Ogawa, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study was to evaluate the usefulness of myocardial extracellular volume fraction (ECV) from iodine density
The purpose of this study was to evaluate the usefulness of myocardial extracellular volume fraction (ECV) from iodine density
image using ssDECT by comparison with subtraction derived ECV.
METHOD AND MATERIALS
SsDECT image was collected from patients suspected of coronary artery disease or further evaluation of reducing ejection fraction.
All subjects were performed non-contrast and equilibrium contrast-enhanced CT using ssDECT. Manually-measured ECV (mECV),
automatically-subtracted ECV using non-rigid deformation (nECV) and equilibrium-iodine density derived ECV (iECV) using iodine
density image without subtraction were calculated on the mid-left ventricular level. mECV, nECV and iECV were compared by using
Pearson correlation. Agreements among three methods were assessed by using Bland-Altman comparison.
RESULTS
Twenty-two patients were evaluated. iECV was calculated without plain CT. The correlations of each ECV measurement approach
were as follows: (mECV and iECV; r=0.754, p<0.001), (mECV and nECV; r=0.623, p=0.002). ECV was higher in patients with heart
failure than healthy control subjects for mECV (30.73 vs. 24.45, p=0.012), nECV (30.60 vs. 24.95, p=0.027) and iECV (29.79 vs.
24.68, p=0.007). Mean radiation dose was 3.5±0.2mSv for each CT acquisition.
CONCLUSION
ECV using iodine density image correlates with ECV calculated by subtraction, which allows for the noninvasive technique
quantification of the diffuse fibrosis burden in myocardial diseases with less radiation dose and without plain CT.
CLINICAL RELEVANCE/APPLICATION
ECV derived from Iodine density image using ssDECT enables measurement of ECV without non-enhanced CT and discriminate
patient increased ECV as well as subtraction derived ECV. This approach leads to reduction of X-ray exposure.
SSA02-03
Underestimation of Atherosclerotic Burden by Invasive Coronary Angiography Compared to Dual
Energy Computed Tomography
Sunday, Nov. 29 11:05AM - 11:15AM Location: S502AB
Participants
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Macarena De Zan, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Goldsmit, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
Dual energy (DE) CTCA has emerged as a novel approach that aims to convey a more accurate assessment of atherosclerotic
coronary plaques since it attenuates some of the limitations related to the polychromatic nature of x-rays, by means of synthesized
monochromatic evaluation. We sought to explore the differences between atherosclerotic burden with invasive coronary
angiography (ICA) and DE-CTCA in symptomatic patients.
METHOD AND MATERIALS
The present prospective study involved patients with suspected coronary artery disease (CAD) referred for invasive coronary
angiography (ICA). Patients were categorized according to the atherosclerotic burden extent using the modified Duke prognostic
CAD index, the CAD extension score, and the segment stenosis score (SSS), which reflect the extension and severity of the
atherosclerotic burden; and the segment involvement score (SIS), which only reflects the extent of the atherosclerotic burden.
RESULTS
Eighty patients were prospectively included in the study protocol. The mean age was 62.0±10.9 years, and 59 (74 %) patients
were male. The mean SIS (8.2±3.9 vs. 6.0±3.7, p<0.0001), modified Duke index (4.33±1.6 vs. 4.0±1.7, p= 0.003), the CAD
extension score (4.84±1.8 vs. 4.43±2.1, p= 0.005), and the median SSS (13.5 (9.0-18.0) vs. 9.5 (5.0-15.0), p<0.0001) were
significantly higher at DE-CTCA compared to ICA. DE-CTCA showed a significantly higher number of patients with any left main
coronary artery lesion (46 (58 %) vs. 18 (23 %), p<0.0001) and with severe proximal lesions (0.28±0.03 vs. 0.26±0.03, p<0.0001)
than ICA. Overall, DE-CTCA identified a larger extent of disease at proximal and mid coronary segments compared to ICA,
particularly higher at the left main coronary artery (DE-CTCA 0.69±0.7 vs. ICA 0.29±0.6, p <0.0001).
CONCLUSION
In this study, CTCA using dual energy imaging identified a significantly larger atherosclerotic burden compared to ICA, particularly
involving the proximal segments. Our findings provide further insights into the limitations of ICA and the concept of normal or near
normal coronary arteries, although the potential clinical implications should be explored in further prospective natural history
studies.
CLINICAL RELEVANCE/APPLICATION
Dual energy (DE) CTCA has emerged as a novel approach that aims to convey a more accurate assessment of atherosclerotic
coronary plaques since it attenuates some of the limitations related to the polychromatic nature of x-rays.
SSA02-04
Dual Energy Computed Tomography Coronary Angiography. Diagnostic Performance in Patients with
Intermediate to High Likelihood of Coronary Artery Disease
Sunday, Nov. 29 11:15AM - 11:25AM Location: S502AB
Participants
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Macarena De Zan, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Goldsmit, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
Dual energy (DE) CTCA has emerged as a novel approach that shows promise to attenuate some of the limitations related to the
polychromatic nature of x-rays.We sought to explore the diagnostic performance of DE-CTCA in patients with intermediate to high
likelihood of CAD referred to ICA, and the influence of different energy levels and the extent of coronary calcification.
METHOD AND MATERIALS
Between May 2014 and January 2015, consecutive symptomatic patients with suspected CAD referred for ICA who accepted to
undergo DE-CTCA and a coronary artery calcium (CAC) scoring. 45, 65 and 85 keV datasets were randomly assigned for analysis by
consensus of two observers blinded to the clinical data and to energy level applied. Quantitative image quality assessment and
luminal attenuation and signal noise was evaluated at the aortic root. Coronary artery calcium (CAC) scores were calculated by a
forth independent observer. Each coronary segment was assigned a vessel territory and categorized into tertiles according to the
individual vessel CAC score.
RESULTS
Sixty-seven patients were prospectively included. The mean effective radiation dose of DECT was 4.1±1.0 mSv and of CAC 0.9±0.3
mSv. The median CAC scoring was 597 (interquartile range 184-1095). Ten segments (1.0 %) were deemed non-assessable among
45 keV reconstructions, compared to 5 (0.5 %) among both 65 keV and 85 keV reconstructions (p= 0.07, Friedman test). Image
quality was significantly lower at 45 keV reconstructions. No significant differences were observed between groups regarding the
diagnostic performance either on a per patient or per segment basis. Patients with moderate calcification showed a modest
increase in the positive predictive value among mid and high energy levels compared to reconstructions at 45 keV, modest
improvement in likelihood ratios, and a trend towards a significant improvement in diagnostic performance with 65 keV versus 45
keV reconstructions [(45 keV, AUC 0.92 vs. 65 keV, AUC 0.96, p= 0.06]. The diagnostic performance of DE-CTCA was significantly
lower in segments with severe calcification, independently of the energy level applied.
CONCLUSION
DE-CTCA had a good diagnostic performance, with a high specificity even in patients with diffuse calcification.
CLINICAL RELEVANCE/APPLICATION
Dual energy (DE) CTCA has emerged as a novel approach that shows promise to attenuate some of the limitations related to the
polychromatic nature of x-rays.
SSA02-05
Quantitative Evaluation of Beam-Hardening Artefact Correction at Dual-Energy CT Myocardial
Perfusion Imaging
Sunday, Nov. 29 11:25AM - 11:35AM Location: S502AB
Participants
Andreas Bucher, MD, Frankfurt, Germany (Presenter) Nothing to Disclose
Lucas L. Geyer, MD, Charleston, SC (Abstract Co-Author) Speaker, General Electric Company
Julian L. Wichmann, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Carlo N. De Cecco, MD,PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Felix G. Meinel, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Andrew D. McQuiston, BS, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Christopher Wolla, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Moritz H. Albrecht, MD, Frankfurt am Main, Germany (Abstract Co-Author) Nothing to Disclose
Aleksander Krazinski, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Thomas J. Vogl, MD, PhD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To quantitatively assess the impact of a novel reconstruction algorithm ("kernel D33f") with beam-hardening correction (BHC) on
beam-hardening artefacts of the myocardium at dual-energy computed tomography myocardial perfusion imaging (DE-CTMPI).
METHOD AND MATERIALS
Rest-series of DE-CTMPI studies from 14 patients were retrospectively analyzed. Six image series were reconstructed for each
patient using 3.0 mm section thickness: a) 100kV, b) 140kV, and c) linearly-blended MIX0.5, each with BHC (D33f kernel) and
without (D30f). A total of 756 myocardial regions were analyzed. Seven regions of interest (ROI) equally subdivided the myocardium
in the axial section. Three subdivisions were made within areas prone to BHA. Reports of SPECT studies within 30 days of CT
examination were used to confirm presence and location of true perfusion defects. The relative difference of ROI attenuation from
average myocardial attenuation (RDTM) was determined as an indicator for homogeneity of myocardial attenuation. Paired student
t-test was used for statistical evaluation.
RESULTS
Overall mean myocardial attenuation was lower on corrected reconstructions (D30f, 87.3±24.1 HU; D33f, 85.5±21.5 HU, p=0.009).
Overall RDTM was more homogeneous using BHC (D30f, -0.3±11.4%; D33f, 0.1%±10.1% p<0.001). Changes in RDTM were greatest
in the postero-basal myocardium (D30f, -16.2±10.0%; D33f, 3.4±10.7%; p<0.001).
CONCLUSION
A dedicated reconstruction algorithm with BHC can significantly reduce beam-hardening artefacts at DE-CTMPI to improve the
specificity of myocardial perfusion defect assessment.
CLINICAL RELEVANCE/APPLICATION
DE-CTMPI datasets may be routinely reconstructed with a BHC algorithm to decrease beam-hardening artefacts and improve
assessment of the myocardium.
SSA02-06
Diagnostic Value of Spectral CT Combined with Serum Biomarkers in Determining Coronary Artery
Plaque Characteristics-A Preliminary Study
Sunday, Nov. 29 11:35AM - 11:45AM Location: S502AB
Participants
Huang Renjun, Suzhou, China (Presenter) Nothing to Disclose
Dai Hui, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Li Yonggang, Suzhou, China (Abstract Co-Author) Nothing to Disclose
Guo Liang, Suzhou, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of the present study was to evaluate the value of spectral computed tomography (CT) in determining coronary plaque
composition and in reflecting coronary plaque vulnerability which were compared with CT values and the findings of serum
biomarkers as the reference standard.
METHOD AND MATERIALS
107 consecutive patients(65 males and 42 females)underwent coronary CTA on a GSI capable 64-slice CT scanner.Plaques were
divided into 5 groups according to MSCT criteria(plaque density expressed by Hounsfield units[HU])and the size of calcification in
mixed plaques.Spectral curve and effective atomic number and two-material decomposition(FAT and HAP)technique were used to
analyze coronary plaques.The vulnerability of plaques was determined by serum biomarkers including soluble OX40
ligand(sOX40L)and matrix metalloproteinases(MMP-9)and lipoprotein associated phospholipase A2(Lp-PLA2).The concentration of
serum biomarkers were measured by ELISA.
RESULTS
159 coronary artery plaques were analyzed.90 cases of blood samples were obtained,and 42 cases were negative on CT.By
measuring CT values,the plaques were classified as fibrous(group1,n=29),which had a density of 61-129HU(75±20
HU),soft(group2,n=35),which had a density of≤60HU(36±30HU),and calcified(group3,n=24),which had a density of≥130HU(774±234
HU).Mixed plaques with larger(group4,n=40,465±196HU)or spotty(group5,n=31,53±32HU)calcification were also analyzed.Except the
value of FAT between group1 and group5 and between group2 and group5,there were statistically significant differences of four
spectral results among the 4 groups(p<0.05).Levels of three serum biomarkers were significantly higer in positive
patients(p<0.05).There were significant differences of MMP-9 levels between group2 and group3(p<0.05).Negative correlations was
found between serum MMP-9 levels and CT density(r=-0.501,p<0.05)and effective atomic number(r=-0.372,p<0.05)and slope of
spectral curves(r=-0.378,p<0.05)and value of HAP(r=-0.411,p<0.05).
CONCLUSION
Our results indicate that spectral CT might be used to differentiate atherosclerotic plaques.Serum levels of sOX40L and MMP-9 and
Lp-PLA2 correlate with the coronary atherosclerosis,and the elevated levels of MMP-9 might be associated with coronary plaque
vulnerability.
CLINICAL RELEVANCE/APPLICATION
spectral CT might be used to differentiate atherosclerotic plaques and indicate coronary plaque vulnerability.
SSA02-07
Interobserver Agreement of Stress Rest Dual Energy CT Myocardial Perfusion
Sunday, Nov. 29 11:45AM - 11:55AM Location: S502AB
Participants
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Roxana Campisi, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Maria Munain, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
The objectives of this paper are to determine the interobserver variability in the evaluation of myocardial perfusion defects by
Stress-Rest DECT myocardical perfusion and to assess the Sensitivity (S), Specificity (Sp), Positive predictive value (PPV) and
Negative predicitive value (NPV) of two observers in correlation with SPECT findings.
METHOD AND MATERIALS
We evaluated 20 patients with known or suspected coronary disease who had a positive exercise test for ischemia or had an
indication of SPECT.Prospective ECG-triggered cardiac DECT was performed with a 128 slice CT scanner (Discovery CT750 HD; GE
Medical Systems).First a stress CT scan was carried out and 30 minutes later a rest CT scan was complemented. Dipyridamole drug
was used for stress myocardial perfusion imaging in both CT and SPECT studies.The protocol was approved by an Institutional
Ethics Committee and all patients signed a informed consent.A 17 segmental model analysis was done using the DECT
monochromatic data at 70 kev by two independent observers.SPECT analysis was done and compared with DECT.Statistical
analysis:The 95% confidence interval of the proportions was calculated by the exact binomial method to determine the presence of
myocardial perfusion defects for both observers (O1; O2).Interobserver agreement between both observers was measured by the
kappa coefficient.
RESULTS
There were 680 myocardial segments for analysis. For the detection of myocardial perfusion defects for O1 and O2: S, Sp, PPV and
NPV were 82,1% , 96.74% , 85.48% , 96.04% and 83.3%, 96.2%, 83.3% 96.2%, respectively. The correlation between O1 and O2
was k= 0.79 (0.71 to 0.86). The mean radiation dose for each patient was 7.1 +/- 1.2 mSv.
CONCLUSION
There was good interobserver agreement of Stress-Rest DECT for the detection of myocardial perfusion defects as well as
adecuate sensitivity and specificity with SPECT findings, with similar radiation dose than single energy CT scans.
CLINICAL RELEVANCE/APPLICATION
Stress-Rest DECT for the detection of myocardial perfusion defects is feasible and shows a good performance compared to SPECT
scans.
SSA02-08
Improvement of Image Quality Using Adaptive Statistical Iterative Reconstruction in the Evaluation of
Chronic Myocardial Infarction Using Iodine Density Image with Spectral CT
Sunday, Nov. 29 11:55AM - 12:05PM Location: S502AB
Participants
Junichi Kishimoto, Yonago, Japan (Presenter) Nothing to Disclose
Yasutoshi Ohta, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Shinichiro Kitao, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Tomomi Watanabe, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Toshihide Ogawa, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of this study was to evaluate the effect and determine the optimal blend percentages of adaptive statistical iterative
reconstruction (ASiR) for iodine density imaging (IDI) of myocardial late iodine enhancement (LIE) in the evaluation of chronic
myocardial infarction (CMI) with spectral CT.
METHOD AND MATERIALS
A total of 28 patients underwent cardiac LIE using single source dual-energy CT scanner (DiscoveryCT 750HD, Freedom Edition:
GE). IDI between 0% and 100% of contributions of ASiR in 10% increments were reconstructed. The signal-to-noise ratio (SNR) of
remote myocardium and the contrast-to-noise ratio (CNR) of infarcted myocardium were measured. Transmural extent of infarction
was graded by using a 5-point scale (0= no late enhancement, 1= late enhancement with 1-24% of transmural extent, 2= 25-49%,
3= 50-74%, 4= 75-100%). The SNR, CNR, and transmural extent were assessed in a contribution ratio of each ASiR. The transmural
extents were compared with MRI as a reference standard.
RESULTS
In comparison with 0% ASiR, the use of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, and 100% ASiR resulted in reduction of
image noise between groups (-5.4%, -12.9%, -20.3%, -26.9%, -34.0%, -41.3%, -47.6%, -54.0%, -60.1% and -64.8%,
respectively; p<0.01) without difference in signal (p=NS). Compared with 0% ASiR images, reconstruction with 100% ASiR image
demonstrated the highest improvement in SNR (229%; p<0.001) and CNR (199%; p<0.001). 80%-100% ASiR demonstrated the
highest ratio (73.7%) of accurate transmural extent classification in comparison to MRI.
CONCLUSION
ASiR intensity of 80% to 100% improves image quality without changes in signal and maximizes the accuracy of transmural extent in
infarcted myocardium.
CLINICAL RELEVANCE/APPLICATION
Use of ASiR improves the image quality of LIE on iodine density image and leads to accurate diagnosis of transmural extent.
SSA02-09
Reduction of Coronary Motion Artifact in Monochromatic Imaging at Various Energy Levels Using a
Motion Correction Algorithm in ECG-gated Single-source Dual-Energy Coronary CT Angiography with
Rapid Switching of the Tube Voltage: Clinical Impact
Sunday, Nov. 29 12:05PM - 12:15PM Location: S502AB
Participants
Rika Fukui, Tokyo, Japan (Presenter) Nothing to Disclose
Jianbo Gao, MD, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
Haruhiko Machida, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Kazuyo Kita, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Yun Shen, PhD, Beijing, China (Abstract Co-Author) Employee, General Electric Company Researcher, General Electric Company
Eiko Ueno, MD, Chiyoda-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Isao Tanaka, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Takuya Ishikawa, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the clinical impact of reduction of coronary motion artifact in monochromatic imaging (MI) at various energy levels
obtained using a motion correction algorithm (MCA) in electrocardiography-gated single-source dual-energy coronary computed
tomography angiography with rapid switching of the tube voltage (DECCTA)
METHOD AND MATERIALS
We retrospectively assessed 134 consecutive patients (73 men; mean age 68 ± 11 years; mean heart rate 53.7 ± 5.0 bpm) who
underwent DECCTA. On 65-keV MI reconstructed at the optimal cardiac phase without the MCA using the detail kernel, adaptive
statistical iterative reconstruction algorithm (50% blending ratio), and 20-cm field of view, 3 readers independently graded pervessel coronary motion artifact from one (poor) to 5 (excellent) (3 to 5, interpretable) for the right (#one to 3) and left coronary
arteries (#5 to 8) and left circumflex artery (#11, 13). For 30 uninterpretable vessels in 24 of 134 patients, MI was reconstructed
at 45 to 105 keV at 20-keV intervals with the MCA; the readers regraded per-vessel coronary motion artifact on the MI; and the
percentage of interpretable vessels achieved with the MCA was calculated at each energy level. We compared grades between
images obtained with and without the MCA using Wilcoxon signed-rank test and for each energy level with the MCA using KruskalWallis test.
RESULTS
For the 30 vessels in 24 patients that were uninterpretable without the MCA, 26 (87%) at 45 and 65 keV, 21 (70%) at 85 keV; and
16 (53%) at 105 keV were interpretable with the MCA. Grades of coronary motion artifact were 1.6 ± 0.5 at 65 keV without the
MCA and 3.7 ± 1.0 at 45 keV, 3.6 ± 1.0 at 65 keV, 3.1 ± 1.1 at 85 keV, and 2.8 ± 1.2 at 105 keV with the MCA. Grades were
significantly better with the MCA than without at any energy level (P < 0.01 for all), and the grade with the MCA between any 2
energy levels (P > 0.05) differed significantly only between 45 and 105 keV.
CONCLUSION
Use of the MCA on MI at 45 to 65 keV is clinically useful for reducing coronary motion artifact in DECCTA.
CLINICAL RELEVANCE/APPLICATION
Use of the MCA for MI at a lower keV is clinically useful to reduce coronary motion artifact and improve image interpretability and
diagnostic accuracy in DECCTA.
SSA03
Cardiac (Anatomy and Function)
Sunday, Nov. 29 10:45AM - 12:15PM Location: S504AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Gregory W. Gladish, MD, Houston, TX (Moderator) Nothing to Disclose
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Moderator) Institutional Research Grant, Koninklijke Philips NV
Sub-Events
SSA03-01
Utility of Ungated Free-breathing Through-time Radial GRAPPA in Pediatric Cardiac MRI- Preliminary
Results
Sunday, Nov. 29 10:45AM - 10:55AM Location: S504AB
Participants
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Abstract Co-Author) Institutional Research Grant, Koninklijke Philips NV
Deepa Prasad, MBBS, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Lydia Everhart, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Vikas Gulani, MD, PhD, Ann Arbor, MI (Abstract Co-Author) Research support, Siemens AG
Nicole Seiberlich, PhD, Cleveland, OH (Abstract Co-Author) Research Grant, Siemens AG
Ravi Ashwath, MD, Cleveland, OH (Presenter) Nothing to Disclose
Robert C. Gilkeson, MD, Cleveland, OH (Abstract Co-Author) Research Consultant, Riverain Technologies, LLC Research support,
Koninklijke Philips NV Research support, Siemens AG
PURPOSE
Cardiac MRI (CMR) sequences require ECG gating and multiple breath holds, which may be difficult in children and often require
general anesthesia. We sought to compare the image quality and quantitative ventricular parameters with ungated free breathing
through-time radial GRAPPA to gold-standard breath-hold cine sequences.
METHOD AND MATERIALS
The study included 9 patients, 7 on 1.5 T and 2 on 3 T scanners. Both gold-standard breathheld SSFP scans with ECG gating and
free breathing ungated highly under sampled radial bSSFP scans were acquired. Radial data was reconstructed using through-time
radial GRAPPA. ESV, EDV, EF and mass were assessed for both scans and compared using two-sided t-tests. Images were
evaluated by two independent cardiac imagers for several features including endocardial border detection, blood pool, myocardium,
mitral and tricuspid valve, global and regional cardiac wall motion abnormalities on a 5 point scale (1- worst, 5- best). Artifacts
were graded on a 5 point scale (1- no artifacts, 5- extensive artifacts).
RESULTS
There was excellent correlation of quantitative measurements between the two MRI techniques (EF R=0.89, EDV R=0.99, ESV
R=0.93, mass R=0.98). The differences in EF, EDV, ESV and mass between gold-standard and real-time methods were not
statistically significant. For the Bland-Altman plot, the mean difference of the measurements between the gold-standard and realtime methods was -0.35% (1.57% and -2.27%) and 95% limits of agreement contained 100% of the difference scores. On
qualitative assessment, mitral valve was seen well (p=0.01) in SSFP but all the other features were comparable in both sequences.
The mean artifact score was significantly lower in the real- time images (1.1 vs 2.8, p < 0.005). The mean scan time was also
shorter with real time real time method (4.1 mins vs 6.5 mins, p < 0.001)
CONCLUSION
Real-time functional CMR with through-time radial GRAPPA performed without ECG-gating under free-breathing can be considered as
an alternative to gold-standard breath hold cine imaging for the evaluation of quantitative and qualitative parameters in pediatric
patients with comparable results, fewer artifacts and shorter scan times.
CLINICAL RELEVANCE/APPLICATION
This novel sequence is useful in cardiac MRI of children, who often are not compliant with breath holding instructions and may thus
obviate the need for general anesthesia in these children.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
SSA03-02
Accuracy, Precision, and Inter-Observer Variability of Left Ventricular Mass Quantification with 4D
Flow MRI
Sunday, Nov. 29 10:55AM - 11:05AM Location: S504AB
Awards
Trainee Research Prize - Fellow
Participants
Kate Hanneman, MD, Toronto, ON (Presenter) Nothing to Disclose
Aya Kino, MD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Joseph Y. Cheng, PhD, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Marcus T. Alley, PhD, Stanford, CA (Abstract Co-Author) Research Funding, General Electric Company; Research Consultant,
Arterys;
Shreyas S. Vasanawala, MD, PhD, Palo Alto, CA (Abstract Co-Author) Research collaboration, General Electric Company;
Consultant, Arterys; Research Grant, Bayer AG;
PURPOSE
4D flow MRI has been shown to comprehensively evaluate flow, ventricular function, and anatomy in congenital heart disease. Here,
we aim to compare the accuracy, precision, and inter-observer variation of left ventricular (LV) mass quantification by 4D flow MRI
versus the gold standard cardiac-gated cine steady-state free precession (SSFP).
METHOD AND MATERIALS
With IRB approval, informed consent, and HIPAA compliance, 22 consecutive patients with suspected or known congenital heart
disease (10 males, 6.4±4.8 years) referred for 3T ferumoxytol-enhanced cardiac MRI were prospectively recruited. Complete
ventricular coverage was obtained with both axial 4D flow and standard two-dimensional short-axis multi-slice SSFP sequences.
Two blinded cardiovascular imagers independently segmented the images for LV myocardium on end systolic (ES) and end diastolic
(ED) images, thus yielding four blinded measurements of LV mass by each imager in each subject. Linear regression, ANOVA, BlandAltman analysis, and intra-class correlation (ICC) were used to assess the hypothesis that the accuracy, precision and interobserver variability of LV mass measurements are not significantly difference between 4D flow and cine SSFP acquisitions.
RESULTS
Significant positive correlations were found for LV mass between 4D flow and SSFP at ED (32.8±14.2g vs. 33.3±14.4g, r=0.989,
p<0.001) and ES (33.2±14.4g vs. 31.8±13.6g, r=0.988, p<0.001). Mean bias between ED and ES LV mass measurements as a
percentage of the mean were -2.1±10.3% for 4D flow and 4.2±4.7% for SSFP, respectively. There was no significant difference
between 4D flow and SSFP with respect to mean square difference of ED-ES LV mass (F=2.05, p=0.159). High levels of interobserver agreement were achieved for LV mass with 4D flow (ED ICC 0.948 (95%CI 0.880, 0.978); ES ICC 0.936 (95%CI 0.851,
0.973)) and SSFP (ED ICC 0.960 (95%CI 0.906, 0.983); ES ICC 0.953 (95%CI 0.890, 0.980)), with overlapping confidence intervals.
CONCLUSION
Ferumoxytol-enhanced 4D flow MRI determines LV mass with comparable precision, accuracy and inter-observer agreement relative
to cine SSFP.
CLINICAL RELEVANCE/APPLICATION
4D flow imaging allows for accurate and reliable assessment of LV mass, potentially reducing costs and increasing patient comfort
due to shortened data acquisition times.
SSA03-03
Deformable Registration Based Analysis of Cine MR for Quantification of Regional Myocardial
Function: Comparison to MR Feature Tracking and Speckle-Tracking Echocardiography
Sunday, Nov. 29 11:05AM - 11:15AM Location: S504AB
Participants
Mariana M. Lamacie, MD, Toronto, ON (Presenter) Nothing to Disclose
Dinesh Thavendiranathan, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Kate Hanneman, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Marie-Pierre Jolly, Princeton, NJ (Abstract Co-Author) Employee, Siemens AG
Andreas Greiser, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Elsie Nguyen, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Richard Ward, MSc, MRCP, Toronto, ON (Abstract Co-Author) Grant, Novartis AG Grant, Apotex, Inc
Bernd J. Wintersperger, MD, Toronto, ON (Abstract Co-Author) Speakers Bureau, Siemens AG; Research support, Siemens AG
PURPOSE
The aim of this study is to assess deformable registration algorithms using cine SSFP data for analysis of myocardial strain in
comparison to cine SSFP feature tracking (FT) and speckle-tracking echocardiography (STE)
METHOD AND MATERIALS
In this prospective study, 28 patients with thalassemia major and 10 healthy volunteers underwent cardiac MRI at 1.5T (Avanto fit,
Siemens, Germany). LV peak systolic global longitudinal (GLS) based on 3 long axis SSFP cine images was measured using MR
feature tracking (2D Cardiac Performance Analysis MR, Tomtec, Germany) and a prototype automatic contouring tool with
integrated inverse deformable registration analysis (DRA) (TrufiStrain, Siemens CT, Princeton, US) based on material coordinates
assessment (Lagrangian strain). Repeated analysis was performed for both MR approaches to assess for measurement variability. 2D
speckle-tracking echocardiography (STE) (EchoPAC, GE, UK) was performed within 2h of the MR examination.
RESULTS
STE based longitudinal strain analysis was feasible in 89% of subjects while both MR approaches successfully analyzed all data sets
(100%). GLS measured by FT (-23.2±3.9%; P<0.0001) and DRA (-16.0±1.7%; P<0.0001) was significantly different from STE (19.9±1.6%). While GLS data based on FT analysis did not significantly correlate to STE (r=0.09; P=0.61) DRA derived GLS showed
significant correlation (r=0.34; P=0.049). DRA demonstrated significantly lower intra-observer variability in comparison to FT
analysis (COV (%): 1.63 vs. 6.22, F=14.43, p<0.001) with also low inter-observer variability (COV 3.179%). Assessment of ICC also
demonstrates superiority in repeated measurements (intra-observer agreement) for DRA (0.9903; 95% CI: 0.9815 to 0.9950) as
compared to FT analysis 0.9659 (95% CI: 0.8479 to 0.9874).
CONCLUSION
Deformable registration based analysis of cine SSFP data is a novel semi-automated method that allows assessment of longitudinal
deformation with superior reproducibility in comparison to MR feature tracking approach. Although DRA derived GLS values differed
from those obtained by STE and FT MR methods, the values were still within the published normal values.
CLINICAL RELEVANCE/APPLICATION
Strain analysis is an important measure of regional ventricular function and subclinical myocardial dysfunction. Automated, accurate
and reproducible assessment of strain using standard Cine SSFP data can promote routine use in clinical practice.
SSA03-04
Feature Tracking Cardiac MRI Reveals Abnormalities in Ventricular Function in Patients with Bicuspid
Aortic Valve and Normal Ejection Fraction
Sunday, Nov. 29 11:15AM - 11:25AM Location: S504AB
Participants
Nicholas S. Burris, MD, San Francisco, CA (Presenter) Nothing to Disclose
Karen G. Ordovas, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Michael D. Hope, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Prior echocardiographic studies of congenital bicuspid aortic valve (BAV) have found evidence of subclinical systolic and diastolic
dysfunction. Patients with BAV commonly undergo cardiac magnetic resonance imaging (CMR) for evaluation of valvular function
and aortic dimensions. Feature tracking CMR (FT-CMR) is a technique that allows for assessment of myocardial strain using
standard 2D cine sequences. The purpose of this study was to investigate differences in myocardial strain between BAV patients
with preserved ejection fraction and healthy controls using FT-CMR.
METHOD AND MATERIALS
Patients with isolated BAV and normal ejection fraction (EF), who had previously undergone CMR (n=36), were compared to an ageand sex-matched sample of healthy control subjects (n=10). FT-CMR strain analysis software (Circle Cardiovascular Imaging, Inc.)
was used to measure LV mass, EF and 2D ventricular strain parameters. Comparison of means was performed with student's t-test
assuming unequal variance.
RESULTS
Average age was 30.4 ± 10.7 for the BAV group and 29.4 ± 8.7 for healthy controls (p=0.8). Gender distribution was similar
between groups (BAV: 47% F, Control: 50% F). The majority of BAV patients had mild or no valve dysfunction by echocardiography
(stenosis: 64%, insufficiency: 72%). There was a trend towards higher global peak circumferential and radial strain in BAV patients
compared to controls [(-19.8 ± 1.8 vs. -18.8 ± 1.2%, p=0.07) and (40.3± 6.4% vs. 36.8 ± 4.3, p=0.08) respectively], but these
differences did not reach statistical significance. Compared to controls, myocardial mass index was higher in BAV patients (61.3 ±
13.5 vs. 46.1 ± 8.7 g/m2, p<0.001). Peak diastolic circumferential and radial strain rates were lower in BAV patients compared to
controls [(0.83 ± 0.21 vs. 1.1 ± .21 s^-1, p=0.01) and (-2.0 ± 0.66 vs. -2.8 ± 0.50 s^-1, p=0.02) respectively]. Longitudinal
strain and strain rate were not different between groups.
CONCLUSION
Feature-tracking CMR can identify abnormalities of left ventricular strain in a clinical cohort of BAV patients with normal EF.
Differences in diastolic strain rate between BAV and control groups may indicate evidence of early diastolic dysfunction.
CLINICAL RELEVANCE/APPLICATION
Feature tracking cardiac MRI strain analysis may aid in identifying early diastolic dysfunction in congenital BAV patients undergoing
cardiac MR evaluation.
SSA03-05
Is CMR Reproducible Enough for the Follow-up of RVEF? Comparison with Gated Blood Pool SPECT
in Various Subgroups of Heart Disease
Sunday, Nov. 29 11:25AM - 11:35AM Location: S504AB
Participants
Laurent Dercle, MD, Villejuif, France (Presenter) Nothing to Disclose
Thomas Giraudmaillet, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Fatima-Zohra Mokrane, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Charline Zadro, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Marie Agnes Marachet, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Herve P. Rousseau, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
The estimation of right ventricular ejection fraction (RVEF) is crucial in order to establish the diagnosis, the risk stratification, the
prognosis, and the response to treatment in a wide range of heart disease. Cardiac Magnetic Resonance Imaging (CMR) is the
reference-standard for the evaluation of RV volumes but the manual delineation of endocardial border leads to a significant
operator-dependency. This report investigates if new MRI techniques are reproducible enough to be considered as the referencestandard for the follow-up of RVEF (in 12 subgroups of heart disease), in comparison with the most reproducible technique: gated
blood pool single photon emission computed tomography (GBPS).
METHOD AND MATERIALS
94 CMR and 99 GBPS were measured by two physicians. GBPS was performed using 2 automatic algorithms: BP-SPECT and QBS and
a semi-automatic algorithm: TOMPOOL. Relative Inter-Observer Variability (IOV) was defined as the absolute difference between
the two calculated measurements normalized to their average and expressed as a percentage.
RESULTS
The overall IOV (%) was greater using semi-automatic GBPS procedure (TOMPOOL: 16±20%) than CMR (12±14%) or automatic
GBPS algorithm (QBS: 8±12%, BP-SPECT: 6±6%). The IOV of CMR challenged GBPS in 2 subgroups of heart disease treated
arrhythmia (6±5%) and hyperdynamic cardiomyopathy / cirrhosis (4±3%). Overall, the factors that most influenced the IOV were
right valve regurgitation (20±18%; n=27), dilated cardiomyopathy (20±20%; n=24), RVEF<45% (20±18%; n=32), end-systolic
diameter of the left ventricle>41mm (17±19%; n=30) and left valve regurgitation (17±20%; n=27).
CONCLUSION
The most reproducible procedure is automatic GBPS. Changes occurring during the follow-up should be interpreted cautiously on
CMR (IOV: 12%) or semi-automatic GBPS (IOV: 16%). The parameters responsible for increased IOV on CMR are: valve
regurgitation, altered ejection fraction and enlargement of the left ventricle. The reproducibility of CMR challenged GBPS in treated
arrhythmia and hyperdynamic heart disease.
CLINICAL RELEVANCE/APPLICATION
The estimation of RVEF is crucial in a wide range of heart disease. A reproducible technique is necessary for an optimal follow-up of
RV dysfunction.
SSA03-06
Left Ventricular Function Can Be Adequately Assessed Using Compressed Sensing Cine Imaging with
High Spatial and Temporal Resolution
Sunday, Nov. 29 11:35AM - 11:45AM Location: S504AB
Participants
Juliane Schelhorn, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Felix Nensa, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Haemi P. Schemuth, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Stefan Maderwald, PhD, MSc, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Marcel Gratz, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Kai Nassenstein, Essen, Germany (Presenter) Nothing to Disclose
Michael Zenge, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Harald H. Quick, PhD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Thomas W. Schlosser, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac magnetic resonance cine imaging currently bases on time consuming cine SSFP sequences with limited spatial and temporal
resolution. Here we assessed whether two compressed sensing cine sequences with high spatial or high temporal resolution can
reliably quantify left ventricular volumes and mass.
RESULTS
Small differences were observed between standard SSFP and sparse 1 for end-diastolic volume (EDV, median difference 4ml,
p=0.044), stroke volume (SV, mean difference, 7±10ml, p=0.013), ejection fraction (EF, 1%, p=0.029), and myocardial mass (8±7g, p<0.001), but no significant difference was found for end-systolic volume (ESV, p=0.135). No significant differences were
observed between standard SSFP and sparse 2 regarding EDV (-1±5ml, p= 0.528), ESV (-3±5ml, p=0.058), SV (2±5ml, p=0.139),
and EF (1±3%, p=0.105), except for myocardial mass (-6±8g, p=0.017). Intraclass correlation coefficients comparing standard
SSFP with both sparse sequences were at least 0.95. Bland-Altman analysis and Passing-Bablock regression showed good
agreement between all sequences. Intraobserver agreement was good to excellent (kappa: 0.76-0.90).
CONCLUSION
Compressed sensing cine sequences with improved spatial or temporal resolution enable reliable assessment of LV volumes and
mass.
CLINICAL RELEVANCE/APPLICATION
Compressed sensing cine imaging allows an adequate assessment of the left ventricular function and an improved spatial and
temporal resolution.
SSA03-07
CMR-derived TAPSE Is a Useful Marker for Detection of RV Function Changes in Patients with Chronic
Thromboembolic Pulmonary Hypertension
Sunday, Nov. 29 11:45AM - 11:55AM Location: S504AB
Participants
Xiaojuan Guo, PhD, Beijing, China (Presenter) Nothing to Disclose
Min Liu, Beijing, China (Abstract Co-Author) Nothing to Disclose
Zhanhong Ma, Beijing, China (Abstract Co-Author) Nothing to Disclose
Tao Jiang, Bei Jing, China (Abstract Co-Author) Nothing to Disclose
Shuang Wang, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Tianjing Zhang, Beijing, China (Abstract Co-Author) Employee, Siemens AG
PURPOSE
The aim of this study is to determine whether CMR-derived right ventricular fractional shortening (RVFS), tricuspid annular plane
systolic excursion with a reference point within the right ventricular apex (TAPSEin) and with one outside the ventricle (TAPSEout)
: (1) can predict pulmonary hypertension ,(2)correlates with pulmonary vascular resistance index (PVR) and main pulmonary artery
flow in patients with CTEPH.
METHOD AND MATERIALS
37 patients (age, 50.1 ± 11.7 years; male,22) with chronic thromboembolic pulmonary hypertension (CTEPH) and 15 healthy
subjects (age,47.4 ± 13.6 years; male, 9) underwent CMR imaging at 3T. The four-chamber Cine images were acquired to get the
distance between the cutting edge of the tricuspid annulus with the RV free wall and the RV apex or a reference point outside the
RV apex in end-diastole (end-diastolic length (EDL)in or EDLout) and end-systole (end systolic length (ESL)in or ESLout). All
patients underwent right heart catheterization to get PVR.The parameters between different group were compared by an
independent t- test. The ROC curve analysis was used to evaluate the diagnosis value of TAPSE derived by CMRI. TAPSE obtained
by CMRI were correlated with PVR and MPA mean velocity by Spearman or Pearson correlation analysis.
RESULTS
TAPSEout (t=5.69, p<0.001), TAPSEin (t=5.83, p<0.001) and RVFS (t=6.05, p<0.001) revealed a significant difference between
patients with CTEPH and the healthy group .ROC curve analysis showed that TAPSEout had a high predictive value for CTEPH
(Auc=0.92 for TAPSEout, 0.89 for TAPSEin ,0.88 for RVFS, p<0.01). The diagnostic threshold for TAPSEout was15.7mm for CTEPH
patients.In patients with CTEPH, PVR showed a significant but weak correlation with TAPSEout (r=-0.31, p=0.04) and no correlation
with TAPSEin (r=- 0.09, p=0.61) and RVFS (r=-0.08, p=0.64). There was a moderate correlation between MPA mean velocity and
TAPSEout (r=-0.54, p<0.03) and no correlation with TAPSEin (r=-0.13, p=0.62) and RVFS (r=0.-0.06, p=0.83).
CONCLUSION
CMR-derived TAPSEout is a useful marker to predict CTEPH. TAPSEout shows a good correlation with PVR and MPA mean velocity in
CTEPH patients. TAPSEout might be a potential indicator for detection of RV function changes.
CLINICAL RELEVANCE/APPLICATION
CMR -determined TAPSE measurement is a quick screening method to identify patients with potential RV dysfunction and to select
patients in whom a more detailed analysis would be used.
SSA03-08
Body Mass Index-Based Reduction of Radiation Exposure in Coronary CT Angiography Using a 3rd
Generation Dual-Source CT Scanner
Sunday, Nov. 29 11:55AM - 12:05PM Location: S504AB
Participants
Stefanie Mangold, MD, Charleston, SC (Presenter) Nothing to Disclose
Carlo N. De Cecco, MD,PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Julian L. Wichmann, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Maxwell Stroebel, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Christian Canstein, Charleston, SC (Abstract Co-Author) Employee, Siemens AG
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Giuseppe Muscogiuri, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Konstantin Nikolaou, MD, Tuebingen, Germany (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group
Speakers Bureau, Bayer AG
Akos Varga-Szemes, MD, PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To retrospectively investigate the potential of further dose reduction at coronary computed tomography angiography (CCTA) based
on body mass index (BMI) using a 3rd generation dual-source CT (DSCT) scanner and automated tube voltage selection.
METHOD AND MATERIALS
We evaluated 231 patients who underwent CCTA with a 3rd-generation DSCT. Prospectively ECG-triggered adaptive sequential
acquisition at 70, 80, 90, 100 and 120kV (pulsing window 30-90%, full dose at 70% of the cardiac cycle) was performed with
automated attenuation-based selection of tube current and voltage and advanced modeled iterative reconstruction. Patients were
divided in three classes: 1, 70-80kV (n=44); 2, 90-100kV (n=59) and 3, 120kV (n=118). BMI and effective dose (ED) was recorded.
Vascular attenuation in proximal and distal coronary arteries was measured. Contrast-to-noise ratio (CNR) was calculated. To
subjectively evaluate vessel enhancement and image noise five-point scales were used.
RESULTS
Image quality was diagnostic in 98.7% of the examinations. BMI between the groups was significantly different with 24.2kg/m2 in
group 1, 27.5kg/m2 in group 2 and 34.3kg/m2 in group 3 (p=.0006 and p<.0001, respectively). Proximal and distal CNR was
significantly lower in group 1 compared to group 2 (14.5vs16.8 and 11.4vs14.0,p=.049 and .007) and in group 3 compared to group
2 (13.6 and 10.9;p=.002 and .0001). However, no significant differences between the groups were shown by subjective image
quality analysis (p>.05). Intragroup comparison in group 1 and 2 revealed no significant differences regarding the BMI and objective
image quality parameters between 70 and 80kV (mean BMI: 24.0±3.0vs25.1±3.4kg/m2,p=.370; mean proximal CNR:
15.0vs14.1,p=.492) and between 90 and 100kV (mean BMI: 27.7±4.6vs27.2±4.3kg/m2,p=.717; mean proximal CNR:
16.1vs17.5,p=.429). However, ED was significantly lower for 70kV in comparison to 80kV (1.7±1.4vs2.7±1.5mSv,p=.001) as well as
for 90kV compared to 100kV (5.0±3.4vs6.5±3.3mSv,p=.011). Mean ED at 120kV was 11.2±4.4mSv.
CONCLUSION
For CCTA with 3rd generation DSCT automated tube voltage selection is effective in reducing the ED according to patient size.
CLINICAL RELEVANCE/APPLICATION
Automated tube voltage selection can be used to achieve significant reduction of radiation dose in CCTA in patients with a wide
range of body types.
SSA03-09
The Impact of Dipper Status in Hypertension on Cardiac Structure, Global Function and Regional
Myocardial Strain: Insights from Cardiac Magnetic Resonance (CMR)
Sunday, Nov. 29 12:05PM - 12:15PM Location: S504AB
Participants
Jonathan C. Rodrigues, MRCP,FRCR, Bristol, United Kingdom (Presenter) Nothing to Disclose
Antonio M. Amadu, MD, Sassari, Italy (Abstract Co-Author) Nothing to Disclose
Amardeep Ghosh Dastidar, MBChB,MRCP, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Stephen M. Lyen, FRCR, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Amy Burchell, MBBCh,MRCP, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Laura Ratcliffe, MBBS,MRCP, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Emma Hart, BSC,PhD, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Mark Hamilton, MRCP, FRCR, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Chiara Bucciarelli Ducci, MD, PhD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Julian Paton, BSC,PhD, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Angus Nightingale, MBBCHIR,MD, Bristol, United Kingdom (Abstract Co-Author) Nothing to Disclose
Nathan Manghat, FRCR, MD, Plymouth, United Kingdom (Abstract Co-Author) Nothing to Disclose
PURPOSE
The loss of normal nocturnal dip in blood pressure in hypertension has adverse prognostic implications. We investigated the impact
of dipper status on cardiac structure and function using cardiac magnetic resonance (CMR).
METHOD AND MATERIALS
24 hour ambulatory blood pressure monitoring (ABPM) and comprehensive CMR including late gadolinium enhancement (LGE) for
myocardial scar assessment (1.5T Avanto, Siemens) were performed in 72 hypertensive patients referred from our tertiary
hypertension clinic. Dipper status (n=33) was defined as >10% drop and non-dipper (n=39) as 0-10% drop in nocturnal systolic BP
(SBP) versus diurnal SBP. Left ventricular mass (LVM) and volumes indexed to body surface area. Regional myocardial strain was
estimated from the global mid LV from a 3D model generated from 4-chamber, 2-chamber and short axis cines (cvi42, Circle
Cardiovascular Solutions Inc.). Fishers exact or unpaired student T tests were used as appropriate.
RESULTS
The results are show in Table 1. Non-dippers were significantly older than dippers (54±14 vs 46±15 years p<0.05). There was no
difference in overall SBP and DBP between dippers and non-dippers but the latter had significantly higher nocturnal SBP (152±23 vs
129±13 mmHg p<0.0001) and DBP (82±14 vs 76±12 mmHg p<0.05). There were non-significant trends towards higher indexed LVM
(90±25 vs 84±18g/m2) and prevalence of subendocardial LGE suggesting previous subclinical myocardial infarction (11% vs 3%) in
non-dippers compared to dippers. Time to peak longitudinal strain was significantly higher in non-dippers compared to dippers
(346±68 vs 316±54ms p<0.05) despite no significant difference in BP. A similar trend was observed for time to peak radial strain
(332±68 vs 306±68ms p=0.07).
CONCLUSION
Significantly higher nocturnal SBP and DBP occur in non-dippers versus dippers. Trends towards increased indexed LVM, prevalence
of subendocardial MI and prolonged time to peak strain. The latter suggests increased peripheral vascular resistance in non-dippers.
These findings may help explain the adverse cardiovascular risk conferred by non-dipper status.
CLINICAL RELEVANCE/APPLICATION
CMR provides insights into different structural and function differences in non-dippers versus dippers and has potential to aid risk
stratification in patients with hypertension.
CAS-SUA
Cardiac Sunday Poster Discussions
Sunday, Nov. 29 12:30PM - 1:00PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Udo Hoffmann, MD, Boston, MA (Moderator) Nothing to Disclose
Hildo J. Lamb, MD, PhD, Leiden, Netherlands (Moderator) Nothing to Disclose
Robert M. Steiner, MD, Philadelphia, PA (Moderator) Consultant, Educational Symposia; Consultant, Johnson & Johnson
Sub-Events
CA210-SDSUA1
Submillisievert Computed Tomography with Model-based Iterative Reconstruction before Pulmonary
Veins Radiofrequency Catheter Ablation of Atrial Fibrillation: Impact on Radiation Exposure and
Outcome
Station #1
Participants
Gianluca Pontone, MD, Milan, Italy (Presenter) Speakers Bureau, General Electric Company; Consultant, General Electric Company;
Research Consultant, HeartFlow, Inc; Speakers Bureau, HeartFlow, Inc; Speakers Bureau, Medtronic, Inc; Speakers Bureau, Bayer
AG
Daniele Andreini, MD, Milan, Italy (Abstract Co-Author) Consultant, General Electric Company
Andrea Daniele Annoni, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Maria Petulla, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Eleonora Russo, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Ester Innocenti, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Marco Guglielmo, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Saima Mushtaq, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Claudio Tondo, Milan, Italy (Abstract Co-Author) Advisory Board, Medtronic, Inc Speaker, St. Jude Medical, Inc Consultant, St. Jude
Medical, Inc Speaker, Johnson & Johnson Consultant, Johnson & Johnson
Mauro Pepi, Milan, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
The outcome of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has improved thanks to left atrium (LA) anatomy
reconstruction by computed tomography with adaptive statistical iterative reconstruction algorithm (CT-ASIR) before the
procedure.Recently, a model-based iterative reconstruction algorithm (MBIR, GE Healthcare,Waukesha,Wisconsin) has been
developed (CT-MBIR) for image noise reduction reducing the effective radiation dose (ED) close to chest X-ray exposure. The aim
of this study is to compare the CT and RFCA characteristics, AF recurrence after procedure and ED between RFCA guided by image
integration with CT-ASIR versus CT-MBIR
METHOD AND MATERIALS
One-hundred twenty consecutive patients with drug-refractory paroxysmal or persistent AF were addressed to CT-ASIR (Group
1;N: 60;mean age 60.3±10.1 yo;male:46) or CT-MBIR protocol (Group 2; N: 60; mean age 59.7±11.3 yo; male:45) for evaluation of
LA before RFCA. All patients were subsequently treated by image integration-supported RFCA. Image noise, signal to noise ratio
(SNR), contrast to noise ratio (CNR), RFCA procedural characteristics, rate of AF recurrence and CT radiation exposure were
measured and compared between the two groups.
RESULTS
The two groups were homogeneous in terms of demographic characteristics, cardiovascular risk factors, prevalence of persistent
AF, medical therapy and echocardiographic characteristics. The mean follow-up was similar (578±284 vs. 591±278 days,
respectively, p:ns). Group 2 showed a higher signal to noise ratio (25.9±7.1 vs. 13.8±5.1) and contrast to noise ratio (22.7±6.5 vs.
and 14.08±4.1) of left atrium as compared to Group 1 (p<0.001). No differences were found in terms of RFCA parameter [procedural
duration (130.9±130.6. vs. 143.8±80.4 min); fluoroscopy time (27.9±14.1.0 vs. 32.0±16.4 min); pulmonary veins isolated (3.8±0.4
vs. 3.9±0.4)] and the rate of AF recurrence (31% vs. 29%) between Group 2 vs Group 1. Group 2 showed a 94% reduction of ED
as compared to Group 1 (0.4±0.04 mSv vs 6.4±1.8 mSv, p<0.01).
CONCLUSION
CT-MBIR allows accurate non-invasive reconstruction of LA anatomy in AF patients undergoing to RFCA with a submillisievert
effective radiation and comparable success rate of RFCA with CT-ASIR technique.
CLINICAL RELEVANCE/APPLICATION
CT-MBIR allows accurate reconstruction of LA anatomy in AF patients undergoing to RFCA with a submillisievert effective radiation
and comparable success rate of RFCA with CT-ASIR technique.
CA202-SDSUA3
Image Quality of Coronary CT Angiography for Low Contrast Agent and Radiation Dose Protocol
Using 3rd Generation Dual-source CT
Station #3
Participants
Atsushi K. Kono, MD, PhD, Kobe, Japan (Presenter) Nothing to Disclose
Yoshiaki Watanabe, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Tatsuya Nishii, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tatsuro Ito, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Shumpei Mori, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tomofumi Takaya, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Sei Fujiwara, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Satoru Takahashi, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kazuro Sugimura, MD, PhD, Kobe, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation Research Grant, Koninklijke
Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group
PURPOSE
The purpose of this study is to evaluate the image quality of a low contrast agent dose and radiation dose protocol for coronary CT
angiography (CCTA) using 3rd generation dual-source CT (DSCT).
METHOD AND MATERIALS
A total of 68 consecutive patients who underwent CCTA in the clinical setting between June 2014 and April 2015 were
retrospectively reviewed. The regular 2nd generation DSCT protocol of scanning at 120 kVp tube voltage and injecting 0.06 ml/kg
body weight of 370 mgI/ml contrast agent was used in 48 patients (67.9 ± 10.7 years old, 21 female). A low dose 3rd generation
DSCT protocol was performed at 70 kVp and 60% of the regular contrast agent amount in 20 patients (69.1 ± 7.7 years old, 10
female). Each protocol was evaluated for the CT value of the aortic root, image noise, contrast-to-noise-ratio per unit dose
(CNRD), and estimated effective radiation dose. Image noise was defined as standard deviation of CT value in the left ventricular
lateral wall. CNR was calculated by dividing CT value by image noise. CNRD was calculated by dividing CNR by the square root of
the CT dose index volume. The effective radiation dose was calculated from the dose length product and a conversion factor (k =
0.014 mSv/mGy×cm). We compared these values using the Mann-Whitney U test.
RESULTS
The mean CT value and image noise was higher for the low dose protocol than for the regular protocol (537.0 vs. 397.1 HU, 36.8
vs. 21.5 HU, respectively; P < 0.001 for both). The mean value of CNRD was lower in the low dose protocol (2.2 vs. 3.5, P <
0.001). On the contrary, the mean value of CNRD was not significantly different (2.4 vs. 2.0, P = 0.24). The amount of contrast
agent and effective radiation dose was reduced in the low dose protocol (30.7 vs. 53.9 ml and 5.1 vs. 12.6 mSv, respectively; P <
0.001 for both).
CONCLUSION
The low contrast agent and radiation dose protocol significantly reduced radiation and contrast agent doses with maintaining the
image quality of CCTA using 3rd generation DSCT.
CLINICAL RELEVANCE/APPLICATION
The low dose protocol for CCTA using 3rd generation DSCT can provide 60% reduction of radiation dose and 40% reduction of
contrast material amount.
CA203-SDSUA4
Dual Energy Computed Tomography Coronary Angiography. Diagnostic Performance in Patients with
Intermediate to High Likelihood of Coronary Artery Disease
Station #4
Participants
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Macarena De Zan, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Goldsmit, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
Dual energy (DE) CTCA has emerged as a novel approach that shows promise to attenuate some of the limitations related to the
polychromatic nature of x-rays.We sought to explore the diagnostic performance of DE-CTCA in patients with intermediate to high
likelihood of CAD referred to ICA, and the influence of different energy levels and the extent of coronary calcification.
METHOD AND MATERIALS
Between May 2014 and January 2015, consecutive symptomatic patients with suspected CAD referred for ICA who accepted to
undergo DE-CTCA and a coronary artery calcium (CAC) scoring. 45, 65 and 85 keV datasets were randomly assigned for analysis by
consensus of two observers blinded to the clinical data and to energy level applied. Quantitative image quality assessment and
luminal attenuation and signal noise was evaluated at the aortic root. Coronary artery calcium (CAC) scores were calculated by a
forth independent observer. Each coronary segment was assigned a vessel territory and categorized into tertiles according to the
individual vessel CAC score.
RESULTS
Sixty-seven patients were prospectively included. The mean effective radiation dose of DECT was 4.1±1.0 mSv and of CAC 0.9±0.3
mSv. The median CAC scoring was 597 (interquartile range 184-1095). Ten segments (1.0 %) were deemed non-assessable among
45 keV reconstructions, compared to 5 (0.5 %) among both 65 keV and 85 keV reconstructions (p= 0.07, Friedman test). Image
quality was significantly lower at 45 keV reconstructions. No significant differences were observed between groups regarding the
diagnostic performance either on a per patient or per segment basis. Patients with moderate calcification showed a modest
increase in the positive predictive value among mid and high energy levels compared to reconstructions at 45 keV, modest
improvement in likelihood ratios, and a trend towards a significant improvement in diagnostic performance with 65 keV versus 45
keV reconstructions [(45 keV, AUC 0.92 vs. 65 keV, AUC 0.96, p= 0.06]. The diagnostic performance of DE-CTCA was significantly
lower in segments with severe calcification, independently of the energy level applied.
CONCLUSION
DE-CTCA had a good diagnostic performance, with a high specificity even in patients with diffuse calcification.
DE-CTCA had a good diagnostic performance, with a high specificity even in patients with diffuse calcification.
CLINICAL RELEVANCE/APPLICATION
Dual energy (DE) CTCA has emerged as a novel approach that shows promise to attenuate some of the limitations related to the
polychromatic nature of x-rays.
CA224-SDSUA5
A Novel Contrast Enhancement Technique for Subtraction Coronary Computed Tomography
Angiography with Short Breath-holding Times
Station #5
Participants
Takayoshi Yamaguchi, Sapporo, Japan (Presenter) Nothing to Disclose
Daichi Takahashi, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Mari Morita, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Tomonori Fujii, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Teppei Sugaya, MD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Jyungo Furuya, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Keiichi Igarashi, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Katsuhiro Ichikawa, PhD, Kanazawa, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Subtraction coronary computed tomography angiography (SCCTA) is clinically effective for calcified and in-stent lesions in coronary
arteries (CA). However, its long breath-holding (BH) time (20-40 s) is sometime problematic for elderly or respiratory failure
patients. We developed a novel contrast enhancement technique for SCCTA using an area-detector CT scanner, which enabled a
short BH time of 13 s. The purpose of this study is to evaluate the validity of the proposed technique.
METHOD AND MATERIALS
In this technique, test bolus (TB) and main bolus (MB) were injected continuously including interval time for 10 seconds. The first
time enhancement curve (TEC) is measured by using the bolus tracking, and the pre-contrast image (pre-CI) scan was started
after 8s when TEC peak appears. Then the contrast image (CI) scan was started after 5 s from pre-CI scan. (Test bolus tracking
method) We evaluated 127 patients with 400 or more Agatston units or STENT treatment history by using this technique. Coronary
subtraction was performed using the scanner's embedded software. The CT numbers of pre-CI and CI were evaluated in major
vessels and CA. The image quality (IQ) was assessed using a 4-point scale (1:uninterpretable, 2:poor, 3:moderate, 4:good) in the
calcified and STENT segments.
RESULTS
The mean time from the pre-CI scan to the CI scan was 8.0±0.5s, and the mean BH time was 13.2 ± 0.6s. There was no significant
difference in heart rate between pre-CI and CI (53.8±4.6 bpm vs. 53.7±4.4 bpm, p>0.05). In the pre-CI, the mean CT number of
the main pulmonary artery (580.4±186.5 HU) was significantly highest in all measurement points, and CA was slightly enhanced
(99.2±32.2 HU). The mean CT number of CA in CI (469.7±69.7 HU) was significantly higher than that in the pre-CI (p<0.001). The
mean CT number of CA in subtraction images (SI) was 367.0±77.2 HU. The mean IQ score of SI was significantly higher than that
of CI (3.6±0.6 vs. 2.5±1.0 (n=393): p<0.0001).
CONCLUSION
The proposed contrast enhancement technique for SCCTA we developed presented sufficient enhancements of CA, achieving short
BH times of approximately 13 s.
CLINICAL RELEVANCE/APPLICATION
SCCTA is clinically effective. However, its long breath-holding time (20-40 s) is problematic. Our proposed technique would
contribute to facilitate the SCCTA examinations by shortening the breath-holding time to approximately 13 s.
CA102-EDSUA6
Bridge to Heart Transplantation: Left Ventricular Assisted Device (LVAD) and Total Artificial Heart
(TAH) and Their Complications
Station #6
Participants
Carrie K. Gomez, DO, Rochester, NY (Presenter) Nothing to Disclose
Susan K. Hobbs, MD, PhD, Rochester, NY (Abstract Co-Author) Nothing to Disclose
Katherine A. Kaproth-Joslin, MD, PhD, Rochester, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The discrepancy between the clinical need for donor hearts and the available supply has led to the development of devices such as
LVAD and TAH. The HeartMate II LVAD device is implanted into a pump pocket. Its inflow cannula is anastomosed to the left
ventricular apex; the outflow cannula is anastomosed to the ascending aorta. A driveline wire traverses the abdominal wall to
connect the external battery pack to an internal motor. The LVAD has been associated with multiple complications such as
infections/abscesses, thrombotic events, hemorrhage, kinking, rotation, and malposition of the inflow or outflow cannulas. The total
artificial heart replaces the patient's native ventricles and valves. The TAH is connected to an external console by pneumatic
drivelines. The most common complications on TAH recipients include infections, bleeding, thrombosis, liver failure, renal failure,
neurological events such as stroke and device malfunction.
TABLE OF CONTENTS/OUTLINE
The parts of LVAD and TAH will be portrayed using both CT and plain films. Multiple complications of the HeartMate II LVAD will be
illustrated based on their CT appearance. Complications involving the Syncardia total artificial heart such as infections of the
drivelines/neopericardium, device malfunction, intrathoracic and extrathoracic thrombosis/hemorrhages will be presented.
CAS-SUB
Cardiac Sunday Poster Discussions
Sunday, Nov. 29 1:00PM - 1:30PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
FDA
Discussions may include off-label uses.
Participants
Udo Hoffmann, MD, Boston, MA (Moderator) Nothing to Disclose
Hildo J. Lamb, MD, PhD, Leiden, Netherlands (Moderator) Nothing to Disclose
Robert M. Steiner, MD, Philadelphia, PA (Moderator) Consultant, Educational Symposia; Consultant, Johnson & Johnson
Sub-Events
CA205-SDSUB1
Prediction of Functional Coronary Artery Stenosis by ECG-gated CT Angiography: Significance of
Coronary Artery to Aorta Luminal Attenuation Ratio
Station #1
Participants
Tomofumi Misaka, RT, Ikoma, Japan (Presenter) Nothing to Disclose
Yuki Sugitani, MD, Ikoma, Japan (Abstract Co-Author) Nothing to Disclose
Tsutomu Shomura, RT, Ikoma, Japan (Abstract Co-Author) Nothing to Disclose
Hidekazu Nambu, Ikoma, Japan (Abstract Co-Author) Nothing to Disclose
Hiroharu Okada, PhD, Ikoma, Japan (Abstract Co-Author) Nothing to Disclose
Kaoru Okajima, MD, Ikoma, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
To detect decreased blood flow to the myocardium, we developed a new method using the coronary artery to aorta luminal
attenuation ratio (CAR) on coronary CT angiography (cCTA). This study aimed to assess the diagnostic performance of CAR in the
detection of functionally significant coronary artery stenosis.
METHOD AND MATERIALS
A total of 32 consecutive patients (mean age±SD: 69±8) who underwent both cCTA (64 slices) and coronary angiography (CAG)
within a 3-month period were included. Functional ischemia was evaluated by the treadmill test (TMT) or myocardial perfusion
imaging (MPI). A total of 83 arteries were categorized into two groups: group 1 had stenosed arteries (≥50% stenosis on CAG) and
functional ischemia determined by TMT or MPI; all other arteries were categorized into group 2. CAR was calculated by measuring
mean luminal CT attenuation values (Hounsfield unit) of the coronary arteries and ascending aorta at the diastolic phase and
expressing them as a ratio. The CT value of coronary arteries was defined as the average of values in 10 short-axis slices
perpendicular to the arteries, in segments with diameter of 2-3 mm. The diagnostic performance of CAR compared with cCTA was
evaluated by areas under the curves (AUCs) in receiver operating characteristic analysis, where group 1 was regarded as true
positives.
RESULTS
Group 1 and 2 had 22 and 61 arteries, respectively. CAR values were 0.448 (SD: 0.051) in group 1 and 0.480 (0.049) in group 2.
When ischemia was evaluated by cCTA (stenosis ≥50%), sensitivity was 91.3% and specificity was 63.8%, whereas CAR (<0.447)
could predict ischemia with sensitivity of 73.9% and specificity of 74.1%. AUCs were also calculated for arteries that showed
positive findings in both cCTA and CAR. AUCs in detecting ischemia were 0.81 (95% CI: 0.70-0.91), 0.79 (95% CI: 0.67-0.90), and
0.87 (95%CI: 0.76-0.97) for cCTA, CAR, and cCTA/CAR, respectively. The diagnostic performance of cCTA was significantly
improved by combination with CAR (AUCs: 0.81 vs. 0.87, p<0.05)
CONCLUSION
CAR correlated well with functional ischemia and showed better diagnostic performance when combined with cCTA.
CLINICAL RELEVANCE/APPLICATION
The added value of CAR measurements to cCTA may help identifying functionally significant coronary artery stenosis.
CA206-SDSUB2
Cardiac CT Angiography Versus Intra-vascular Ultrasound for the Assessment of Myocardial
Coronary Bridges
Station #2
Participants
Signe H. Forsdahl, MD,PhD, Palo Alto, CA (Presenter) Nothing to Disclose
Ingela Schnittger, MD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Ian S. Rogers, MD, MPH, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Jennifer A. Tremmel, MD,PhD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Shigemitsu Tanaka, MD,PhD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Takumi Kimura, MD,PhD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Frandics P. Chan, MD, PhD, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Dominik Fleischmann, MD, Palo Alto, CA (Abstract Co-Author) Research support, Siemens AG;
Hans-Christoph R. Becker, MD, PhD, Stanford, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Myocardial bridges (MB) are congenital coronary conditions and a common finding on coronary computed tomography (CTA). An
abnormal septal wall motion with sparing of the apex in exercise echocardiograph (EE) has been reported to be associated with a
high likelihood of MB. However, intravascular ultrasound (IVUS) is considered the gold standard for the detection of MB. The
purpose of this study was to investigate whether CTA is comparable to IVUS for the assessment of MB and atherosclerotic plaques
that are frequently associated with MB in patients with symptoms and suspicion raised by EE.
METHOD AND MATERIALS
We reviewed the CT and IVUS datasets from 59 patients (13-72 years of age) in our clinical database from 2009-2014 who had
chest pain and distinctive septal wall motion abnormality on EE suggestive for MB. We analyzed the CT images for atherosclerotic
plaques, distance of the MB to the circumflex coronary artery, shape of coverage, length and embedded side branches. The IVUS
datasets were assessed for plaques, distance, the specific MB halo sign, compression as well as embedded side branches within the
MB. Bland-Altman and unpaired t-test were performed to compare these measurements.
RESULTS
Considering IVUS as the gold standard, CTA had a sensitivity and specificity of 100% and 72.7% to detect MB´s, respectively
(Kappa = 0.813 with p < 0.001). For the detection of atherosclerotic lesions upstream from the MB, sensitivity and specificity and
NPV was 43,8%, 100%, respectively. (Kappa = 0.416 with p < 0.001.)The sensitivity for embedded septal and diagonal branches
was 57.4%. The systematic error and limit of agreement between CTA and IVUS for the distance and length was 3.2±30.9 mm and
2.2±25.8 mm, respectively. There was a significant correlation between the thickness of the bridge in CTA and the thickness of
halo sign in IVUS, but no significant correlation between depth of coverage and degree of compression.
CONCLUSION
CTA compares well with IVUS in patients with chest pain and hence distinctive septal wall motion abnormality on EE for the
assessment of MB, but limited for the detection of plaques and number of side branches.
CLINICAL RELEVANCE/APPLICATION
CTA is comparable to IVUS in patients with suspected MB and may therefore be considered a non-invasive alternative in these
patients. Further studies are needed to determine if CTA can differentiate MB with and without clinical relevance.
CA207-SDSUB3
Detection of Cardiac Involvement in Sarcoidosis: Assessment by Image Fusion with DelayedEnhanced MRI and F-18 FDG PET/CT
Station #3
Participants
Rami Yokoyama, Toon, Japan (Presenter) Nothing to Disclose
Masao Miyagawa, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Takahiro Yokoi, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Ryo Ogawa, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Yuki Tanabe, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Naoki Fukuyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiko Nishiyama, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Tomoyuki Kido, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Teruhito Kido, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Teruhito Mochizuki, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Sudden death is the leading cause of mortality in patients (pts) with sarcoidosis in Japan. Delayed gadolinium-enhancement (DE) on
cardiac magnetic resonance imaging (CMR) represents scar tissue and/or necrosis, meanwhile F-18 fluoro-2-deoxyglucose (FDG)
accumulation on positron emission tomography (PET) represents active inflammatory lesions. Both modalities are reported to be
useful for detection of cardiac sarcoidosis. The aim is to assess the cardiac involvement in sarcoidosis by image fusion with these
two modalities.
METHOD AND MATERIALS
Twenty-five pts diagnosed as cardiac sarcoidosis who underwent PET/CT and DE-CMR were included. Bull's eye polar-map
representations with 16 myocardial segments of DE on CMR or FDG accumulation on PET/CT were generated. The percentages of
the DE-CMR is more evident in the basal anteroseptal segments than the other ones. As to FDG PET, lower accumulation is found in
apex. Discrepancy between DE-CMR and FDG PET findings is more in mid-ventricular segments. Area in each segment on CMR were
determined using software and semi-quantification was performed with a 4-point scoring system as follows: 0, 0- 25%; 1, 25-50%;
2, 50-75%; and 3, 75-100% of each segment. Segments with the score of 1 or more were considered as positive. Meanwhile, FDG
accumulation in each segment on PET/CT was assessed by the standard uptake value (SUV) with a 4- point scoring system as
follows: 0: SUV=0-2, 1: SUV=2-3, 2: SUV=3-4, and 3: SUV>4. Segments with a score>1 were considered positive.
RESULTS
DE-CMR or FDG accumulation was found in 24 of 25 pts (96%). The positive segments of FDG were significantly greater than those
of DE-CMR . The mean score of FDG accumulation was 1.55± 1.14, which was significantly greater than that of DE-CMR
(0.82±1.15, p<0.0001). DE-CMR is more evident in the basal anteroseptal segments than the other ones. As to FDG PET, lower
accumulation is found in apex. Discrepancy between DE-CMR and FDG PET findings is more in mid-ventricular segments.
CONCLUSION
Both PET/CT and CMR provide high sensitivity for diagnosing cardiac sarcoidosis. Image fusion of these two modalities is useful
because the different distributions of the findings suggest the potential in detecting different pathological processes.
CLINICAL RELEVANCE/APPLICATION
Both PET/CT and CMR provide high sensitivity for diagnosing cardiac sarcoidosis. Image fusion of these 2 modalities might
contribute to patient management.
CA208-SDSUB4
Interobserver Agreement of Stress Rest Dual Energy CT Myocardial Perfusion
Station #4
Participants
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Roxana Campisi, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Maria Munain, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
The objectives of this paper are to determine the interobserver variability in the evaluation of myocardial perfusion defects by
Stress-Rest DECT myocardical perfusion and to assess the Sensitivity (S), Specificity (Sp), Positive predictive value (PPV) and
Negative predicitive value (NPV) of two observers in correlation with SPECT findings.
METHOD AND MATERIALS
We evaluated 20 patients with known or suspected coronary disease who had a positive exercise test for ischemia or had an
indication of SPECT.Prospective ECG-triggered cardiac DECT was performed with a 128 slice CT scanner (Discovery CT750 HD; GE
Medical Systems).First a stress CT scan was carried out and 30 minutes later a rest CT scan was complemented. Dipyridamole drug
was used for stress myocardial perfusion imaging in both CT and SPECT studies.The protocol was approved by an Institutional
Ethics Committee and all patients signed a informed consent.A 17 segmental model analysis was done using the DECT
monochromatic data at 70 kev by two independent observers.SPECT analysis was done and compared with DECT.Statistical
analysis:The 95% confidence interval of the proportions was calculated by the exact binomial method to determine the presence of
myocardial perfusion defects for both observers (O1; O2).Interobserver agreement between both observers was measured by the
kappa coefficient.
RESULTS
There were 680 myocardial segments for analysis. For the detection of myocardial perfusion defects for O1 and O2: S, Sp, PPV and
NPV were 82,1% , 96.74% , 85.48% , 96.04% and 83.3%, 96.2%, 83.3% 96.2%, respectively. The correlation between O1 and O2
was k= 0.79 (0.71 to 0.86). The mean radiation dose for each patient was 7.1 +/- 1.2 mSv.
CONCLUSION
There was good interobserver agreement of Stress-Rest DECT for the detection of myocardial perfusion defects as well as
adecuate sensitivity and specificity with SPECT findings, with similar radiation dose than single energy CT scans.
CLINICAL RELEVANCE/APPLICATION
Stress-Rest DECT for the detection of myocardial perfusion defects is feasible and shows a good performance compared to SPECT
scans.
CA209-SDSUB5
Characterizing Regional Myocardial Velocity with MR Feature Tracking: A Comparison to Tissue Phase
Mapping
Station #5
Participants
Kai Lin, MD, MSc, Chicago, IL (Presenter) Nothing to Disclose
Jeremy D. Collins, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Bruce Spottiswoode, Chicago, IL (Abstract Co-Author) Employee, Siemens AG
Marie-Pierre Jolly, Princeton, NJ (Abstract Co-Author) Employee, Siemens AG
Varun Chowdhary, MD, BS, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Julie A. Blaisdell, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Michael Markl, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
James C. Carr, MD, Chicago, IL (Abstract Co-Author) Research Grant, Astellas Group Research support, Siemens AG Speaker,
Siemens AG Advisory Board, Guerbet SA
PURPOSE
To test the hypothesis that velocities acquired with MR feature tracking (FT) and tissue phase mapping (TPM) are correlated for
describing regional myocardial motion.
METHOD AND MATERIALS
In compliance with HIPAA regulations, 19 healthy volunteers (14 men) were recruited as part of this IRB approved study. For each
participant, a segmented bSSFP sequence was used to acquire cardiac cine images in the two-chamber, four-chamber and shortaxis view (8-10 slices) of the left ventricle (LV) at 1.5T. TPM data were acquired at basal, midventricular and apical locations at
with the short-axis view using a black-blood prepared 2D cine phase-contrast sequence with tri-directional phase encoding. MR FT
velocity data was derived from deformation field analysis on prototype software (Siemens Corporation, Princeton, NJ). After 8
anchor points were set on landmark anatomic structures, the in-plane time-resolved regional myocardial velocities in radial (Vrr) and
circumferential (Vcc) were generated and mapped on a standard 16-segment AHA model for FT analysis. The TPM images were
processed using a software package programmed in MATLAB. All epicardial and endocardial LV contours were manually traced by
one observer. The segmental velocities in systole (sys) and diastole (dia) representing LV contraction/expansion (Vr), rotation (VΦ)
were acquired. The time to peak (TTP) were also determined. The Pearson's correlation coefficient (r) was used to investigate the
correlations between peak velocities acquired with FT and TPM.
RESULTS
On a per-slice basis (base, mid, apex), there is moderate to good correlation between LV velocity components measured with FT
On a per-slice basis (base, mid, apex), there is moderate to good correlation between LV velocity components measured with FT
(Vrr, Vcc) and TPM (Vr, VΦ). Peak Vrr-sys is related with peak Vr-sys (r = 0.554, p < 0.001) and TTP-Vr-sys (r = 0.410, p =
0.002). Peak Vrr-dia is related with peak Vr-sys (r = 0.653, p < 0.001), peak Vr-dia (r = 0.426, p < 0.001) and TTP-Vr-sys (r =
0.400, p = 0.002). Peak Vcc-sys (r = 0.516, p < 0.001) and peak Vcc-dia (r = 0.442, p = 0.001) are related with peak VΦ-sys.
CONCLUSION
Regional peak systolic and diastolic myocardial velocities derived from FT and TPM demonstrated extensive correlation between
techniques in a cohort of healthy volunteers.
CLINICAL RELEVANCE/APPLICATION
MR FT analysis can be applied to cine bSSFP images enabling regional assessment of myocardial function without lengthening MR
scan time; such regional analysis may be sensitive to early changes in myocardial structure.
CA104-EDSUB6
What's Wrong with my Broken Heart? Imaging as the Key to the Diagnosis of Nonischemic
Cardiomyopathies
Station #6
Participants
Richard W. Ahn, MD, PhD, Dallas, TX (Presenter) Co-founder, ViXa LLC; Stockholder, Vixa LLC
Kelly A. Tornow, BS, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Nicholas Faulconer, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Suhny Abbara, MD, Dallas, TX (Abstract Co-Author) Author, Reed Elsevier; Editor, Reed Elsevier; Institutional research agreement,
Koninklijke Philips NV; Institutional research agreement, Siemens AG
Nagina Malguria, MBBS, Dallas, TX (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Need for differentiation of nonischemic and ischemic cardiomyopathies as treatment varies substantially. 2. Nonischemic
cardiomyopathies have overlapping genetic, clinical and pathological features and imaging is the key to classifying and identifying
the different subtypes. 3. Viewers will understand the major subtypes and imaging characteristics of individual diseases.4. Emerging
techniques of imaging non-ischemic cardiomyopathy will be reviewed.
TABLE OF CONTENTS/OUTLINE
Table of Contents/Outline1. Diagnostic approaches to non-ischemic cardiomyopathy. 2. Individual diseasesa. Hypertrophic
Cardiomyopathyb. Hemochromatosisc. Amyloidosisd. Sarcoidosise. Chagas Diseasef. Myocarditisg. Left ventricular noncompactionh.
Arrythmogenic right ventricular dysplasiai. Dilated cardiomyopathy j. Takostubo disease
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Suhny Abbara, MD - 2014 Honored Educator
RC103
Read with the Experts (Cardiac Radiology) (An Interactive Session)
Sunday, Nov. 29 2:00PM - 3:30PM Location: N226
CA
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Moderator) Research Grant, Toshiba Corporation;
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Presenter) Research Grant, Toshiba Corporation;
Satinder P. Singh, MD, Birmingham, AL, (ssingh@uabmc.edu) (Presenter) Nothing to Disclose
Sanjeev Bhalla, MD, Saint Louis, MO (Presenter) Nothing to Disclose
Jacobo Kirsch, MD, Weston, FL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To illustrate common cardiac pathologies encountered in noninvasive imaging. 2) To review imaging protocols designed to best
depict cardiac pathology. 3) To review image post-processing tools to render cardiac imaging findings for interpretation and
communication with referring clinicians. Please bring your charged mobile wireless device (phone, tablet or laptop) to participate.
ABSTRACT
This session will include live reads with experts in cardiac radiology to meet the learning objectives. Specific cases and clinical
scenatios will be presented to best demonstrate the pathology and the strategies for imaging and image interpretation.
URL
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Sanjeev Bhalla, MD - 2014 Honored Educator
Jacobo Kirsch, MD - 2013 Honored Educator
RC154
Precision Medicine through Image Phenotyping
Sunday, Nov. 29 2:00PM - 3:30PM Location: S403A
CA
CH
VA
BQ
IN
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Ella A. Kazerooni, MD, Ann Arbor, MI (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn what the term precision medicine means. 2) To understand how informatics intersects with clinical radiology to enable
precision medicine in practice. 3) To learn through concrete examples how informatics based radiology precision medicine impacts
health
ABSTRACT
Biomarkers have been emrabced by both the scientific and regulatory communities as surrogates end points for clinical trials, paving
the way for their widespread use in medicine. The field of imaging biomarkers has exploded, and the their integration into clinical
practice relies heaving on and intersects with the field of bioinformatics.. Once specific biomakers are show to have value, easily
integrating them into the digital environment of the radiologist and communcating them to the health care providers and or directly
to patients effeiciently and seamlessly is important for their value and impact on health to be realized. Culturally, it is taking
radiologists from the era of description and largely qualitative reporting, into a quantitative future state, and leveraging informatics
to extract information from imaging alone ot together with data available in the electronic medical record is essential for future
sucess in this new world. To get there, understanding the impact of this approach as a value of our services, and standardization
of imaging technques along the lines of what the RSNA QIBA initiative is designing, are essential, so that imaging biomarkers are
robust, accurate and reprodicbile. Embraching this approach enables and facilitates new appracohes, relationships of imaging and IT
researchers, vendors and consumers, to fully realize the possiblities. This course will discuss and describe the overall constructs,
and use tangible exams of using this in practice today and for the future.
Sub-Events
RC154A
Lung Nodules: Combining Population and Patient Specific Data to Inform Personalized Decision
Making
Participants
Eliot L. Siegel, MD, Severna Park, MD (Presenter) Research Grant, General Electric Company; Speakers Bureau, Siemens AG; Board
of Directors, Carestream Health, Inc; Research Grant, XYBIX Systems, Inc; Research Grant, Steelcase, Inc; Research Grant, Anthro
Corp; Research Grant, RedRick Technologies Inc; Research Grant, Evolved Technologies Corporation; Research Grant, Barco nv;
Research Grant, Intel Corporation; Research Grant, Dell Inc; Research Grant, Herman Miller, Inc; Research Grant, Virtual Radiology;
Research Grant, Anatomical Travelogue, Inc; Medical Advisory Board, Fovia, Inc; Medical Advisory Board, Toshiba Corporation;
Medical Advisory Board, McKesson Corporation; Medical Advisory Board, Carestream Health, Inc; Medical Advisory Board, Bayer AG;
Research, TeraRecon, Inc ; Medical Advisory Board, Bracco Group; Researcher, Bracco Group; Medical Advisory Board, Merge
Healthcare Incorporated; Medical Advisory Board, Microsoft Corporation; Researcher, Microsoft Corporation
LEARNING OBJECTIVES
1) Describe how data from a clinical trial can be repurposed as a decision support tool. 2) List some of the potential techniques
that can be utilized to predict likelihood of a malignant nodule from the NLST database. 3) Explain how the Fleischner Guidelines can
be personalized utilizing data from NLST and PLCO. 4) Detail the implications for lung screening trials of having access to NLST and
PLCO data. 5) Demonstrate how a healthcare enterprise can create their own local reference database using information from their
own patient population.
ABSTRACT
The era of personalized/precision medicine offers the potential to utilize patient and lesion specific data to personalize screening
and diagnostic work-up, diagnosis, and treatment selection to a particular patient to optimize effectiveness. Although recently, the
emphasis has been on utilization of genomic data in personalized medicine, there is a 'gold mine' of useful data in previously
conducted clinical trials as well as patient medical electronic records that has, until now, gone largely untapped. The purpose of
this presentation is to describe how the screening, diagnosis, and treatment of lung nodules can be personalized utilizing data from
the NLST and PLCO clinical trials and how the Fleischner Guidelines and screening criteria for lung cancer can be modified according
to the characteristics of an individual patient and individual nodule. The presentation will also include ways in which a facility can
collect local data on their own patients to supplement these reference databases with experience from their own patient
population.
RC154B
Managing Cardiovascular Care through Image Phenotyping Combined with Patient Level Data
Participants
John J. Carr, MD, MS, Nashville, TN (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
View learning objectives under main course title.
ABSTRACT
Cardiovascular diseases(CVD) develop over an individual's lifetime. CVD is the number one cause of death and morbidity worldwide.
Integrated application of genomics, quantitative imaging and "big data" has the potential to positively transform cardiovascular
prevention and care and reduce the health and economic consequence of CVD. In this talk we will review how easily obtainable
imaging biomarkers, already available, can power this change. Measures of cardiac and vascular structure and function as well as
body composition provide great insight into and individual's risk of CVD, level of physical activity, diet, vascular health and general
well-being.
ED002-MO
Cardiac Monday Case of the Day
Monday, Nov. 30 7:00AM - 11:59PM Location: Case of Day, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Jennifer L. Mulkerin, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Identify pertinent findings and generate differential diagnosis for cardiac imaging studies. 2) Develop differential diagnoses based
on the clinical information and imaging findings. 3) Recommend appropriate management for patients based on imaging findings.
SPDL20
RSNA Diagnosis Live™: 'Bo you don't know Didley' - Test Your Diagnostic Skills at the Crack of Dawn
Monday, Nov. 30 7:15AM - 8:15AM Location: E451B
CA
GI
HN
MK
NR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Adam E. Flanders, MD, Penn Valley, PA (Presenter) Nothing to Disclose
Christopher G. Roth, MD, Philadelphia, PA (Presenter) Nothing to Disclose
Sandeep P. Deshmukh, MD, Philadelphia, PA, (sandeep.deshmukh@jefferson.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The participant will be introduced to a series of radiology case studies via an interactive team game approach designed to
encourage "active" consumption of educational content. 2) The participant will be able to use their mobile wireless device (tablet,
phone, laptop) to electronically respond to various imaging case challenges; participants will be able to monitor their individual and
team performance in real time. 3) The attendee will receive a personalized self-assessment report via email that will review the
case material presented during the session, along with individual and team performance. This interactive session will use RSNA
Diagnosis Live™. Please bring your charged mobile wireless device (phone, tablet or laptop) to participate.
MSMC21
Cardiac CT Mentored Case Review: Part I (In Conjunction with the North American Society for Cardiac
Imaging) (An Interactive Session)
Monday, Nov. 30 8:30AM - 10:00AM Location: S406A
CA
CT
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Pamela K. Woodard, MD, Saint Louis, MO (Director) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
Pamela K. Woodard, MD, Saint Louis, MO (Moderator) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
Jill E. Jacobs, MD, New York, NY (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify cardiac and coronary artery anatomy. 2) Recognize cardiac disease processes, including coronary atherosclerosis, as
diagnosed on CT. 3) Understand methods of cardiac CT and coronary CT angiography post-processing.
Sub-Events
MSMC21A
Normal Coronal Anatomy
Participants
Shawn D. Teague, MD, Indianapolis, IN (Presenter) Stockholder, Apple Inc
LEARNING OBJECTIVES
1) Recognize normal anatomy and common variants of the coronary arteries. 2) Understand the unique advantages and
disadvantages of CT for coronary artery evaluation. 3) Describe the current State-of-the-Art capabilities for CT in coronary artery
evaluation.
ABSTRACT
MSMC21B
Anomalous Coronary Arteries
Participants
Cylen Javidan-Nejad, MD, Saint Louis, MO (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Using Coronary Artery CT cases to review anomalous origins of the coronary arteries
RC203
Imaging Nonischemic and Ischemic Disease of the Myocardium
Monday, Nov. 30 8:30AM - 10:00AM Location: S504AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
LEARNING OBJECTIVES
ABSTRACT
Sub-Events
RC203A
MRI and CT of Cardiac Masses
Participants
Phillip M. Young, MD, Rochester, MN, (young.phillip@mayo.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To review role of MR and CT in assessing cardiac masses. 2) To highlight the potential for detection, characterization, staging,
and guiding surgical decision making with cardiac MR and CT through clinical cases. 3) To review some practical tips and tricks to
keep in mind when imaging these challenging cases.
ABSTRACT
RC203B
Infiltrative Diseases (Amyloid, Hemochromatosis Fabrys, Sarcoid)
Participants
Kristopher W. Cummings, MD, Phoenix, AZ (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Understand the role of cardiac MR in the evaluation of infiltrative cardiomyopathy. 2) Describe typical patterns and locations of
MR late gadolinium enhancement associated with various types of infiltrative disease. 3) Explain the role of noncontrast MR in the
evaluation for myocardial iron deposition.
ABSTRACT
RC203C
Non Infiltrative Non-ischemic Cardiomyopathies (HCM, Noncompaction, ARVD, Myocarditis, Takatzubo
etc.)
Participants
Karen G. Ordovas, MD, San Francisco, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To understand how to differentiate ischemic from non-ischemic cardiomyopathies on cardiac MRI. 2) To recognize the cardiac MR
findings suggestive of the diagnosis of different types of non-ischemic cardiomyopathies. 3) To identify cardiac MR findings that
have a prognostic role in patients with non-ischemic cardiomyopathies
ABSTRACT
RC203D
T1-mapping, T2 Mapping and Quantitative Imaging
Participants
Arthur E. Stillman, MD, PhD, Atlanta, GA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To review the role of T1, T2 and ECV mapping for aiding cardiac disease diagnosis. 2) To review the potential of T1 and T2
mapping for monitoring therapy.
ABSTRACT
Recent advances permit quantitative MRI imaging using T1- and T2- maps. These provide a new method for tissue characterization
and can be used to aid diagnosis and for monitoring treatment. Examples relating to cardiac imaging in include acute myocardial
infarction, myocarditis, amyloid and Fabry disease. Recent literature suggests that quantitative T1-and T2- maps improve
diagnostic capabilities compared with T1- and T2 weighted MRI. When used following the administration of gadolinium contrast, T1maps can be used to calculate the extracelluar volume maps of myocardium. This literature will be reviewed and illustrated with
case examples.
MSMC22
Cardiac CT Mentored Case Review: Part II (In Conjunction with the North American Society for Cardiac
Imaging) (An Interactive Session)
Monday, Nov. 30 10:30AM - 12:15PM Location: S406A
CA
VA
CT
AMA PRA Category 1 Credits ™: 1.75
ARRT Category A+ Credits: 2.00
Participants
Pamela K. Woodard, MD, Saint Louis, MO (Director) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
Geoffrey D. Rubin, MD, Durham, NC (Moderator) Consultant, Fovia, Inc; Consultant, Informatics in Context, Inc; Research
Consultant, General Electric Company;
Arthur E. Stillman, MD, PhD, Atlanta, GA (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify cardiac and coronary artery anatomy. 2) Recognize cardiac disease processes, including coronary atherosclerosis, as
diagnosed on CT. 3) Understand methods of cardiac CT and coronary CT angiography post-processing.
Sub-Events
MSMC22A
Coronary Atherosclerosis I
Participants
Geoffrey D. Rubin, MD, Durham, NC (Presenter) Consultant, Fovia, Inc; Consultant, Informatics in Context, Inc; Research
Consultant, General Electric Company;
LEARNING OBJECTIVES
View learning objectives under main course title.
MSMC22B
Coronary Atherosclerosis II
Participants
Smita Patel, MBBS, Ann Arbor, MI (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
View learning objectives under main course title.
ABSTRACT
MSMC22C
Valves and Cardiac Function
Participants
Andrew J. Bierhals, MD, Saint Louis, MO (Presenter) Research Grant, Johnson & Johnson
LEARNING OBJECTIVES
View learning objectives under main course title.
ABSTRACT
Cardiac CT can provide information on valves and function when retrospective ECG gating is used in the acquisition. These studies
require extensive image post-processing to accurately depict the moving structures. This presentation will highlight basic image
acquisition as well as the evaluation of normal and abnormal patients.
SSC01
Cardiac (Nonischemic Cardiomyopathies)
Monday, Nov. 30 10:30AM - 12:00PM Location: S502AB
CA
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Konstantin Nikolaou, MD, Tuebingen, Germany (Moderator) Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Speakers
Bureau, Bayer AG
Ella A. Kazerooni, MD, Ann Arbor, MI (Moderator) Nothing to Disclose
Vincent B. Ho, MD, MBA, Bethesda, MD (Moderator) In-kind support, General Electric Company
Sub-Events
SSC01-01
Myocardial Hyperintensity on T2-weighted MRI of Hypertrophic Cardiomyopathy: Distribution and
Clinical Significance Related to Phenotypes
Monday, Nov. 30 10:30AM - 10:40AM Location: S502AB
Participants
Shogo Imai, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Yasuo Amano, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Fumi Yamada, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Kumiko Aita, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Masaki Tachi, MD, PhD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Makoto Obara, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shinichiro Kumita, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
T2-weighted magnetic resonance imaging (MRI) visualizes myocardial injuries that are different from late gadolinium enhancement
(LGE). The aim of this study was to evaluate the distribution and clinical significance of myocardial hyperintensity on T2-weighted
MRI (T2-high) in patients with two phenotypes of hypertrophic cardiomyopathy (HCM): asymmetrical septal HCM (ASH) and apical
HCM (APH).
METHOD AND MATERIALS
Thirty-six ASH and 18 APH patients and their 864 myocardial segments based on the American Heart Association model were
investigated using cardiac MRI. The two patient groups were age-matched. The distribution of T2-high was compared with that
shown by LGE. The relationships between T2-high and the episode of unexpected syncope or nonsustained ventricular tachycardia
and elevated troponin T levels were evaluated. In four patients with HCM, T2 values of the T2-high were quantitatively estimated
with multi-echo spin-echo T2 mapping.
RESULTS
T2-high was observed in 18 segments (3.1%) in 13 ASH patients (36.1%) and in 12 segments (4.2%) in 8 APH patients (44.4%).
One-third of T2-high was located outside LGE in ASH patients, and half of the T2-high was outside LGE in APH patients. The
concordance of T2-high and LGE was moderate when analyzed on the per-patient basis (k = 0.47) and mild when analyzed on the
per-segment basis (k = 0.30) in ASH. In APH, the concordance of T2-high and LGE was fair when analyzed on both the per-patient
basis (k = 0.05) and per-segment basis (k = 0.20). In ASH patients, the presence of T2-high was significantly related to the
episode of unexpected syncope (P = 0.016). T2-high had greater T2 values (mean, 61.1 ms) than the remote myocardium of HCM
(mean, 47.3 ms) and the normal myocardium of 5 volunteers (mean, 47.4 ms).
CONCLUSION
T2-high reflects changes in myocardial water contents, which may be related to syncope associated with ASH. Because the T2high is often localized outside the LGE area, T2-weighted MRI should be interpreted carefully in HCM.
CLINICAL RELEVANCE/APPLICATION
Myocardial hyperintensity on T2-weighted MRI, which may be related to syncope, should be investigated carefully in patients with
hypertrophic cardiomyopathy.
SSC01-02
Comprehensive Cardiac Magnetic Resonance in Acute Myocarditis
Monday, Nov. 30 10:40AM - 10:50AM Location: S502AB
Participants
Julian A. Luetkens, Bonn, Germany (Presenter) Nothing to Disclose
Rami Homsi, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Alois Martin Sprinkart, MSc, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Jonas Doerner, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Darius Dabir, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Daniel Kuetting, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Wolfgang Block, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Rene Andie, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Christian Stehning, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Rolf Fimmers, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Gieseke, DSc, Bonn, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Daniel K. Thomas, MD, PhD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Claas P. Naehle, MD, Bonn, Germany (Abstract Co-Author) Consultant, Medtronic, Inc
PURPOSE
Cardiac magnetic resonance (MR) can visualize inflammatory tissue changes in acute myocarditis. Several quantitative imagederived parameters have been described to enhance the diagnostic value of cardiac MR, but no direct comparison of all these
techniques is available.
METHOD AND MATERIALS
34 patients with suspected acute myocarditis and 50 control subjects underwent cardiac MR. Cardiac MR protocol included
quantitative assessment of T1 relaxation times using modified Look-Locker inversion recovery (MOLLI) and shortened MOLLI
(ShMOLLI) acquisition schemes, extracellular volume fraction (ECV), T2 relaxation times, and longitudinal strain. Established LakeLouise Criteria (LLC) consisting of T2-weighted signal intensity ratio (T2 ratio), early gadolinium enhancement ratio (EGEr) and late
gadolinium enhancement (LGE) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic
performance.
RESULTS
Areas under the curve of native T1 (MOLLI: 0.95; ShMOLLI: 0.92) and T2 relaxation times (0.92) were higher compared to those of
other cardiac MR parameters (T2 ratio: 0.71, EGEr: 0.71, LGE: 0.87, LLC: 0.89, ECV MOLLI: 0.77, ECV ShMOLLI: 0.80, longitudinal
strain: 0.83). Combined with LGE each native mapping technique outperformed the diagnostic performance of LCC (P<0.01
respectively). A combination of native parameters (T1, T2 and longitudinal strain) significantly increased the diagnostic performance
of cardiac MR compared to LCC without the need of contrast media application (0.99 vs. 0.89; P=0.002).
CONCLUSION
In patients suspected of having acute myocarditis, diagnostic performance of cardiac MR can be improved by implementation of
quantitative cardiac MR parameters. Especially native mapping techniques have the potential to replace current LCC.
CLINICAL RELEVANCE/APPLICATION
Based on these study findings, an update to the Lake-Louise criteria with respect to quantitative CMR parameters may become
necessary.
SSC01-03
Myocardial T1-mapping and T1-derived Extracellular Volume Fraction (ECV) in Patients with Chronic
HIV Infection
Monday, Nov. 30 10:50AM - 11:00AM Location: S502AB
Participants
Julian A. Luetkens, Bonn, Germany (Presenter) Nothing to Disclose
Jonas Doerner, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Christoph Boesecke, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Jan-Christian Wasmuth, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Carolynne Schwarze-Zander, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Rockstroh, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Claas P. Naehle, MD, Bonn, Germany (Abstract Co-Author) Consultant, Medtronic, Inc
PURPOSE
Chronic HIV infection is associated with an increased risk for cardiovascular disease. Diffuse myocardial pathologies may
noninvasively be assessed by quantitative cardiac magnetic resonance (CMR) using myocardial T1 mapping, and T1-derived
extracellular volume fraction (ECV).
METHOD AND MATERIALS
The institutional review committee approved the study and all subjects gave informed consent prior to CMR. Patients with chronic
HIV infection undergoing combination antiretroviral therapy and healthy controls were included in this study. All patients had no
medical history of cardiac disease and no cardiac risk factors. CMR protocol at 3 Tesla (Ingenia, Philips Healthcare, The
Netherlands) included common SSFP sequences, T2 STIR imaging, late gadolinium enhancement imaging, and a pre- and 10 minutes
post-contrast 3-3-5 MOLLI scheme for myocardial T1 mapping. Hematocrit-corrected ECV was derived from the pre- and postcontrast T1 maps.
RESULTS
27 patients with HIV infection (age 49.1 ± 9.5 years) and 18 controls (age 40.6 ± 15.6 years) underwent CMR. Pre-contrast global
T1 relaxations times were significantly prolonged in HIV patients compared to healthy controls (1116.1 ± 57.0 ms vs. 1075.1 ± 65.5
ms; P=.033). Post-contrast T1 relaxation times were decreased (405.0 ± 50.5 ms vs. 455.7 ± 77.5 ms, P=.007). ECV was higher in
the HIV group compared to controls (25.8 ± 3.5 % vs. 22.4 ± 5.1 %, P=.015). Left ventricular ejection fraction was lower in the
HIV group (60.3 ± 6.6 % vs. 64.4 ± 5.4 %; P=.038).
CONCLUSION
This study revealed signs of subtle myocardial disease (i.e. cardiac fibrosis) in asymptomatic HIV using quantitative myocardial T1
mapping analysis. Preclinical detection of myocardial involvement in HIV infection appears feasible and may allow for early risk factor
modification.
CLINICAL RELEVANCE/APPLICATION
Myocardial T1 mapping might serve as a potential screening parameter for beginning cardiovascular disease in the course of HIVinfection.
SSC01-04
Characteristics of Peak Systolic Longitudinal Strain Using Strain-encoded Magnetic Resonance in
Patients with Hypertrophic Cardiomyopathy: Comparison with Healthy Subjects and Relationship with
Late Gadolinium Enhancement and with Wall Thicknes
Monday, Nov. 30 11:00AM - 11:10AM Location: S502AB
Participants
Fumiko Kimura, MD, PhD, Hidaka-Shi, Japan (Presenter) Nothing to Disclose
Takatomo Nakajima, MD, Shinjuku-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Masahiro Takahashi, MD, Hidaka, Japan (Abstract Co-Author) Nothing to Disclose
Toshiko Hoshi, MD, Kumagaya, Japan (Abstract Co-Author) Nothing to Disclose
Shigetoshi Nishimura, MD, PhD, Hidaka, Japan (Abstract Co-Author) Nothing to Disclose
Nael Osman, Baltimore, MD (Abstract Co-Author) CEO, Diagnosoft, Inc
PURPOSE
To clarify characteristics of peak systolic longitudinal strain (PSLS) using strain-encoded cardiac magnetic resonance (SENC) in
patients with hypertrophic cardiomyopathy (HCM) with normal left ventricular ejection fraction (LVEF)
METHOD AND MATERIALS
We retrospectively assessed 31 patients with HCM with LVEF ≥ 55% (20 men, 11 women; mean age 62.6 ± 12.3 years; mean LVEF
68.7 ± 8.6%) who underwent MR evaluation of late gadolinium enhancement (LGE) and PSLS using a 1.5 T-system in 2 hospitals
between August 2012 and December 2014. For reference, we assessed the PSLS of 9 healthy control subjects. We compared the
average segmental PSLS and the variability of segmental PSLS using 16-segment models between the HCM and control groups and
then, in patients with HCM, directly correlated PSLS with corresponding myocardial wall thickness and compared PSLS with the
percentage of area with LGE. We defined LGE as signal intensity (SI) 6 or more standard deviations (SDs) above the mean SI of
normal myocardium, defined the normal range of segmental PSLS as the average segmental LS ± 2 SD in controls, and used an
expression of reduction of PSLS when the absolute value of PSLS was reduced more than 2 SD of that of controls.
RESULTS
The average segmental PSLS was significantly reduced (HCM, -14.8%; control, -19.5%; P < 0.0001) and significantly more
inhomogeneous (SD of average PSLS: HCM, 6.2%; control, 3.3%; P < 0.0001) in the HCM group than controls. We identified LGE in
28 of 31 patients with HCM (90.3%) and 253 of 496 segments (51.0%). In HCM group, the PSLS correlated moderately with
myocardial wall thickness (R = 0.53, P < 0.0001) and weakly with the percentage of area of LGE (R = 0.30, P < 0.0001). Defining
the normal range of segmental PSLS as above, PSLS in the HCM group was reduced in segments with and without LGE (PSLS was
reduced in 80 of 243 segments with no LGE).
CONCLUSION
The average PSLS was significantly reduced and inhomogeneous in those with HCM despite a normal LVEF. Segmental PSLS
correlated moderately with wall thickness, and weak correlation with segmental LGE percentage was probably due to the presence
of segments with reduced PSLS and no LGE.
CLINICAL RELEVANCE/APPLICATION
In patients with HCM and normal LVEF, peak systolic longitudinal strain was reduced and inhomogeneous compared to controls and
reduced in thick myocardium and myocardium with and without LGE.
SSC01-05
Relationship between Myocardial Markers and Myocardial Fibrosis of Hypertrophic Cardiomyopathy:
Accessed by 3.0T Cardiac Magnetic Resonance
Monday, Nov. 30 11:10AM - 11:20AM Location: S502AB
Participants
Huayan Xu, Chengdu, China (Presenter) Nothing to Disclose
Zhigang Yang SR, PhD,MD, Chengdu, China (Abstract Co-Author) Nothing to Disclose
Yingkun Guo, Chengdu, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To quantitatively detect myocardial fibrosis of hypertrophic cardiomyopathy (HCM) by 3.0 T cardiac magnetic resonance(CMR) Late
gadolinium enhancement (LGE) technology, and get the relationship of LGE and myocardial markers, to investigate whether HCM
patients' elevated myocardial markers are associated with myocardial fibrosis.
METHOD AND MATERIALS
34 HCM patients and 20 healthy volunteers were enrolled in this research. HCM patients and 20 healthy volunteers were underwent
3.0 T Cardiac Magnetic Resonance scanning, including short axis cine sequences and LGE sequences. Left ventricular function was
obtained on short axis cine sequence. LGE parameters, including total LGE rate, total LGE volume and total LGE mass were detected
on LGE sequences by commercial available software(cmr42, Circle Cardiovascular Imaging Inc., Calgary, Canada) . Myocardial
marker, including creatine kinase isoenzyme and troponin were detected. Independent sample t-test and Pearson correlation were
used.
RESULTS
All myocardial markers of HCM patients were greater than clinical normal range. By LGE detection, LGE parameters of HCM group,
including total LGE rate, total LGE volume and total LGE mass, were greater than normal control group (18.95±9.87 vs.
50.82±14.18; 8.50±4.50 vs.4.50±41.99; 9.00±4.80 vs.90.58±44.11, all P<0.05). Pearson correlation has been proved that creatine
kinase isoenzyme of HCM patients were positively correlated to LGE rate and LGE volume (r=0.759, P=0.000; r=0.448, P=0.008).
Troponin of HCM patients were also positively correlated to LGE rate and LGE volume (r=0.647, P=0.000; r=0.578, P=0.000).
CONCLUSION
Myocardial fibrosis of Hypertrophic Cardiomyopathy was quantitatively accessed by 3.0 T cardiac magnetic resonance late
gadolinium enhancement technologies. Creatine kinase isoenzyme and troponin of HCM patients were positively correlated to LGE.
Myocardial fibrosis may induce myocardial markers in the myocardial cells releasing, which affect the myocardial metabolic function
further and induced heart function damage eventually.
CLINICAL RELEVANCE/APPLICATION
CMR-LGE is a well-established tool for the assessment of myocarium fibrosis in patients with HCM.Creatine kinase isoenzyme and
troponin of HCM patients were positively correlated to LGE. Myocardial fibrosis may induce myocardial markers in the myocardial
cells releasing, which affect the myocardial metabolic function further and induced heart function damage eventually.
SSC01-06
Magnetic Resonance Feature Tracking Derived Myocardial Strain Parameters: The Discriminative
Power of Right Ventricular Strain Analysis in the Diagnosis of Acute Myocarditis
Monday, Nov. 30 11:20AM - 11:30AM Location: S502AB
Participants
Bettina Baessler, MD, Cologne, Germany (Presenter) Nothing to Disclose
Guido Michels, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
Frank Schaarschmidt, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Anastasia Dick, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
David C. Maintz, MD, Koln, Germany (Abstract Co-Author) Nothing to Disclose
Alexander C. Bunck, Koln, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic value of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain-analysis of the left and
right ventricle in patients with CMR-proven acute myocarditis (ACM).
METHOD AND MATERIALS
CMR cine data of 34 patients with clinically suspected ACM and confirmation of diagnosis by CMR according to the Lake Louise
criteria were retrospectively analyzed. 20 age-matched healthy volunteers (HV) served as a control. Analysis of global longitudinal,
circumferential (circ.) and radial strain and strain rate (SR) of both ventricles was performed in one long-axis and three short-axis
slices using a dedicated FT-software (TomTec). Statistical analysis was conducted using independent t-test, one-way ANOVA with
tukey-type comparisons, multiple and multinominal logistic regression analyses, and ROC-analyses.
RESULTS
ACM patients showed significantly reduced LV longitudinal strain (-12.7 ± 1.1 vs. -16.8 ± 1.3 %, p = .022) and LV circ. strain (22.9 ± 1.0 vs. -27.8 ± 1.0 %, p = .001) compared to HV. Conversely, they showed improved basal RV circ. SR (-0.70 ± 0.04 vs. 0.47 ± 0.07 s-1, p = .008). In a multiple logistic regression model, LV circ. strain and RV basal circ. SR proved to be the best
independent predictors of ACM with an AUC of 0.87 in ROC-analysis. In ACM patients with preserved LV ejection fraction (LV-EF),
RV basal circ. SR (-0.76 ± 0.05 vs. -0.47 ± 0.07 s-1, p = .005) was significantly increased compared to HV while LV strain
parameters showed no significant differences between both groups. In multinominal logistic regression analysis, again LV circ. strain
and RV basal circ. SR proved to be the best independent predictors of ACM when LV-EF is preserved with an AUC of 0.82 in ROCanalysis.
CONCLUSION
A combination of LV circ. strain and RV basal circ. SR is the best predictor for the presence of ACM, even in patients with
preserved EF. Concurrently, the RV basal circ. SR appears to be particularly sensitive to alterations caused by ACM hinting at a
potentially compensatory mechanism of basal RV hyperkinesia. Taken together, our results point to a discriminative power of RV
strain analysis in the CMR-based diagnosis of ACM.
CLINICAL RELEVANCE/APPLICATION
ACM represents one of the most frequent causes of sudden cardiac death in young patients. Therefore, an improvement of the
currently still challenging noninvasive diagnosis of ACM is highly desirable.
SSC01-07
Quantification of Myocardial Fibrosis by LGE, Pre- / Post-contrast T1 and ECV in Patients with
Hypertrophic Cardiomyopathy Referenced to Normal Appearing Myocardium and Healthy Volunteers
Monday, Nov. 30 11:30AM - 11:40AM Location: S502AB
Participants
Maxim Avanesov, MD, Hamburg, Germany (Presenter) Nothing to Disclose
Dennis Saring, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Enver G. Tahir, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Monica Patten, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Ulf K. Radunski, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Kai Muellerleile, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Christian Stehning, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Gerhard B. Adam, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gunnar K. Lund, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Quantification of myocardial fibrosis by pre- and post-contrast T1, ECV as well as LGE in patients with hypertrophic cardiomyopathy
(HCM) referenced to normal appearing myocardium and to normal values of healthy volunteers.
SSC02
Cardiac (Viability and Ischemia)
Monday, Nov. 30 10:30AM - 12:00PM Location: S504AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Jadranka Stojanovska, MD, MS, Northville, MI (Moderator) Nothing to Disclose
Hajime Sakuma, MD, Tsu, Japan (Moderator) Departmental Research Grant, Siemens AG; Departmental Research Grant, Koninklijke
Philips NV; Departmental Research Grant, Bayer AG; Departmental Research Grant, Guerbet SA; Departmental Research Grant,
DAIICHI SANKYO Group; Departmental Research Grant, FUJIFILM Holdings Corporation; Departmental Research Grant, Nihon MediPhysics Co, Ltd
Jacobo Kirsch, MD, Weston, FL (Moderator) Nothing to Disclose
Sub-Events
SSC02-01
Can Native T1 Mapping Distinguish between Infarct Area and Area-at-Risk in Patients between Acute
ST-elevation Myocardial Infarction?
Monday, Nov. 30 10:30AM - 10:40AM Location: S504AB
Participants
Nicola Galea, MD, Rome, Italy (Presenter) Nothing to Disclose
Pierpaolo Palumbo, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Fiorelli, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Vincenzo Noce, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Marco Francone, MD, Rome, Italy (Abstract Co-Author) Speakers Bureau, Bracco Group
Carlo Catalano, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Iacopo Carbone, MD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac Magnetic Resonance (CMR) has been established as the reference standard for in vivo identification and assessment of
myocardial damage in acute myocardial infarction (AMI). Conventional CMR approach required a combined evaluation of myocardial
edema and necrosis by using respectively T2-weighted sequences and late gadolinium enhanced (LGE) imaging. However the
standard acquisition protocol for AMI is time-consuming (about 40-50 minutes), poorly tolerated by patients in inadequate clinical
conditions and needs of the administration of contrast agent.Novel T1 mapping technique offers a pixel-by-pixel calculation of
tissue T1 relaxation time determined by water content and cellularity. Our purpose was to investigate the capability of native T1
mapping to differentiate infarcted area, healthy myocardium and area-at-risk using conventional CMR sequences as reference in
patients with AMI.
METHOD AND MATERIALS
Twenty consecutive patients performed CMR within the first 7 days following STEMI. CMR protocol included MOLLI, STIR T2w and
cineMR sequences. IR-TSE T1w images were acquired for LGE after gadobenate dimeglumine (Gd-BOPTA, Bracco) administration.
MOLLI images were analyzed with a dedicated software (Cvi42, Circle) by placing four ROIs within necrotic areas (LGE area,
excluding microvascular obstruction area), area-at-risk (hyperintense area on STIR images without LGE) and in the remote
myocardium. Acquisition time of each sequence was measured. Results are expressed on mean±SD and compared with Student's t
test.
RESULTS
The mean T1 native value of all patients (age 54±9yrs, 68% male) was 1317±66ms in the necrotic area (LGE+/MVO-),1149±57ms in
the area-at-risk (LGE-/STIR+) and 952±76ms in remote myocardium (LGE-/STIR-). Significant differences were found in the
comparison of t1 values between all regions (p<0.01 for all). Infarct size was 25±12% of left ventricular mass. Acquisition time of
CMR protocol including only localizer, native MOLLI sequence and cineMR was 22.4±8.7min; acquisition time of standard CMR
protocol (including localizer,STIR,cineMR and LGE) was 45.4±9.5min; p<0.01.
CONCLUSION
Native T1 mapping may reliably distinguish between necrotic area and area-at-risk after AMI.
CLINICAL RELEVANCE/APPLICATION
Native T1 mapping might offer a complete assessment of myocardial injury after AMI in shorter time and without contrast injection
compared to conventional CMR approach.
SSC02-02
Subendocardium and Subepicardium Myocardial Blood Flow, Comparison in Normal and Ischemic
Territories? A Dynamic CT Perfusion Study
Monday, Nov. 30 10:40AM - 10:50AM Location: S504AB
Participants
Adriaan Coenen, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Marisa M. Lubbers, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Raluca G. Saru, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Atsushi K. Kono, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
Alexia Rossi, MD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Marcel L. Dijkshoorn, RT, Rotterdam, Netherlands (Abstract Co-Author) Consultant, Siemens AG
Robert J. Van Geuns, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Gabriel P. Krestin, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Consultant, General Electric Company; Research Grant,
General Electric Company; Research Grant, Bayer AG; Research Grant, Siemens AG; Speakers Bureau, Siemens AG
PURPOSE
Dynamic CT myocardial perfusion (CTP) uses a consecutive series of acquisitions in which the distribution of the contrast media
over the myocardium is measured. By measuring time-attenuation curves and the arterial input function, the myocardial blood flow
(MBF) can be computed. The examination is performed in a pharmacological hyperemic state.The subendocardium is known to be
more susceptible for ischemia due to the wavefront phenomenon. One of the advantages of CTP compared with other modalities is
the high spatial resolution, allowing for distinguishing the subendocardium and subepicardium. In this study the subendocardial and
subepicardial perfusion are investigated for normal and ischemic territories, defined by invasive fractional flow reserve (FFR).
METHOD AND MATERIALS
For this study 43 patients, 94 vessels territories were analyzed. Short axis slices of MBF were reconstructed from dynamic CTP.
Blinded to the invasive FFR outcomes the MBF was measured in the subendocardium and subepicardium within the suspected
perfusion defect. Ischemic and normal territories were defined by invasive FFR, applying a threshold of ≤0.80 for ischemic
territories.
RESULTS
Of the 94 vessels 48 were ischemic with an invasive FFR ≤0.80. The mean subendocardium MBF was 67 ±30 in the ischemic and 88
±38 ml/100ml/min in the normal territories. Compared with a subepicardium MBF of 80 ±22 in the ischemic and 92 ±29 ml/100ml/min
in normal territories (figure 1). The area under the receiver operator curve for MBF as a diagnostic determinant for ischemia was
larger for the subendocardium (0.71) compared with subepicardium (0.63).
CONCLUSION
Dynamic CT perfusion allows for measurement of the MBF in the subendocardium and subepicardium. The subendocardium is more
susceptible for ischemia and MBF measurements in that region perform better for the detection of hemodynamically significant
coronary artery disease.
CLINICAL RELEVANCE/APPLICATION
The susceptibility of the subendocardium for ischemia could be utilized by dynamic CT myocardial perfusion.
SSC02-03
Myocardium: Dynamic CT Perfusion Imaging: A Comparison to Coronary Angiography/FFR and to MR
First Pass Perfusion Imaging
Monday, Nov. 30 10:50AM - 11:00AM Location: S504AB
Participants
Armin M. Huber, MD, Munchen, Germany (Presenter) Nothing to Disclose
Bettina M. Gramer, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Vivian Leber, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Daniela Muenzel, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Alexander W. Leber, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Johannes Rieber, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Mani Vembar, MS, Cleveland, OH (Abstract Co-Author) Employee, Koninklijke Philips NV
Ellen Hoffmann, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Ernst J. Rummeny, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the diagnostic accuracy of dynamic computed tomographic (CTP) perfusion imaging of the myocardium for the
detection of hemodynamically relevant coronary artery stenosis compared with the accuracy of coronary angiography and fractional
flow reserve (FFR) measurement and with MR first pass perfusion imaging of the myocardium.
METHOD AND MATERIALS
This study was approved by the institutional review board and the Federal Radiation Safety Council (Bundesamt für
Strahlenschutz). All patients provided written informed consent. Thirty-two consecutive patients in adenosine stress conditions
underwent dynamic CT perfusion imaging (14 consecutive data sets) performed by using a 256-section scanner with an 8-cm
detector and without table movement. Myocardial blood flow (MBF) was determined quantitatively. Results were compared with
those of coronary angiography and FFR measurement by using a receiver operating characteristic (ROC) analysis. In addition results
were compared to MR first pass perfusion imaging under adenosine and at rest. For evaluation of MR perfusion imaging the
myocardial perfusion reserve index was calculated derived from the ratio of the parameter upslope determined under the stress and
the rest conditions. In addition, threshold values based on the Youden index and sensitivity and specificity were calculated.
RESULTS
The comparison of CTP with the invasive reference method coronary angiography and FFR showed an area under the ROC curve, a
sensitivity, and a specificity of 0.86, 75.9% (95% CI: 56.5%, 89.7%), and 100% (95% CI: 94.6%, 100%) for the quantitative
parameter MBF.The thresholds determined by using the Youden index was 1.64 mL/g/min. The comparison to MR perfusion imaging
showed an area under the ROC curve, a sensitivity and a specificity of 0.90, 83.3 % (95% CI: 63.5%, 92.7%), 86.6 % (95% CI:
70.2 %, 93.2 %).
CONCLUSION
Dynamic CT perfusion imaging of the myocardium using the quantitative parameter MBF shows a similar diagnostic accuracy, when
compared to the invasive reference methods coronary angiography and FFR and when compared to MR first pass perfusion imaging
of the myocardium.
CLINICAL RELEVANCE/APPLICATION
Dynamic CT Perfusion imaging shows a high diagnostic accuracy and may be used in addition to CTA in order to improve the
specificity and/or the positive predictive value in patients with a high pretest probability.
SSC02-04
Diffusion Weighted Images: New Application in the Evaluation of Myocardial Infarction and
Microvascular Obstruction
Monday, Nov. 30 11:00AM - 11:10AM Location: S504AB
Participants
Giulia Benedetti, Milan, Italy (Presenter) Nothing to Disclose
Francesco A. De Cobelli, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Antonio Esposito, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Mariangela Cava, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Paolo G. Camici, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Alessandro Del Maschio, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
CMR is one of the most accurate tool for myocardial damage evaluation after STEMI; LGE and STIR sequences are routinely used,
even if STIR may suffer from some limitations. Aim of our study is to explore the potential role of Diffusion Weighted Imaging(DWI),
in the detection of myocardial infarction and microvascular obstruction(MVO), in comparison with standard-reference sequences.
METHOD AND MATERIALS
STEMI patients underwent PCI and CMR within 5 days from the acute event with DWI(b= 0, 100, 300, 500), perfusion, LGE and
STIR.Infarction walls involvement(apex, septal, anterior, lateral and inferior wall) and MVO presence were analyzed by two blinded
observers; inter-observer reproducibility was assessed. DWI findings were compared to LGE as standard reference for the detection
of the infarcted area, STIR for edema and perfusion for MVO. DWI sensitivity(Se) and specificity(Sp) in MVO detection were
calculated; DWI-MVO was related with others CMR parameters.
RESULTS
51 pts were enrolled. Infarcted areas were hyperintense at DWI, and matched with hyperintensity at LGE and STIR, except for
inferior and anterior walls infarctions, which couldn't be detected by axial DWI. Inter-observer reproducibilities for the detection of
different walls infarctions were: septum k=0,75; apex k=0,90; lateral wall k=0,52.ADCmaps showed different intensity between
normal and infarcted myocardium: ADCNormal Myocardium= 2.96 ± 0.78 x 10-3 mm2/sec, ADCInfarcted Myocardium = 4.75 ± 0.76 x
10-3 mm2/sec (p<0.001).Comparing DWI and LGE positive findings: septum 33vs34 pts; apex 35vs37; lateral wall 14vs13. Similarly,
comparing DWI and STIR positive findings: septum 33vs38 pts; apex 35vs37; lateral wall 14vs14.31 pts had perfusion-MVO, 28
showed corresponding hypointensity within the hyperintensity at DWI (p=0.005), with good inter-observer reproducibility (k=0,71),
Se=0,80 and Sp=0,70.Pts with DWI-MVO had higher LGE MVO% (Early-MVO%: 5.39 vs 1.62, p=0.011; Late-MVO% : 3.04 vs 0.54,
p=0.019), larger and more edematous infarctions(LGE%: 38.36 vs 21.42, p<0.001; Oedema%: 44.57 vs 29.92, p<0.001).
CONCLUSION
ADC is a sensible technique in revealing the presence of myocardial infarction. DWI may also detect MVO, when more represented.
CLINICAL RELEVANCE/APPLICATION
DWI is a promising CMR tool in pts with acute STEMI. DWI may became an alternative to traditional STIR, when Diffusion Imaging
reliability will be confirmed on larger groups.
SSC02-05
Inversion Time Dependence of the Accuracy of Late Gadolinium Enhancement Quantification Using T1
Map Based Synthetic Inversion Recovery Imaging
Monday, Nov. 30 11:10AM - 11:20AM Location: S504AB
Participants
Akos Varga-Szemes, MD, PhD, Charleston, SC (Presenter) Nothing to Disclose
Rob J. van der Geest, PhD, Leiden, Netherlands (Abstract Co-Author) Nothing to Disclose
Giuseppe Muscogiuri, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Carlo N. De Cecco, MD,PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Julian L. Wichmann, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Bruce Spottiswoode, Chicago, IL (Abstract Co-Author) Employee, Siemens AG
Stefanie Mangold, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Rozemarijn Vliegenthart, MD, PhD, Groningen, Netherlands (Abstract Co-Author) Nothing to Disclose
Pal Suranyi, MD, PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the influence of inversion time (TI) on the accuracy of myocardial late gadolinium enhancement (LGE) quantification
using synthetic inversion-recovery (IR) imaging.
METHOD AND MATERIALS
Thirty-eight patients with suspected myocardial infarction underwent 1.5T MR imaging. Twelve minutes after the administration of
0.1mmol/kg gadobenate-dimeglumine, conventional single-shot magnitude and phase-sensitive inversion-recovery (MagIR, PSIR)
LGE imaging and fast myocardial T1-mapping were performed in a single short axis plane. Based on the T1 maps, synthetic
magnitude (MagIRsy) and PSIR (PSIRsy) images were calculated in a TI range of -100 and +150ms relative to the most optimal TI
(TI0) with 5ms increments, using an in-house developed application integrated in the Research Mass Software. LGE was quantified
using two binary methods: applying thresholds of 5 standard deviations (5SD) above the average signal of the normal myocardium,
and using the lower threshold of the full width at half maximum (FWHM) of the signal of the infarcted myocardium. LGE area was
compared within the TI range.
RESULTS
LGE was observed in 15 (39.4%) patients. LGE area quantified by 5SD thresholding in MagIRsy, PSIRsy (at TI0), and conventional
MagIR, and PSIR techniques were 5.29±1.39, 4.44±1.35, 5.71±1.88, and 4.72±1.49cm2, respectively, while the same parameter
with FWHM was 3.46±2.39, 3.10±1.18, 4.01±2.16, and 3.32±1.43cm2, respectively. LGE areas obtained by the synthetic and the
conventional methods were in agreement at TI0. The 5SD method showed significantly larger infarct areas than FWHM (P<0.05) in
both synthetic and conventional images. LGE area was essentially constant over the TI range in the PSIRsy images. The MagIRsy
technique provided accurate LGE area at TIs beyond TI0, while the accuracy was compromised for TIs below TI0.
CONCLUSION
The accuracy of LGE area quantification using MagIRsy images is constant over a wide TI range above TI0, while the accuracy
using PSIRsy images is constant over the entire clinically relevant TI range (250-400ms).
CLINICAL RELEVANCE/APPLICATION
Synthetic T1-based IR images are reliable for infarct quantification and may provide a benefit over conventional LGE methods by
eliminating the operator dependence (i.e. selection of optimal TI).
SSC02-06
Improved Detectability of Myocardial Delayed-Enhancement Using a Subtraction Myocardial
Computed Tomography
Monday, Nov. 30 11:20AM - 11:30AM Location: S504AB
Participants
Takayoshi Yamaguchi, Sapporo, Japan (Presenter) Nothing to Disclose
Teppei Sugaya, MD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Jyungo Furuya, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Keiichi Igarashi, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Katsuhiro Ichikawa, PhD, Kanazawa, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Subtraction coronary computed tomography (CT) angiography is effective for assessing calcified lesions in coronary arteries,
enhancing visibilities of the enhanced coronaries. If this subtraction technique can be applied to delayed enhancement (DE) for
assessing myocardial viability, the detectability of myocardial delayed enhancement might be improved. We propose the new
subtraction technique, which removes coronary CTA images from DE CT images. The obtained images are similar to black blood
delayed gadolinium enhancement images of magnetic resonance imaging (MRI). The purpose of this study is to evaluate the
effectiveness of the subtraction myocardial CT (SMCT), compared with a myocardial MRI (MMRI).
METHOD AND MATERIALS
18 patients (mean age 62.6±14.7 years) with suspected coronary artery disease underwent DE imaging with a 320-slice CT and a
1.5-T MRI. SMCT images were obtained using dedicated software. We assessed DE transmurality per segment on a five-point scale
(0 = 0%; 1 = 1- 25%; 2 = 26-50%; 3 = 51-75% and 4 = 76-100% transmurality), contrast-to-noise ratios (CNRs) in infarct and
healthy myocardiums and left ventricular blood pools for MMRI, non-subtracted myocardial CT (NSMCT), and SMCT.
RESULTS
81/306 (26.5%) segments showed DE in MRI. Using MRI DE detection in the transmurality scores as the reference standard, the
kappa value of SMCT was higher than that of NSCT (0.775 vs. 0.646). CNRs at myocardiums for MRI, NSMCT and SMCT were 31.7
±18.2, 3.15 ±2.58, and 5.15 ±2.16, respectively, while CNRs based on the blood pool were 11.9 ±14.7, -0.85 ±1.77, and 36.0
±11.4, respectively.
CONCLUSION
DE imaging using SMCT technique showed better CNR compared with NSMCT, and comparably reasonable detectability of DE with
MMRI.
CLINICAL RELEVANCE/APPLICATION
Conventional delayed enhanced CT imaging of myocardial infarction suffers from low contrast, especially between the area of
infarction and the blood pool. The SMCT technique would contribute to improve the detectability of myocardial DE.
SSC02-07
Development of Infarct and Edema Size in the Course of the First 6 Months after Acute Myocardial
Infarction Measured by LGE- and T2w-CMR Imaging
Monday, Nov. 30 11:30AM - 11:40AM Location: S504AB
Participants
Enver G. Tahir, MD, Hamburg, Germany (Presenter) Nothing to Disclose
Martin Sinn, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Maxim Avanesov, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Dennis Saring, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Kai Muellerleile, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Ulf K. Radunski, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gerhard B. Adam, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gunnar K. Lund, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study was to serially analyze the development of infarct and edema size over 6 months after first acute
myocardial infarction (AMI) using late gadolinium enhancement (LGE)- and T2-weighted (T2w)-CMR imaging, respectively.
METHOD AND MATERIALS
Consecutive baseline (BL) at 7 ±4.9 days and follow-up (FU) imaging at 1.2 ±0.3 months (FU1), 3.3 ±0.6 months (FU2) and 6.3
±0.7 months (FU3) was performed on 25 patients with first-time AMI using a 1.5 Tesla MRI machine (Achieva, Philips). Short-axis
LGE- and T2w-images of the entire left ventricle were acquired with a slice thickness of 8 mm and a gap of 2 mm. CMR studies
were quantitatively evaluated by two experienced observers in respect to infarct and edema size using a threshold method with the
dedicated HeAT-Software. Infarct and edema size were measured on LGE- und T2w-images as gram (g) of infarcted left ventricular
myocardium. Statistical analysis was performed using GraphPad Prism 5 and Excel, Microsoft.
RESULTS
Mean size of infarcted myocardium was 26 ±21.9 gram (gr) at BL and decreased on FU1 and FU2 to 20.7 ±16.4 gram (P< 0.04) and
18.8 ±14.6 gram (P< 0.03), respectively. FU3 did not show further decline in infarct size. Infarction was present in all 25 patients
on BL and FU imaging, whereas edema was present in 88% of the patients at BL, in 72% of patients on FU1, in 32% of patients on
FU2 and only in 8% of patients on FU3. Mean myocardial edema was 41 ±28.3 gram at BL and decreased to 21 ±16.2 gram (P=
0.001) on FU1 and 13.7 ±13 gram (P= 0.005) on FU2, respectively. On FU3 edema was detected in two patients and measured 3.9
±2 gram.
CONCLUSION
After first AMI a continuous decrease in the size of gadolinium enhancing infarcted area is observed during the first 3.3 ±0.6 months
and remains constant afterwards, whereas main edema decrease occurs during the first 1.2 ±0.3 months. Nevertheless, in 32% of
patients edema is still present after 3.3 ±0.6 months and can even persist in 8% after 6.3 ±0.7 months.
CLINICAL RELEVANCE/APPLICATION
Infarct healing, defined as edema resorption, mainly occurs between 6 weeks and 3 months after AMI. However, in 1/3 of patients
edema still persists after 3 months indicating prolonged infarct healing.
SSC02-08
Serial Native T1 and T2 Mapping for Quantitative Monitoring of Myocardial Edema Resorption after
Acute Myocardial Infarction
Monday, Nov. 30 11:40AM - 11:50AM Location: S504AB
Participants
Enver G. Tahir, MD, Hamburg, Germany (Presenter) Nothing to Disclose
Martin Sinn, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Maxim Avanesov, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Joshua Wien, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Dennis Saring, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Christian Stehning, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Ulf K. Radunski, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Kai Muellerleile, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gerhard B. Adam, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gunnar K. Lund, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Currently, myocardial edema monitoring after acute myocardial infarction (AMI) is based on visualization of the region with
increased signal-intensity on T2-weighted (T2w) images. Native T1 and T2 mapping are promising novel cardiac magnetic
resonance imaging (CMR) techniques to quantitatively assess edema. The purpose of the study was to evaluate resorption of
myocardial edema following AMI by native T1 and T2 mapping.
RESULTS
Edema size continuously decreased from BL with 29.9%LV to 19.6%LV at FU1, to 8.6%LV at FU2 and to 5.6%LV at FU3 using T2wCMR. An identical decrease of edema size was observed using native T2 and T1 mapping. T2 times decreased between BL from
83±8 ms to 76±7 ms at FU1 (P<0.05), but no further change was observed later with 73±7 ms at FU2 and 72±5 ms at FU3. The T2
times of remote normal myocardium were about 55±3 ms at all times and significantly lower compared to the edema zone. Native T1
time within the edema was with 1253±103 ms significantly increased compared to remote normal myocardium with 1018±43 ms and
remained constantly high in the edema zone throughout all follow-ups.
CONCLUSION
Edema size continuously decreased within the following months after AMI, but was still present at low levels after 6 months.
Additionally, quantitative mapping showed increased T2 and T1 values within the edema zone indicating prolonged presence of
edema up to 6 months after AMI.
CLINICAL RELEVANCE/APPLICATION
T2 and T1 mapping may improve the ability to differentiate edematous myocardium over T2w techniques allowing a more precise
determination of area at risk after AMI.
SSC02-09
Integrating Anatomical and Functional Assessment of Coronary Artery Disease Using Single-scan
Stress Computed Tomography Perfusioin: A Comparison with Combined Invasive Coronary
Angiography and Cardiac Magnetic Resonance Imaging
Monday, Nov. 30 11:50AM - 12:00PM Location: S504AB
Participants
Sung Min Ko, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
This study was aimed to determine the diagnostic performance of single-scan stress computed tomography perfusion (CTP) for
This study was aimed to determine the diagnostic performance of single-scan stress computed tomography perfusion (CTP) for
identifying hemodynamically significant coronary artery disease (CAD).
METHOD AND MATERIALS
Twenty-nine (21 men, 63.9±9.1 years) patients with suspected or known CAD underwent single-scan CTP, stress perfusion
cardiovascular magnetic resonance (SP-CMR), and invasive coronary angiography (ICA). Dual-source CT was performed as follows:
1) coronary calcium scan: non-enhanced, prospectively ECG-triggered scan; 2) single-scan CTP for coronary artery anatomy
(coronary CT angiography, CCTA) and inducible myocardial perfusion (CTP): contrast-enhanced, retrospectively ECG-gated scan
during adenosine infusion; 3) delayed scan: acquired 5 min after single-scan CTP using prospectively ECG-triggered scan.
Diagnostic values of CCTA for detecting hemodynamically significant stenosis were assessed before and after CTP on a per-vessel
basis compared with combined ICA and SP-CMR as reference standard. A coronary vessel was considered to be significantly
stenosed if there was at least 1 segment with ≥ 50% lumen reduction
RESULTS
By ICA, 26 (90%) patients had 57 (66%) significantly stenotic vessels. By SP-CMR, perfusion defects were noted in 23 (79%)
patients with 48 (55%) vessel territories. Ten (34%) patients had old myocardial infarction. Combined ICA/SP-CMR showed
hemodynamically significant stenoses in 23 (79%) patients with 47 (54%) vessel territories. The performance of sing-scan CTP for
detecting perfusion defects compared with SP-CMR on per-vessel (segment) basis was sensitivity, 88% (78%); specificity, 92%
(84%); positive predictive value, 94% (76%); negative predictive value, 85% (86%). Compared to ICA/SP-CMR, per-vessel territory
sensitivity, specificity, positive predictive value, and negative predictive value of CCTA were 75%, 93%, 96%, and 63%,
respectively, those by using CTP were 86%, 92%, 94%, and 83%, respectively, and those by using single-scan CTP (CCTA and
CTP) were 90%, 90%, 91%, and 88%, respectively. The area under the receiver operating characteristic curve increased from 0.79
to 0.90 (p=0.013) using single-scan CTP compared with CCTA.
CONCLUSION
Single-stress CTP allows for the detection of hemodynamically significant coronary stenosis.
CLINICAL RELEVANCE/APPLICATION
Single-stress CTP has the potential to become the preferred CT technique for identifying hemodynamically significant CAD at a
single-examination.
CAS-MOA
Cardiac Monday Poster Discussions
Monday, Nov. 30 12:15PM - 12:45PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Leena Mammen, MD, Grand Rapids, MI (Moderator) Nothing to Disclose
Sub-Events
CA211-SDMOA2
Comparison of Transthoracic Echocardiography versus Cardiac Magnetic Resonance for Implantable
Cardioverter Defibrillator Therapy in Primary Prevention Strategy of Dilated Cardiomyopathy Patients
Station #2
Participants
Gianluca Pontone, MD, Milan, Italy (Presenter) Speakers Bureau, General Electric Company; Consultant, General Electric Company;
Research Consultant, HeartFlow, Inc; Speakers Bureau, HeartFlow, Inc; Speakers Bureau, Medtronic, Inc; Speakers Bureau, Bayer
AG
Daniele Andreini, MD, Milan, Italy (Abstract Co-Author) Consultant, General Electric Company
Anna Solbiati, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Marco Guglielmo, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Saima Mushtaq, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Baggiano, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Virginia Beltrama, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Cristina Rota, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Guaricci, MD, Foggia, Italy (Abstract Co-Author) Nothing to Disclose
Mauro Pepi, Milan, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Implantable cardioverter-defibrillators (ICDs) has been proved as a valid primary prevention strategy to reduce mortality in patients
with dilated cardiomyopathy (DCM) with reduced left ventricular ejection function (LVEF) <35%.Several studies have shown
differences between CMR and TTE evaluation. The aim of this study is to determine whether LV evaluation and late gadolinium
enhancement (LGE) detection by CMR are superior to conventional TTE measurements for risk stratification of DCM patients
evaluated for ICD implantation in primary prevention strategy.
METHOD AND MATERIALS
270 consecutive DCM patients (Mean age 63±13 yo,male 220 patients) referred to our Institution to be evaluated for ICD
implantation in primary prevention were enrolled. All patients underwent both TTE and CMR left ventricle end-diastolic (LVEDV) and
end-systolic (LVESV) volumes and LVEF estimation. Additionally, LGE presence was also detected by CMR. All patients were
followed-up for the major adverse cardiac events (MACE) defined as a combined endpoint of ventricular tachycardia, ventricular
fibrillation and sudden cardiac death.
RESULTS
The mean follow-up was 850±330 days. TTE showed a lower LVEDV (86±28 vs. 131±41 ml/m2) and LVEDV (57±21 vs. 93±40
ml/m2) and a higher LVEF (35±10 vs. 31±9 %) as compared to CMR (p<0.0001). MACE occurred in 68 patients (25%). Patients
experienced MACE showed a higher LVEDV-TTE (94±28 vs.84±28 ml/m2, p:0.01), LVESV-TTE (64±27 vs.55±23 ml/m2, p:0.003),
LVEDV-CMR (141±43 vs.128±41 ml/m2,p:0.01), LVESV-CMR (105±42 vs.90±39 ml/m2, p:0.003), lower LVEF-CMR (29±10 vs.
32±9%,p:0.0027) and a higher LGE prevalence (67 vs.44%,p:0.0009) as compared to patients without MACE. At multivariate
analysis,LVEF-CMR [HR:2.3(1.6-3.01)] and presence of LGE [HR:4.08(2.15-6.02)] were independently associated with MACE
(p<0.001). In the subset of patients with LVEF-TTE>35%, the addition of LVEF-CMR and LGE provides a net reclassification
improvement (NRI) of 42% and 26%, respectively, in terms of outcomes.
CONCLUSION
LVEF and LGE estimation by CMR might provide additional prognostic stratification as compared to TTE that could identify a subset
of subjects in whom ICD implantation is still indicated despite LVEF-TTE>35%.
CLINICAL RELEVANCE/APPLICATION
LVEF and LGE estimation by CMR might provide additional prognostic stratification as compared to TTE that could identify a subset
of subjects in whom ICD implantation is still indicated despite LVEF-TTE>35%.
CA204-SDMOA3
Utility of Ungated Free-breathing Through-time Radial GRAPPA in Pediatric Cardiac MRI- Preliminary
Results
Station #3
Participants
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Presenter) Institutional Research Grant, Koninklijke Philips NV
Deepa Prasad, MBBS, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Lydia Everhart, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Vikas Gulani, MD, PhD, Ann Arbor, MI (Abstract Co-Author) Research support, Siemens AG
Nicole Seiberlich, PhD, Cleveland, OH (Abstract Co-Author) Research Grant, Siemens AG
Robert C. Gilkeson, MD, Cleveland, OH (Abstract Co-Author) Research Consultant, Riverain Technologies, LLC Research support,
Koninklijke Philips NV Research support, Siemens AG
Ravi Ashwath, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac MRI (CMR) sequences require ECG gating and multiple breath holds, which may be difficult in children and often require
general anesthesia. We sought to compare the image quality and quantitative ventricular parameters with ungated free breathing
through-time radial GRAPPA to gold-standard breath-hold cine sequences.
METHOD AND MATERIALS
The study included 9 patients, 7 on 1.5 T and 2 on 3 T scanners. Both gold-standard breathheld SSFP scans with ECG gating and
free breathing ungated highly under sampled radial bSSFP scans were acquired. Radial data was reconstructed using through-time
radial GRAPPA. ESV, EDV, EF and mass were assessed for both scans and compared using two-sided t-tests. Images were
evaluated by two independent cardiac imagers for several features including endocardial border detection, blood pool, myocardium,
mitral and tricuspid valve, global and regional cardiac wall motion abnormalities on a 5 point scale (1- worst, 5- best). Artifacts
were graded on a 5 point scale (1- no artifacts, 5- extensive artifacts).
RESULTS
There was excellent correlation of quantitative measurements between the two MRI techniques (EF R=0.89, EDV R=0.99, ESV
R=0.93, mass R=0.98). The differences in EF, EDV, ESV and mass between gold-standard and real-time methods were not
statistically significant. For the Bland-Altman plot, the mean difference of the measurements between the gold-standard and realtime methods was -0.35% (1.57% and -2.27%) and 95% limits of agreement contained 100% of the difference scores. On
qualitative assessment, mitral valve was seen well (p=0.01) in SSFP but all the other features were comparable in both sequences.
The mean artifact score was significantly lower in the real- time images (1.1 vs 2.8, p < 0.005). The mean scan time was also
shorter with real time real time method (4.1 mins vs 6.5 mins, p < 0.001)
CONCLUSION
Real-time functional CMR with through-time radial GRAPPA performed without ECG-gating under free-breathing can be considered as
an alternative to gold-standard breath hold cine imaging for the evaluation of quantitative and qualitative parameters in pediatric
patients with comparable results, fewer artifacts and shorter scan times.
CLINICAL RELEVANCE/APPLICATION
This novel sequence is useful in cardiac MRI of children, who often are not compliant with breath holding instructions and may thus
obviate the need for general anesthesia in these children.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
CA213-SDMOA4
Left Ventricular Noncompaction in Adult: Imaging and Clinical Findings from 63 Patients
Station #4
Participants
Se Jin Cho, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Dong Hyun Yang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Joon-Won Kang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Tae-Hwan Lim, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To describe imaging and clinical findings of left ventricular noncompaction (LVNC) in adult
METHOD AND MATERIALS
From 2000 to 2014, 63 patients were diagnosed to LVNC by echocardiography, computed tomography (CT), and magnetic
resonance imaging (MRI) in a single institution. Baseline characteristics, clinical manifestation, combined cardiac or systemic
anomalies, and imaging findings were reviewed and compared between isolated group (LVNC without cardiac anomaly) and combined
group (LVNC with cardiac anomaly). Institutional review board approved the study and informed consent was waived.
RESULTS
Among 63 patients with LVNC, 32 (51%) patients did not have combined cardiac anomaly, isolated group of LVNC. Mean age at
initial diagnosis of isolated LVNC group is higher than the combined group (54.2 years vs. 40.2 years; p<0.001). The combined
group presented symptoms more frequently at initial diagnosis than isolated group (93.6% vs. 75%). Heart failure symptoms were
most common (60.3% in all patients). Thromboembolic events were shown in 20(31.7%) patients in all patients, which were much
higher in combined group (66.7%) than isolated group (33.3%). The most common combined cardiac abnormality was dilated
cardiomyopathy (n=15, 24%) followed by other congenital heart disease (n=12, 19 %). (Imaging findings of CT and MRI are under
analysis. Final presentation will include the imaging findings of LVNC in CT and MRI).
CONCLUSION
The isolated and combined groups of LVNC show differences in age at diagnosis and clinical manifestations. The most common
combined cardiac abnormality was dilated cardiomyopathy.
CLINICAL RELEVANCE/APPLICATION
We provided clinical characteristics of LVNC from 14-year imaging database of a single institution. Clinical and imaging findings of
LVNC presented in the study may be helpful to understand LVNC to determine management plan of the disease
CA214-SDMOA5
Impact of Full Scan Reconstruction for Myocardial Perfusion CT at 320-MDCT Volume Scanning
Station #5
Participants
Toshiaki Shimonobo, Kumamoto, Japan (Presenter) Nothing to Disclose
Yoshinori Funama, PhD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Katsuyuki Taguchi, PhD, Baltimore, MD (Abstract Co-Author) Research Grant, Siemens AG
Daisuke Utsunomiya, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Seitaro Oda, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yasuyuki Yamashita, MD, Kumamoto, Japan (Abstract Co-Author) Consultant, DAIICHI SANKYO Group
PURPOSE
CT coronary angiography uses a half reconstruction to improve temporal resolution. However, variations in beam hardening and
scatter as a function of the source position lead to artifactual variations in the CT numbers. For myocardial perfusion CT, accurate
CT numbers and a radiation dose reduction are more important than the temporal resolution. The purpose of this study was to
evaluate the usefulness of full scan reconstruction for myocardial perfusion CT on a 320-MDCT volume scanner.
METHOD AND MATERIALS
Using an anthropomorphic chest phantom we performed one-volume scans on a 320-MDCT volume scanner (Aquilion ONE ViSION,
Toshiba). The tube voltage, current, and rotation time were 120 kVp, 200 mA, and 275 msec. The heart rate was set at 60 bpm
(R-R interval 1000 msec) using the demo mode. Acquisitions of the coverage at 80 mm (± 40 mm) along the z-axis were repeated 1
times per sec for 24 sec. All CT images were acquired with full and half reconstruction using the same raw data. To compare the
full and half reconstruction we measured the CT number on the same slice level and calculated the mean value and its variations for
24 sec. We also measured the image noise for both reconstruction and calculated the radiation dose reduction from the ratio of
both image noises.
RESULTS
At on-center position (0.0 mm), the mean value and variation were -11.09 HU and ± 0.431 HU with full reconstruction and -11.31
HU and ± 0.847 HU with half reconstruction. Both variations were almost the same at this position. At the off-center position at
+20 mm and +30 mm, the variations with full reconstruction remained constant at ± 0.373 HU and ± 0.457 HU, the same as at the
on-center position. However, with half reconstruction the CT numbers varied considerably on sequentially-acquired images and the
variations increased to ± 3.795 and ± 4.516HU. The image noise with full- and half reconstructions was 16.94 and 24.21 HU at oncenter. The radiation-dose difference was calculated 2.04 times at on-center for full and half reconstructions. Full reconstruction
yielded a 50% radiation dose reduction.
CONCLUSION
Compared to the half reconstruction, full scan reconstruction yields accurate CT numbers and a 50% radiation dose reduction at
the sequential acquisition of myocardial perfusion CT images.
CLINICAL RELEVANCE/APPLICATION
The full reconstruction yields accurate CT numbers of the myocardial perfusion defect and allows for a reduction in the radiation
dose.
CA215-SDMOA6
Wide-Detector Axial CT versus Standard-Detector Helical CT for Transcatheter Aortic Valve
Replacement (TAVR) Planning: Image Quality, Radiation Dose, and Iodine Dose
Station #6
Participants
William P. Shuman, MD, Seattle, WA (Presenter) Research Grant, General Electric Company
Douglas E. Green, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Janet M. Busey, MS, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Mario M. Ramos, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Kent M. Koprowicz, Seattle, WA (Abstract Co-Author) Research Consultant, Axio Research
Kalpana M. Kanal, PhD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare wide-detector (16 cm) axial step-and-shoot TAVR CT to standard-detector (4 cm) helical TAVR CT for multi-level
vascular attenuation, subjective image quality and enhancement, radiation dose, and iodine dose.
METHOD AND MATERIALS
We retrospectively identified 36 consecutive patients who had TAVR planning CT on a wide-detector scanner using axial step-andshoot technique with ECG gating in the chest and no gating in the abdomen/pelvis (protocol 1). Iodinated contrast was
administered as a single continuous bolus. Patients were age and body-size matched to 36 patients who had TAVR planning CT on a
standard-detector scanner using a helical technique with ECG gating in the chest and no gating in the abdomen/pelvis (protocol 2).
Iodinated contrast was administered as two separate bolus injections. Two reviewers working independently scored overall and
aortic root image quality and aortic enhancement on 4 point Likert scales. One reviewer measured HU attenuation at 8 vascular
locations, psoas muscle, and noise in air. Contrast to noise (CNR) and signal to noise (SNR) ratios were calculated. CT dose index
(CTDIvol), total exam dose length product (DLP), Z-axis length, and iodine dose were recorded.
RESULTS
Subjective scores were similar between protocol 1 and 2 for overall image quality (3.6 vs 3.5, p=0.37) and vascular enhancement
(3.9 vs 3.9, p=0.57), but aortic root image quality was better for protocol 1 than 2 (3.3 vs 3.0, p<0.05). Mean vascular HU
attenuation was statistically greater for protocol 1 (358 vs. 300 HU, p<0.001) and was greater at all 8 vascular levels (graph).
There was no significant difference between protocols for image noise, CNR, or SNR (p>0.05). CTDIvol in the chest and
abdomen/pelvis was less for protocol 1 (36.4 vs. 67.8 and 14.8 vs. 20.8, p<0.001), as was DLP (1536 vs. 3244 mGy, p<0.001).
Iodine dose for protocol 1 was less than for protocol 2 (32 vs. 48 g, p<0.001).
CONCLUSION
Wide-detector axial step-and-shoot TAVR planning CT resulted in greater vascular attenuation, similar subjective image quality and
measured image noise, yet with lower radiation dose and less iodine dose compared to standard-detector helical TAVR CT.
CLINICAL RELEVANCE/APPLICATION
Wide-detector axial step-and-shoot TAVR CT may be useful in patients for whom both good image quality and reduction of radiation
or iodine dose are desirable.
CA216-SDMOA7
Qualitative Analysis of Plaque Detected on Coronary CTA with Invasive Coronary Angiography in the
Elderly and Its Effect on Management and Clinical Outcome
Station #7
Participants
Rajesh Gupta, MD, Stony Brook, NY (Presenter) Nothing to Disclose
Ammar A. Chaudhry, MD, Corona, CA (Abstract Co-Author) Nothing to Disclose
Eric J. Feldmann, MD, Smithtown, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the significance of non-calcified plaque detected on Coronary CTA in the elderly and its effect on management and
clinical outcome.
METHOD AND MATERIALS
In this retrospective analysis, patients (age > 65) presented to a tertiary care emergency department with chest pain and
underwent coronary CTA from April 2014 to April 2015. Patients were excluded if they had normal coronary arteries on CTA or if
there were technical limitations preventing a good quality study. Exams were reviewed to identify patients with obstructive
coronary artery disease (CAD) and findings were compared to subsequent invasive coronary angiography procedure and/or
myocardial perfusion examination.
RESULTS
83 patients met the inclusion criteria and were found to have obstructive or non-obstructive CAD. 21/83 (25.3%) patients had
obstructive CAD with soft, mixed or calcified plaque. 9/21 (43%) were considered borderline obstructive with 50-70% stenosis and
subsequently had a normal myocardial perfusion study or no further testing. 12/21 (57.1%) were identified to have >70% stenosis,
eleven had mixed or soft plaque, with invasive coronary angiography performed in eight of these patients. Coronary CTA and
invasive angiography were concordant in 7/8 (87.5%), who eventually required percutaneous intervention or bypass grafting. 1/8
(12.5%, 1/83: 1.2%) patient with obstructive >70% stenosis in the RCA on CTA had discordant findings on invasive angiography,
which revealed < 50% stenosis.
CONCLUSION
Coronary CTA has a high positive predictive value in evaluating greater than 70% obstructive non-calcified coronary artery disease
when compared to invasive coronary angiography. Due to normal stress myocardial perfusion studies in patients with <70% stenosis
on CTA, medical management of CAD with no further testing appears to be a sound alternative saving patients time, money and
radiation exposure.
CLINICAL RELEVANCE/APPLICATION
Coronary CTA is excellent in determining clinically significant non-calcified >70% obstructive stenosis requiring invasive lifesaving
therapy with rare false positives.
CA154-EDMOA8
Magnetic Resonance Imaging of Obesity Phenotypes in Metabolic Syndrome
Station #8
Participants
Karen Rodriguez, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Jadranka Stojanovska, MD, MS, Northville, MI (Presenter) Nothing to Disclose
El-Sayed H. Ibrahim, PhD, MSc, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Dharshan R. Vummidi, MRCP, FRCR, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Luba Frank, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Paul P. Cronin, MD, MS, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Maryam Ghadimi Mahani, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Review obesity phenotypes of metabolic syndrome as illustrated by imaging features.2. Review and illustrate the multi-echo Dixon
(mDixon) MRI technique used for evaluation of thoracic fat depots. 3. Describe future clinical application of mDixon MRI in obesity
imaging.
TABLE OF CONTENTS/OUTLINE
The tissue properties of epicardial and myocardial fat in obesity and metabolic syndrome (MetS) are poorly understood. We are
showing obesity phenotypes using diagnostically appropriate mDixon images for thoracic fat depot tissue differentiation and
quantification. The foundation of using mDixon magnetic resonance imaging (MRI) relies on the different tissue properties of fat.
Appropriate identification of obesity phenotype is crucial for patients' management and it is beyond the use of anthropometric
measurements. Brown adipose tissue has higher water-to-fat ratio and higher density of mitochondria and blood vessels than white
adipose tissue. Cases of MetS, obesity without MetS and normal cases will be illustrated using clinical case-based scenarios with
color-coded image correlation.
CAS-MOB
Cardiac Monday Poster Discussions
Monday, Nov. 30 12:45PM - 1:15PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
FDA
Discussions may include off-label uses.
Participants
Leena Mammen, MD, Grand Rapids, MI (Moderator) Nothing to Disclose
Sub-Events
CA217-SDMOB1
Self-Gated CMR (Cardiac MRI) Using Phase Information
Station #1
Participants
Hyunseok Seo, Daejeon, Korea, Republic Of (Presenter) Nothing to Disclose
Dongchan Kim, Daejeon, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun W. Park, Daejeon, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To obtain high spatiotemporal resolution cardiac MR images from a novel self-gating method, which extracts the motion information
of the heartbeat and breathing from the phase of the projection data
METHOD AND MATERIALS
The proposed method uses the phase information of the projection data. In general, the phase of the MR signal is affected by the
time-varying gradient field and the location of spins. The proposed method obtains the projection data for self-gating. Because the
x-(left-right) directional projection data is more sensitive to the breathing motion, the readout gradient is applied in the y(anterior-posterior) direction. Bi-polar gradients are also applied in the z-(head-foot) direction utilizing the aortal blood flow which is
correlated with the heartbeat motion. Then, cardiac motions due to the heartbeat and breathing are represented as the phase
variation on the projection data. The breathing motion is estimated from the whole phase of the projection data whereas the
heartbeat motion is estimated from the phase of the projection data passing through the aortal region. The difference between the
maximum and the minimum velocity of the aorta can be calculated from the phase variation. In the proposed method, the number of
repetitions for high-frequency components of the k-space is less than those of low-frequency components to reduce the imaging
time for the retrospective gating. The in-vivo studies which were approved by IRB were performed with five healthy volunteers
using a 3.0 T MRI scanner.
RESULTS
Using the proposed self-gating method, the motion information of the heartbeat and breathing was precisely extracted as compared
with the results from the ECG gating and respiratory belt. The averaged heart beat cycle was about 915 ms/cycle, and the
averaged respiratory cycle was about 3.82 s/cycle. The difference between the maximum and the minimum velocity of the aorta
was about 27.1 cm/s. From the proposed method, high-spatiotemporal resolution cardiac MR images were successfully obtained
with imaging time of 2 min. 48 sec. The spatial resolution was 1×1×6 mm³ and there were total 80 cardiac phases.
CONCLUSION
The proposed method provides reliable information of the cardiac motions from the phase of the projection data, which allows
obtaining high spatiotemporal resolution cardiac MR images.
CLINICAL RELEVANCE/APPLICATION
The clinical application of the proposed method is cardiac anatomic/functional imagings.
CA218-SDMOB2
Myocardial T1 and Extracellular Volume Fraction Related to Cardiac Functional Parameters in Dilated
Cardiomyopathy
Station #2
Participants
Masaki Tachi, MD, PhD, Tokyo, Japan (Presenter) Nothing to Disclose
Yasuo Amano, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shogo Imai, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Fumi Yamada, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Makoto Obara, Minato-Ku, Japan (Abstract Co-Author) Employee, Koninklijke Philips NV
Keisuke Inui, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shinichiro Kumita, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Modified Look-Locker inversion recovery (MOLLI) in cardiac magnetic resonance (CMR) provides T1 mapping of the left ventricular
(LV) myocardium and quantify the T1 value and extracellular volume fraction (ECV). The objective of this study was to determine
the interval, by analyzing the correlations between T1 value before or after enhancement or ECV and the cardiac functions in
dilated cardiomyopathy (DCM) cases.
METHOD AND MATERIALS
24 DCM patients underwent CMR using a 3.0 T. As cardiac functional parameters, we measured LV ejection fraction (LVEF), end
24 DCM patients underwent CMR using a 3.0 T. As cardiac functional parameters, we measured LV ejection fraction (LVEF), end
diastolic volume (EDV), end systolic volume (ESV), LV mass, and LV remodeling index (LVRI = LV mass / EDV) on cine MRI. MOLLI
was performed before and 10 minutes after 0.15 mmol/kg Gd injection at the basal and middle short-axis LV slices. We generated
T1 mapping before and after contrast, and T1 value was measured by the basal septum. We calculated ECV from the pre- and
post-contrast T1 values. Correlation between the T1 values or ECV and the cardiac functional parameters were assessed.
RESULTS
Pre-contrast T1 value measured at the septum significantly correlated with LVEF (P < 0.05; r = -0.36), EDV (P < 0.01; r = 0.49),
ESV (P < 0.05; r = 0.45), and LVRI (P < 0.05; r = -0.37). Post-contrast T1 value (10 min) measured at the septum weak correlated
with EDV, ESV, and LVRI (All P < 0.05; r = -0.43, -0.38, 0.36, respectively). There were significant correlations between ECV and
EDV (P < 0.01; r = 0.54), ESV (P < 0.01; r = 0.47) and LV mass (P < 0.05; r = 0.38).
CONCLUSION
Diffuse myocardial damages related to cardiac dysfunction can be detected using pre-contrast MOLLI, probably because precontrast T1 value may reflect intracellular water contents and extracellular volume expansion. We could evaluate the myocardial
damages in DCM patients who are contraindicated to Gd. When Gd is used, we can evaluate ECV that may be related to
morphological variables.
CLINICAL RELEVANCE/APPLICATION
In DCM T1 values evaluated by MOLLI can detect diffuse myocardial fibrosis even before contrast in DCM and ECV also correlates
with cardiac functional parameters in DCM.
CA219-SDMOB3
Image Quality of Coronary Artery Plaque with Rapid kVp-switching Dual-Energy CT
Station #3
Participants
Yasutoshi Ohta, MD, Yonago, Japan (Presenter) Nothing to Disclose
Shinichiro Kitao, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Junichi Kishimoto, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Tomomi Watanabe, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Natsuko Mukai, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Kazuhiro Yamamoto, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
Toshihide Ogawa, MD, Yonago, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of the study was to evaluate and determine the virtual monochromatic imaging (VMI) levels that maximize coronary plaque
image quality in dual-energy computed tomography angiography (DECTA).
METHOD AND MATERIALS
Forty-five coronary plaques from 24 patients underwent CTA were analyzed. All CTAs were performed with single-source DECT
(Discovery CT750HD, freedom edition, GE) using rapid kV switching dual energy scan (80kV, 140kV, 600mA). Spectral HU curve,
signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and noise index were analyzed across multiple segments at varying
monochromatic energy levels (40-140keV) for each component of coronary artery plaque as follows: lumen, calcified plaque (CP),
non-calcified plaque (NCP), adjacent surrounding tissue of coronary artery and distant pericardial fat from coronary artery.
Normalized spectral HU curves were calculated using luminal CT number as reference.Friedman rank sum test and Wilcoxon signed
rank test were then used to determine significance.
RESULTS
In a total of 45 plaques, maximal SNRs were observed at 40keV, 70keV, 130keV and 140keV for plaque, lumen, fat and surrounding
tissue, respectively (p<0.05). Maximal CNRs were observed at 70keV for CP (18.36), NCP (15.23) and fat (30.39) comparison with
lumen (p<0.05), 120keV for NCP (3.31) comparison with surrounding tissue (p<0.05), 70keV and 120keV for NCP (12.03 and 11.68)
comparison with fat (p=0.144). Normalized CT number of CP obtained highest 227.43% at 140keV and surrounding tissue obtained
lowest -37.03% at 140keV, NCP ranged from 16.64% to 24.16%.
CONCLUSION
VMI demonstrates maximal image quality in different energy levels for each component of coronary artery plaque.
CLINICAL RELEVANCE/APPLICATION
VMI in different energy level demonstrates different image quality of plaque component. Optimized energy level enables to obtain
higher image quality for evaluating coronary artery plaque on DECTA.
CA220-SDMOB4
Structural and Functional Correlates of Myocardial T1 Time in 321 Patients with Hypertrophic
Cardiomyopathy
Station #4
Participants
Linda C. Chu, MD, Lutherville, MD (Presenter) Nothing to Disclose
Celia P. Corona-Villalobos, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Mark Halushka, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Yan Zhang, MD, PhD, Jinan, China (Abstract Co-Author) Nothing to Disclose
Chiara Pozzessere, MD, Siena, Italy (Abstract Co-Author) Nothing to Disclose
Iraklis Pozios, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Ihab R. Kamel, MD, PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Rob J. van der Geest, PhD, Leiden, Netherlands (Abstract Co-Author) Nothing to Disclose
David A. Bluemke, MD, PhD, Bethesda, MD (Abstract Co-Author) Research support, Siemens AG
Roselle Abraham, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Theodore Abraham, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Stefan L. Zimmerman, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
PURPOSE
Myocardial fibrosis is an early and consistent pathologic feature in hypertrophic cardiomyopathy (HCM). T1 mapping by cardiac MR
(CMR) can identify markers of interstitial fibrosis. The purpose of this study is to determine structural and functional correlates of
myocardial T1 time in HCM patients.
METHOD AND MATERIALS
CMR of 321 HCM patients were included in this IRB-approved study. All CMR were performed on a 1.5T scanner, including standard
steady-state free precession cine, late gadolinium enhancement (LGE), and post-gadolinium Look-Locker inversion recovery
sequences (TI scout). CMR images were post-processed to quantify maximal left ventricular (LV) wall thickness, LGE mass, and T1
values using dedicated software. Echocardiography exams were reviewed to determine LV outflow tract (LVOT) pressure gradient
and diastolic function. Relationships between myocardial T1 time and LGE%, and structural and functional features were analyzed
using Pearson correlation coefficient. p-value < 0.05 was considered significant.
RESULTS
CMR of 321 HCM patients (220 M, mean age 51.8 years) were reviewed. Mean maximal LV wall thickness was 20.1±5.4mm. Mean 12
min post gadolinium myocardial T1 time was 383.0±58.8 msec. Mean LGE% was 10.1±12.9%. Myocardial T1 time showed significant
correlation with LGE%, a measure of replacement fibrosis (p < 0.01). LGE% showed significant correlation with structural features
such as maximal wall thickness (p < 0.01) and LV mass normalized to body surface area (p < 0.01). Myocardial T1 time showed no
significant correlation with these structural features. With functional features, both myocardial T1 and LGE% were related to
ejection fraction (r = 0.12 and r = -0.18, respectively). LGE% was correlated with E/e' (r = 0.12). Other functional measures were
not related to myocardial T1 times.
CONCLUSION
In this large HCM cohort, both markers of diffuse interstitial fibrosis and replacement fibrosis were related to EF. LGE% was more
closely correlated with other structural and functional features reflective of HCM severity than myocardial T1 times.
CLINICAL RELEVANCE/APPLICATION
The extent of LV replacement fibrosis, as measured by LGE%, is related to global measures of HCM severity, whereas interstitial
fibrosis, as reflected by myocardial T1 times, appears for the most part independent of these features. Clinical utility of T1 mapping
in management of HCM patients remains uncertain.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ihab R. Kamel, MD, PhD - 2015 Honored Educator
Stefan L. Zimmerman, MD - 2012 Honored Educator
Stefan L. Zimmerman, MD - 2015 Honored Educator
CA221-SDMOB5
Ability of Extracellular Volume Imaging to Serially Measure Infarct Size Compared to LGE within Six
Months after Acute Myocardial Infarction
Station #5
Participants
Martin Sinn, Hamburg, Germany (Presenter) Nothing to Disclose
Enver G. Tahir, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Maxim Avanesov, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Ulf K. Radunski, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Kai Muellerleile, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Joshua Wien, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Christian Stehning, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Dennis Saehring, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gerhard B. Adam, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gunnar K. Lund, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
T1 mapping and extracellular volume (ECV) imaging are promising tools to quantify increased extracellular distribution volume of
contrast media after myocardial damage. We evaluated the ability of ECV imaging to measure infarct size compared to late
gadolinium enhancement (LGE) after acute myocardial infarction (AMI). Additionally, the amount of cellular damage was serially
measured by ECV imaging.
METHOD AND MATERIALS
CMR (1.5 Tesla Philips Achieva) was performed in 25 patients four times after reperfused AMI at baseline (BL) at 9.4±5.6 days after
infarction and at 6.9±1.3 weeks (follow-up 1, FU1), 3.6±0.5 months (FU2) and 6.5±0.7 months (FU3), respectively. 8 out of 25
Patients underwent an fourth follow-up (FU4) after 23.1±10.7 months. T1 quantification was performed before (T1pre) and 15
minutes after (T1post) administration of 0.075 mmol/kg gadolinium BOPTA on 3 short-axes for ECV calculation using the modified
Look- Locker inversion-recovery (MOLLI) sequences. T2 and ECV maps were calculated with a dedicated plug-in written for the
OsiriX software. Two experienced observers independently evaluated LGE-CMR as well as ECV and T2 mapping using the HeATSoftware applying a threshold method. Size of infarction and areas of prolonged T2 or increased ECV was measured using a cutoff
>2SD of remote normal myocardium.
RESULTS
Infarct size on LGE images was at BL 23±11 %LV and decreased to 19±12 %LV, 20±11 %LV, 18±10 %LV and 19±12 %LV at FU1,
Infarct size on LGE images was at BL 23±11 %LV and decreased to 19±12 %LV, 20±11 %LV, 18±10 %LV and 19±12 %LV at FU1,
FU2, FU3, and FU4, respectively. Infarct size obtained by EVC imaging was at BL higher (P<0.01) with 30±10 %LV at BL and
decreased to 20±11 %LV at FU1 and remained constant at FU2 with 21±11 %LV, 20±11 %LV at FU3 and 20±8 %LV at FU4 (P=ns
for all time points compared to LGE). Edema size on T2 Map was 32±10% at BL and significantly decreased to 19±9%, 15±7, 12±6,
9±4 at FU1, FU2, FU3 and FU4, respectively.
CONCLUSION
Acute after AMI infarct size measurement by ECV overestimates infarct size and represents size of edema. However, after
resorbtion of edema within 7 weeks after infarction EVC accurately measures infarct size comparable to LGE.
CLINICAL RELEVANCE/APPLICATION
ECV measurement additionally gives information about the magnitude of cellular damage, which slightly increases with in the first 3
Months after AMI and then remains constant.
CA222-SDMOB6
Early Experience with a Third Generation Dual Source CT for TAVI Treatment Planning
Station #6
Participants
Jeremy D. Collins, MD, Chicago, IL (Presenter) Nothing to Disclose
Jessie Aw-Zoretic, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Samir Abboud, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Bradley D. Allen, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Lee Goodwin, Chicago, IL (Abstract Co-Author) Nothing to Disclose
James C. Carr, MD, Chicago, IL (Abstract Co-Author) Research Grant, Astellas Group Research support, Siemens AG Speaker,
Siemens AG Advisory Board, Guerbet SA
PURPOSE
To compare radiation dose in patients undergoing CT evaluation to determine suitability for TAVI between a 3rd generation (3GDS)
and a 1st generation dual source (1GDS) CT system.
METHOD AND MATERIALS
Retrospective analysis of 20 consecutive patients who underwent pre-TAVI assessment using a 3GDS CT system (13 men, 78±9.3
yrs) and 20 consecutive patients imaged on a 1GDS CT system (13 men, 78.4±10.1 yrs). The 3GDS pre-TAVI CT protocol included
a retrospectively gated cardiac scan followed by a high-pitch FLASH CT angiogram with coverage from the groin to the thoracic
inlet. The 1GDS protocol included a retrospectively gated thoracic acquisition followed by a helical CTA of the abdomen and pelvis.
Tube current modulation was identical between systems. kVp selection for the 1GDS was dependent on patient body mass index
(BMI); automatic kVp selection was used for 3GDS scans. Angular tube current modulation was applied to both groups. Sinogrambased iterative reconstruction (SAFIRE) was employed for the 1GDS scanner; model based iterative reconstruction (ADMIRE) was
employed for the 3GDS scanner. Scan parameters (kVp), radiation dose metrics (CT dose index volume (CTDIvol), Dose Length
Product (DLP)), contrast volume (mL), and patient body mass index (BMI, kg/m2) were recorded. The student's t-test assessed
between group differences.
RESULTS
3GDS patients had significantly greater BMI (32.5±7.1 vs 26.9±9.7, p=0.047). There was a significantly greater CTDIvol for cardiac
scans on the 3GDS (65.3±32.2 vs 41.4±25.8, p=0.01); CTDIvol for CT angiography was similar between the 3GDS and 1GDS
systems (10.3±4.3 vs 11.4±6.5, p=0.54). 120 kVp was more frequently utilized on the 3GDS system (45% vs 25% and 65% vs
20%) of cardiac and aortoiliac acquisitions. DLP was similar between 3GDS and 1GDS scans (1853.3±884.7 vs 1501.4±530.2
(p=0.14)). There was a trend towards lower contrast volumes for 3GDS scans (80.7±27.3 vs 95.3±30.6 (p=0.12)).
CONCLUSION
TAVI treatment planning using a 3GDS CT scanner demonstrates comparable radiation doses to those on a 1GDS system despite
greater z-axis coverage, a higher proportion of scans utilizing 120 kVp, and a patient cohort with a greater BMI.
CLINICAL RELEVANCE/APPLICATION
Further optimization of the TAVI scanning protocol on the 3rd generation dual source CT system is necessary to fully realize
potential radiation and contrast dose savings.
CA223-SDMOB7
Evaluation of Dual-Energy Combined Coronary CT Angiography and Myocardial Perfusion Imaging
for the Detection of Acute Myocardial Infarction by using the Second Generation Dual-source CT:
Correlation with Histopathological in Porcine Model
Station #7
Participants
Kai Sun SR, PhD, Beijing City, China (Presenter) Nothing to Disclose
Ruijuan Han, Baotou City, China (Abstract Co-Author) Nothing to Disclose
Kuncheng Li, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Nan Chen, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Xiangying Du, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic accuracy of "one-step" dual-energy combined coronary CT angiography and first-pass myocardial
perfusion imaging for the detection of acute myocardial infarction by using the second generation dual-source CT compared with
conventional digital subtraction angiography and histopathological findings in a porcine model.
METHOD AND MATERIALS
Five minipigs underwent transcatheter embolization of coronary using gelatin sponge to produce acute myocardial infarction.
Arterial-phase myocardial DECT imaging were performed prior to and immediately and 24 hours after the procedure. A colour-coded
iodine map was used for evaluation of myocardial perfusion defect using the 17-segment model. Two radiologists in consensus
interpreted all iodine map imaging studies at DECT and coronary CT angiography images that were acquired during the DECTacquisition. Statistical analysis for diagnostic accuracy was performed.
RESULTS
Following the coronary embolization, DECT iodine maps showed 45 infarcted segments and 40 noninfarcted segments. Based on the
per-segment analysis, the sensitivity, specificity, positive predictive value and negative predictive value were 93%, 95%, 95% and
93%,respectively. The corresponding values to per-territory analysis were 100% ,86 %, 89 % and 100% using histopathological
findings as the reference standard. The average DLP was 219.4 ± 60.9 mGy.cm (172-321 mGy.cm).
CONCLUSION
Our experimental study demonstrates that "one-step" dual-energy combined coronary CT angiography and first-pass myocardial
perfusion imaging provides high diagnostic accuracy for detecting acute myocardial infarction and a comprehensive image quality of
coronary artery with a relatively low dose of radiation dose in a porcine model.
CLINICAL RELEVANCE/APPLICATION
DECT can provide a one-stop imaging that offers information about the coronary morphology as well as the myocardial blood supply
CA109-EDMOB8
Beyond the EKG: Radiologic Imaging is at the Heart of Life-Preserving Cardiac Therapy
Station #8
Participants
Valerie D'Aurora, MD, Newark, NJ (Abstract Co-Author) Nothing to Disclose
Michael A. Sadler, MD, Newark, NJ (Abstract Co-Author) Nothing to Disclose
Vadim Spektor, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Yair Levy, Jerusalem, Israel (Presenter) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is to:1. Demonstrate the critical role of multimodality imaging in the management of patients receiving
life-preserving cardiac therapy including transcatheter aortic valve replacement (TAVR), ventricular assist devices (VADs), and
heart transplantation. 2. Provide examples of the utility of radiologic imaging to pre-operativly identify surgical challenges and assist
in the surgical planning for TAVR procedures. 3. Showcase various prosthetic aortic valvular and cardiac assist devices prior to and
after implantation. 4. Illustrate the efficacy of radiologic imaging for both peri-procedural and long-term surveillance of cardiac
device malfunction and complications related to heart failure therapy.
TABLE OF CONTENTS/OUTLINE
Classification and Treatment Guidelines for Heart Disease Aortic Stenosis Prevalence and Prognosis Pre-Procedural Multimodality
Imaging Goals for TAVR Selection of the Vascular Access Site Assessment of the Aortic Annulus Surgical Implantation of VADs
Review of the Multimodality Appearances of VADs Radiologic Diagnosis of Peri-Operative and Late Post-Operative Complications
Related to TAVR and VADs Case Review and Self-Assessment
MSMC23
Cardiac CT Mentored Case Review: Part III (In Conjunction with the North American Society for Cardiac
Imaging) (An Interactive Session)
Monday, Nov. 30 1:30PM - 3:00PM Location: S406A
CA
VA
CT
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Pamela K. Woodard, MD, Saint Louis, MO (Director) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
Harold I. Litt, MD, PhD, Philadelphia, PA (Moderator) Research Grant, Siemens AG ; Research Grant, Heartflow, Inc;
U. Joseph Schoepf, MD, Charleston, SC, (schoepf@musc.edu) (Moderator) Research Grant, Bracco Group; Research Grant, Bayer
AG; Research Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
LEARNING OBJECTIVES
1) Identify cardiac and coronary artery anatomy. 2) Recognize cardiac disease processes, including coronary atherosclerosis, as
diagnosed on CT. 3) Understand methods of cardiac CT and coronary CT angiography post-processing.
Sub-Events
MSMC23A
Pulmonary Veins and Pericardial Disease
Participants
Jacobo Kirsch, MD, Weston, FL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe normal versus anomalous pulmonary venous anatomy. 2) Understand the imaging findings of complications of ablation
for atrial fibrillation. 3) Describe abnormalities of the pulmonary veins identifiable on routine CT. 4) Identify the most common
pericardial abnormalities evaluated with CT.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Jacobo Kirsch, MD - 2013 Honored Educator
MSMC23B
Coronary Atherosclerosis III
Participants
Elliot K. Fishman, MD, Owings Mills, MD (Presenter) Research support, Siemens AG Advisory Board, Siemens AG Research support,
General Electric Company Advisory Board, General Electric Company Co-founder, HipGraphics, Inc
LEARNING OBJECTIVES
View learning objectives under main course title.
ABSTRACT
The goal of this session is to learn how to interpret pathology involving the coronary arteries beyond the detection of coronary
artery stenosis. Focus on exam acquisition protocols, study interpretation protocols, and minimizing radiation dose are addressed.
Specific topics addressed will also include coronary artery aneurysm, myocardial bridging, anomalous coronary arteries as well as
vasculitis. Potential pitfalls will be addressed and pearls for study optimization will also be discussed.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Elliot K. Fishman, MD - 2012 Honored Educator
Elliot K. Fishman, MD - 2014 Honored Educator
SSE03
Cardiac (TAVR and Other Nonsurgical Interventional Procedures)
Monday, Nov. 30 3:00PM - 4:00PM Location: S502AB
CA
CT
IR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
FDA
Discussions may include off-label uses.
Participants
Jonathon A. Leipsic, MD, Vancouver, BC (Moderator) Speakers Bureau, General Electric Company Speakers Bureau, Edwards
Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc
Lynne M. Hurwitz, MD, Durham, NC (Moderator) Research Grant, Siemens AG Research Grant, General Electric Company
Sub-Events
SSE03-01
Comparison of Three Dimensional Echocardiography with ECG-Gated Cardiac Tomography for
Assessment of the Aortic Annulus Prior to Percutaneous Aortic Valve Replacement (TAVR)
Monday, Nov. 30 3:00PM - 3:10PM Location: S502AB
Participants
Gilda Boroumand, MD, Philadelphia, PA (Presenter) Nothing to Disclose
Howard M. Julien, MD,MPH, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Nicholas J. Ruggiero II, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Praveen Mehrotra, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Ethan J. Halpern, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
PURPOSE
The morphology and size of the aortic annulus are critical factors for preprocedural planning of percutaneous aortic valve
replacement (TAVR). We have previously demonstrated that the oval shape of the aortic annulus results in underestimation of
annular area based upon anteroposterior (AP) measurements on 2D echocardiography relative to area measurements on ECG-gated
cardiac CTA (cCTA). This study evaluated annular size on 3-dimensional transesophageal echocardiography (3D-TEE) in comparison
to cCTA prior to a TAVR procedure.
METHOD AND MATERIALS
3D-TEE and ECG-gated cCTA measurements of the aortic annulus were compared from preprocedural studies on 25 consecutive
TAVR patients. 3D-TEE measurements were obtained during mid-systole, while cCTA measurements were obtained at late-systole
(40% of the R-R interval) and late-diastole (80% of the R-R interval). Annular area was measured by manual planimetry. Pearson
correlation coefficients were computed and paired t-tests were performed to compare AP (short axis) and transverse (long axis)
diameters of the annulus, as well as annular area as measured by echocardiography and by cCTA.
RESULTS
cCTA measurements in systole and diastole were highly correlated: r=0.83 for short axis diameter, r=0.87 for long axis diameter,
r=0.98 for annular area. Good correlation was observed between 3D-TEE and cCTA for short axis diameter (r = 0.73-0.87), long axis
diameter (r = 0.72) and annular area (r = 0.87-0.88). Long axis diameter and annular area measurements obtained by 3D-TEE were
significantly smaller than those obtained by cCTA: Short axis diameter - 3D-TEE: 21.3mm; cCTA systole: 21.9mm; cCTA diastole:
20.7mm (p>0.05). Long axis diameter - 3D-TEE: 24.8mm; cCTA systole: 27.2mm; cCTA diastole: 26.4mm (p<0.001). Annular area 3D-TEE: 413mm^2; cCTA systole: 463mm^2 (p<0.0001); cCTA diastole: 435mm^2 (p=0.034).
CONCLUSION
Although all cCTA measurements of the aortic annulus are highly correlated with measurements by 3D-TEE, diastolic phase cCTA
measurements tend to be closer to standard mid-systolic 3D-TTE measurements. This is especially true for measurement of aortic
annular area which is over measured by an average of 50mm^2 on cCTA during systole relative to 3D-TEE.
CLINICAL RELEVANCE/APPLICATION
cCTA measurements of the aortic annulus are highly correlated between systole and diastole, but diastolic phase measurements
provide a better match with 3D-TEE, especially with respect to annular area.
SSE03-02
Low-Contrast-Medium-Volume Low-Tube-Voltage Computed Tomography for Planning Transcatheter
Aortic Valve Replacement
Monday, Nov. 30 3:10PM - 3:20PM Location: S502AB
Participants
Julian L. Wichmann, MD, Charleston, SC (Presenter) Nothing to Disclose
Lloyd Felmly, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Carlo N. De Cecco, MD,PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Akos Varga-Szemes, MD, PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Stefanie Mangold, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Giuseppe Muscogiuri, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Andrew D. McQuiston, BS, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Stephen R. Fuller, Charleston, SC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To prospectively evaluate the feasibility, diagnostic quality, and safety of low-tube-voltage, low-contrast-volume comprehensive
cardiac and aortoiliac computed tomography angiography (CTA) for planning transcatheter aortic valve replacement (TAVR).
METHOD AND MATERIALS
Forty consecutive TAVR candidates prospectively underwent combined contrast-enhanced (270mgI/mL iodixanol) CTA of the aortic
root complex and aortoiliac vascular access route. Patients were assigned to group A (2nd generation dual-source CT [DSCT], 100
kV, 60 mL contrast material, 4.0 mL/s flow rate, iodine-delivery rate [IDR] 1.08 g/s) or group B (3rd generation DSCT, 70kV, 40 mL
contrast material, 2.5 mL/s flow rate, IDR 0.675 g/s). Mean vascular attenuation, image noise, signal-to-noise ratio (SNR), and
contrast-to-noise ratio (CNR) were measured. Subjective image quality was independently assessed by two blinded readers using
five-point Likert scales. Patient creatinine levels on the day of the exam and during short- and long-term follow-up were measured.
RESULTS
Except for a higher body mass index in group B (24.8 ± 3.8 vs 28.1 ± 5.4 kg/m2, P =0.0339), no significant differences in patient
characteristics between both groups were observed. Mean aortoiliac SNR ( P =0.0003) and CNR ( P =0.4761) were 13.1 ± 6.8 and
24.3 ± 11.9 (group A), and 15.4 ± 6.7 and 24.9 ± 12.3 (group B), respectively. Mean cardiac SNR ( P =0.0003) and CNR ( P
=0.0181) were 15.6 ± 9.0 and 20.2 ± 13.4 (group A) and 12.2 ± 4.5 and 15.3 ± 6.7 (group B), respectively. Subjective image
quality did not significantly differ ( P ≥0.213) except for lower aortoiliac image noise in group B (4.42 vs 4.12, P =0.0374). TAVR
planning measurements were successfully obtained in all studies. There were no significant changes in creatinine levels among and
between patient groups during short- and long-term follow-up ( P ≥0.302). Four patients expired during the study period because
of unrelated causes, but no adverse events attributable to the use of iodinated contrast media were observed.
CONCLUSION
TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using lowtube voltage acquisition.
CLINICAL RELEVANCE/APPLICATION
CTA imaging with reduced contrast volume in pre-TAVR evaluation may improve safety in multimorbid patients considered for this
procedure.
SSE03-03
Incidence of Contrast Induced Nephropathy in Patients Undergoing TAVR Evaluation
Monday, Nov. 30 3:20PM - 3:30PM Location: S502AB
Participants
Alice Wang, Durham, NC (Presenter) Nothing to Disclose
Matthew Ellis, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
J. Kevin Harrison, Durham, NC (Abstract Co-Author) Nothing to Disclose
Todd Kiefer, Durham, NC (Abstract Co-Author) Nothing to Disclose
Rendon C. Nelson, MD, Durham, NC (Abstract Co-Author) Consultant, General Electric Company Consultant, Nemoto Kyorindo Co,
Ltd Consultant, VoxelMetrix, LLC Research support, Bracco Group Research support, Becton, Dickinson and Company Speakers
Bureau, Siemens AG Royalties, Wolters Kluwer nv
Hanghang Wang, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Lynne M. Hurwitz, MD, Durham, NC (Abstract Co-Author) Research Grant, Siemens AG Research Grant, General Electric Company
PURPOSE
Patients with severe aortic valve stenosis (AS) who are at high surgical risk are commonly evaluated for transcatheter aortic valve
replacement (TAVR) with CT angiographic imaging (CTA) of relevant anatomy and coronary angiography (CC). Many of these
patients have increased serum creatinine (Scr), increasing the risk of acute contrast induced nephropathy (CIN). Thus, the
incidence of CIN in patients undergoing workup needs to be assessed.
METHOD AND MATERIALS
Between 2012 and 2014, 258 patients underwent work up for TAVR with CTA at a single academic medical center. Patients who
underwent both CTA and CC with Scr values measured 24 hours before and within 48 hours after contrast exposure were included
in the analysis (n=123). All CTA and CC exams were performed utilizing iopamidol 370mg/ml via intravenous and intra-arterial
administration, respectively, with average contrast volume 110ml ±21ml and 124 ±65ml, respectively. Fifty-five patients had
CTA+CC within 24 hours, 66 patients had CTA+CC within 48 hours, and 55 patients underwent CTA+CC greater than 48 hours
apart. Pre and post-imaging Scr were compared with paired student t-tests. CIN was defined as an increase in 20% of Scr.
RESULTS
The average age was 79 ± 9years, 112 were Caucasian, 79 were male, and 52 had diabetes (DMII). Sixty-nine patients underwent
TAVR and 16 underwent surgical AVR. Scr increased on average 0.057 (4.9%, p=0.053), 0.054 (4.3%, p=0.039) and 0.079 (6.6%,
p=0.068) for patient groups who had CTA+CC within 24 hours, within 48 hours and greater than 48 hours, respectively. CIN
developed in 12.7%, 11.9% and 12.5% of patients who had CTA+CC within 24 hours, 48 hours and greater than 48 hours,
respectively. Patients with pre-existing chronic kidney disease had an increase in Scr of 0.0755 (5.1%. p=0.041) and a CIN rate
12.5% when CTA+CC were within 48 hours. Patients with DMII had an increase in Scr of 0.145 (9.76%, p=0.002) and increased
rate of CIN at 20.7% when CTA+CC were within 48 hours. No patients required dialysis.
CONCLUSION
Work up for TAVR includes significant contrast loads with accompanying risks for CIN. There was a degree of CIN in all groups;
however, patients with DMII are the most susceptible when contrast loads occur less than 48 hours apart.
CLINICAL RELEVANCE/APPLICATION
Incidence of CIN for all patient cohorts ranged from 11.9% to 12.5%. Patients with DMII are most susceptible to develop CIN when
undergoing TAVR evaluation.
SSE03-04
Prediction of Transcatheter Aortic Valve Replacement (TAVR) Paravalvular Leak Diagnosed on Post-
procedure Transthoracic Echo (TTE) with Pre-procedure 3D Printed Models: A Proof of Concept
Study
Monday, Nov. 30 3:30PM - 3:40PM Location: S502AB
Participants
Beth A. Ripley, MD, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Tatiana Kelil, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael Cheezum, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Alexandra Goncalves, MD,PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael L. Steigner, MD, Boston, MA (Abstract Co-Author) Speaker, Toshiba Corporation
Dimitris Mitsouras, PhD, Boston, MA (Presenter) Research Grant, Toshiba Corporation; Speakers Bureau, Toshiba Corporation
Amir Imanzadeh, MD, Cambridge, MA (Abstract Co-Author) Nothing to Disclose
Tianrun Cai, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Abstract Co-Author) Research Grant, Toshiba Corporation;
Ron Blankstein, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Accurate sizing of TAVR prostheses is necessary to minimize post-procedural aortic regurgitation (PPAR or 'leak'), which is
associated with adverse outcomes. We hypothesized that 3D-printed models of the aortic valve (AV) complex derived from preTAVR cardiac CT (CCT) could be used to determine whether the implanted valve would have an appropriate fit and thus predict
which patients are more likely to develop PPAR.
METHOD AND MATERIALS
This retrospective study included 8 patients with pre-TAVR CCT and post-TAVR TTE who developed PPAR and 8 age, sex and valve
size-matched controls. The aortic root, annulus and left ventricular outflow tract were segmented from pre-TAVR CCT (Vitrea 6.7,
Vital Images) by a radiologist blinded to TTE findings and exported as 3D-printable (STL) files into CAD software (3matic,
Materialise) for post-processing. Aortic models were 3D-printed using flexible stereolithography material; valve models meeting
Sapien size specs (26 & 29mm) and a closed base were printed on a material extrusion 3D printer in hard plastic. The valve model
corresponding to the implanted valve was carefully positioned in each aortic model and the presence of leak was determined via
projection of light through the LVOT onto a thin film, captured with a digital camera. The presence of leak (defined as any
paravalvular light transmission) was made by consensus of 2 readers blinded to TTE results
RESULTS
Six out of 8 paravalvular leaks were accurately predicted and 6 out of 8 patients without leaks were correctly ruled out (2 false
negatives and false positives, respectively). The shape and location of light crescents predicting leaks matched PPAR location on
post-procedure TTE.
CONCLUSION
Use of pre-TAVR 3D-printing provides a unique assessment of the 3D relationship between the AV complex and implanted valves,
and may predict which patients are more likely to develop paravalvular leaks. This technology may assist in the development of
future generations of transcatheter valves, with potential to improve outcomes. Given these initial results, further studies focusing
on both clinical outcomes and 3D-printed model optimization are needed.
CLINICAL RELEVANCE/APPLICATION
Flexible 3D-printed models of the AV complex may allow for better TAVR patient selection, procedural planning, and valve size
selection. If verified in future studies, this technology has the potential to lead to better patient outcomes.
SSE03-05
The Prevalence and Clinical Impact of CTA Incidental Findings in TAVI Work-up
Monday, Nov. 30 3:40PM - 3:50PM Location: S502AB
Participants
Floortje van Kesteren, MD, Amsterdam, Netherlands (Presenter) Nothing to Disclose
Esther M. Wiegerinck, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Jaap Stoker, MD, PhD, Amsterdam, Netherlands (Abstract Co-Author) Research Consultant, Robarts Clinical Trials
Jan Baan JR, MD, PhD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
R. Nils Planken, MD,PhD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
PURPOSE
Computed Tomography Angiography (CTA) is used in the work-up for transcatheter aortic valve implantation (TAVI) to assess
cardiovascular anatomy, annulus size and to determine the optimal access route. However, in the elderly TAVI population, CTA
frequently reveals incidental findings that potentially change patient management and prognosis. We aim to determine the effect of
incidental findings on the clinical course of patients in TAVI work-up.
METHOD AND MATERIALS
Single center retrospective analysis including patients who underwent a CTA (64 slice scanner) in TAVI work-up between 2009 and
2014. Experienced radiologists reviewed all examinations prospectively. Incidental findings were classified as (1) clinical significant
findings limiting eligibility for TAVI due to poor prognosis or requiring immediate action, including additional diagnostic testing or
treatment, (2) findings requiring follow-up after TAVI and (3) findings without consequences.
RESULTS
A total of 623 patients were included, 354 (56.8%) were female. Mean age was 79.8 +/- 8.8 years. Clinical significant findings
limiting TAVI or requiring immediate action were reported in 57 patients (9.1%), including; suspected malignancy (n=40, 6.4%),
aortic aneurysm >5 cm (n=13, 2.1%), diverticulitis (n=2, 0.3%), cardiac thrombi (n=2, 0.3%) and suspected colitis (n=1, 0.2%).
Malignancy and diverticulitis were confirmed in 13 and 2 patients (32.5% and 100%), respectively. Findings requiring follow up after
TAVI were found in 78 patients (12.5%) including probably benign tumors (n=72, 11.6%) and aneurysms with follow up requirement
(n=7, 1.1%). Non-significant findings were reported in 581 patients (93.3%).Patients with clinical significant findings requiring
immediate action were more frequently rejected for TAVI than patients without those findings (n=12, 21.1% vs n=51, 9.0%;
p=.004). There was no significant delay between CTA and the TAVI procedure between the groups (median 43.0 [14.5-86.5] vs
29.0 [14.0-63.5] days; p=.105).
CONCLUSION
The prevalence of incidental findings is high in elderly TAVI patients. Incidental findings significantly influence patient management
due to an anticipation on poor prognosis and may lead to treatment delay.
CLINICAL RELEVANCE/APPLICATION
CTA prior to TAVI reveals incidental findings, leading to recurrent discussions in Heart Team meetings. Our results show that
incidental findings are frequent and may influence the clinical course.
SSE03-06
A Strategy of Underexpansion and Ad Hoc Post-dilation of Balloon-Expandable Transcatheter Aortic
Valves in Patients with Borderline Annular Dimensions: Favorable Midterm Outcomes
Monday, Nov. 30 3:50PM - 4:00PM Location: S502AB
Participants
Jonathon A. Leipsic, MD, Vancouver, BC (Presenter) Speakers Bureau, General Electric Company Speakers Bureau, Edwards
Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc
Philipp Blanke, MD, Vancouver, BC (Abstract Co-Author) Consultant, Edwards Lifesciences Corporation ; Consultant, Neovasc Inc
Chesnal Dey Arepalli, MD, Burnaby, BC (Abstract Co-Author) Nothing to Disclose
Christopher Naoum, MBBS, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
David Wood, MD, FRCPC, Vancouver, BC (Abstract Co-Author) Consultant, Edwards Lifesciences Corporation; Consultant, St. Jude
Medical, Inc; Consultant, Medtronic, Inc; Researcher, AstraZeneca PLC; Researcher, Edwards Lifesciences Corporation; Researcher,
Boston Scientic Corporation; Researcher, Medtronic, Inc;
John Webb, MD, FRCPC, Vancouver, BC (Abstract Co-Author) Consultant, Edwards Lifesciences Corporation
PURPOSE
To evaluate one year outcomes with a strategy of intentional underexpansion of balloon expandable transcatheter heart valves
(THVs) in terms of clinical outcomes, valve function, and frame durability at one year.
METHOD AND MATERIALS
We evaluated 47 patients at risk of annular injury who underwent TAVR with a deliberately underexpanded THV, followed by postdilation if required. Clinical evaluation, echocardiography and cardiac CT were obtained pre-TAVR, post-TAVR, and at one year.
RESULTS
Deployment of oversized THVs with modest underfilling of the deployment balloon (<10% by volume) was not associated with
significant annular injury. Paravalvular regurgitation was mild or less in 95.7% of patients, with post-dilation required in 10.7%. THV
hemodynamic function was excellent and remained stable at one year. CT documented stent frame circularity in 87.5%.
Underexpansion was greatest within the intra-annular THV inflow (stent frame area 85.8% of nominal). Progressive stent frame
recoil, deformation, or fracture were not observed at one year.
CONCLUSION
In carefully selected patients with a borderline annulus dimensions and in whom excessive oversizing is a concern, a strategy of
deliberate underexpansion, with ad hoc post-dilation if necessary, may reduce the risk of annular injury without compromising valve
performance.
CLINICAL RELEVANCE/APPLICATION
We present the first intermediate term clinical and imaging follow up data on intentionally underfilled balloon expandable TAVR.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Jonathon A. Leipsic, MD - 2015 Honored Educator
SSE04
Cardiac (Acute Chest Pain in the Emergency Department Patient)
Monday, Nov. 30 3:00PM - 4:00PM Location: S504AB
CA
ER
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Karen G. Ordovas, MD, San Francisco, CA (Moderator) Nothing to Disclose
Travis S. Henry, MD, San Francisco, CA (Moderator) Spouse, Medical Director, F. Hoffmann-La Roche Ltd
Karin E. Dill, MD, Evanston, IL (Moderator) Nothing to Disclose
Sub-Events
SSE04-01
Added Value of the Triple-Rule-Out Study versus Dedicated Coronary CTA for the Evaluation of Chest
Pain in the Emergency Department: Review of a 10-Year Experience
Monday, Nov. 30 3:00PM - 3:10PM Location: S504AB
Participants
Amelia Wnorowski, MD, Philadelphia, PA (Presenter) Nothing to Disclose
Ethan J. Halpern, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Triple-rule-out (TRO) CT examines the coronaries‚ aorta and pulmonary arteries in a single scan. Compared to coronary CTA (cCTA)‚
TRO CT includes anatomic structures above the carina and requires contrast opacification of both right and left sided circulations.
The purpose of this study is to determine the added value of TRO CT for evaluation of chest pain in the emergency department.
METHOD AND MATERIALS
All TRO studies performed at our institution from 2006 to 2015 were reviewed. Scans were performed on a 256 slice iCT (Philips
Medical Systems)‚ using ECG-gating and a biphasic injection with 60 mL of Optiray 350 followed by 60 mL of a 1:1 mixture of
contrast and saline. Scans extended from just above the aortic arch through the base of the heart. Reports were reviewed for
diagnoses that could explain chest pain and significant incidental findings.
RESULTS
There were 1196 total cases. Four were excluded for inadequate image quality. 651 patients (54.6%) were female. Average age
was 51 years. 81.4% of patients could be safely discharged without a significant coronary or non-coronary diagnosis. 139 patients
(11.7%) had significant coronary artery disease (50% stenosis or greater) while 106 patients (8.9%) had a non-coronary diagnosis
that could explain chest pain (p<0.02)‚ including pulmonary embolism (28 cases)‚ aortic aneurysm (24) and other aortic pathology
(10). 30 cases of pulmonary embolism and aortic pathology would not have been detected with cCTA because of unopacified right
sided circulation or limited z-axis coverage. Even if cCTA opacified both right and left sided circulations‚ 4 patients had segmental
upper lobe emboli alone‚ which would not have been included in the cCTA scan. 418 patients (35.1%) had a total of 528 incidental
findings not felt to explain chest pain.
CONCLUSION
Although TRO CT identified a greater number of coronary versus non-coronary diagnoses to explain chest pain‚ 8.9% of patients
had an unsuspected non-coronary explanation for chest pain‚ and 30/106 of these non-coronary diagnoses would have been missed
on dedicated cCTA. Thus‚ TRO CT adds value in the evaluation of acute chest pain‚ particularly in the identification of significant
non-coronary diagnoses.
CLINICAL RELEVANCE/APPLICATION
TRO CT can identify non-coronary diagnoses in acute chest pain patients and is appropriate when there is suspicion for acute
coronary syndrome along with other diagnoses‚ such as pulmonary embolism.
SSE04-02
Incidence of ACS, MACE, and Positive ICA after Acute Chest Pain cCTA in Real World Clinical PracticeA Clinical Registry Comparison versus Published Trials
Monday, Nov. 30 3:10PM - 3:20PM Location: S504AB
Participants
Sumbal A. Janjua, MD, Boston, MA (Presenter) Nothing to Disclose
Pedro V. Staziaki, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Harshna V. Vadvala, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Sean B. Singer, Boston, MA (Abstract Co-Author) Nothing to Disclose
Phillip Kim, Cambridge, MA (Abstract Co-Author) Nothing to Disclose
Tomas Neilan, MD, Boston, MA (Abstract Co-Author) Consultant, GlaxoSmithKline plc
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Brian B. Ghoshhajra, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Multiple randomized controlled trials have established the safety and efficacy of coronary CT angiography (cCTA) in evaluating lowto intermediate risk emergency department (ED) patients with acute chest pain. However, concerns have been raised that results
may vary outside the confines of a trial setting. We report our initial clinical experience at a large-volume tertiary center, and
compare the results to published trials.
METHOD AND MATERIALS
We included all consecutive ED patients presenting with acute chest pain undergoing cCTA between October 2012 and July 2014.
Medical records were reviewed and adjudicated for acute coronary syndrome (ACS) during index hospitalization and for major
adverse cardiac events (MACE) at up to 60 days after discharge. ACS was defined as myocardial infarction (MI) and unstable
angina pectoris requiring hospitalization (UAP) while MACE included MI, UAP and urgent coronary revascularization. We also
determined the positive predictive value (PPV) of cCTA (defined as the rates of invasive coronary angiography (ICA) confirming
>50% luminal narrowing). Results were compared with the published results of the ROMICAT II, ACRIN-PA and CT-STAT trials.
RESULTS
399 patients with a mean age of 51+/-11 years were included. The rate of ACS was 9.5% (n: 38/399), the rate of MI: 1% (n:
4/399) and UAP: 8.5(34/399). The rates of ACS were comparable to other published randomized trials. The rate of ICA was 6.2%
(n: 25/399) with 92% (n: 23/25) of ICA confirming stenosis >50% by cCTA ( PPVof cCTA ) as compared to a PPV of 76.9% in CTSTAT, 76% in ACRIN PA and 78% in ROMICAT II. There were no undetected ACS and 60-day MACE rate after negative cCTA was
0%, with 0.25% MACE overall (n: 1/399; in a patient with severe stenosis managed medically), in keeping with other published
trials.
CONCLUSION
Our unrestricted clinical registry confirmed similar rates of ACS and MACE to large randomized published trials. There were no
undetected ACS nor MACE after negative cCTA. The positive predictive value of cCTA for ICA stenosis >50% was 92%, slightly
higher than published randomized trials.
CLINICAL RELEVANCE/APPLICATION
An ED cCTA clinical registry confirms similar rates of ACS and MACE compared to large published trials, reinforcing the effectiveness
of cCTA in an acute chest pain population.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
SSE04-03
Radiation Exposure of Acute Chest Pain Coronary CTA at a Tertiary Center Versus Recently Published
Studies
Monday, Nov. 30 3:20PM - 3:30PM Location: S504AB
Participants
Pedro V. Staziaki, MD, Boston, MA (Presenter) Nothing to Disclose
Harshna V. Vadvala, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Sean B. Singer, Boston, MA (Abstract Co-Author) Nothing to Disclose
Andy K. Chan, MD, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Jonathan A. Scheske, MD, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Nandini M. Meyersohn, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Brian B. Ghoshhajra, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Coronary CT angiography (CCTA) accurately stratifies patients with acute chest pain into low or increased risk of infarction,
allowing rapid disposition from the emergency department (ED). We report the radiation doses of emergency department (ED)
CCTAs in a tertiary center and compare them with recent studies.
METHOD AND MATERIALS
We included all consecutive ED patients with acute chest pain that presented for CCTA between October 2012 and January 2015.
We compared the mean estimated effective doses of our registry patients versus the published MonashHEART, San Antonio Military
Medical Center, ROMICAT II, and CT-STAT studies.
RESULTS
Our registry comprised 629 patients. Prospective ECG-triggering utilized in 91% of cases; median tube potential was 100 kV (80-120
interquartile range); mean estimated effective dose was 4.5 ± 2.9 mSv; and median estimated effective dose was 3.7 (2.4-5.7)
mSv. MonhashHEART reported 585 patients with a mean estimated effective dose of 6.4 ± 2.8 mSv. San Antonio study reported
median 6.7 (4.9-9.1) mSv. ROMICAT II reported 473 CCTA patients with a mean cumulative dose for all patients of 11.3 ± 5.3 mSv,
whereas in the subset of 78 patients who underwent 128-slice dual source CCTA (identical to our site's equipment) dose was 6.2 ±
3.8 mSv. CT-STAT reported 361 patients, with a median cumulative estimated effective dose of 11.5 (6.8-16.8) mSv.
CONCLUSION
Radiation exposure at CCTA can be decreased in ED patients versus larger trials, with our site noting a median effective dose of 3.7
(2.4-5.7) mSv. This was likely due to increased use of prospective ECG-triggering and tube potential lowering.
CLINICAL RELEVANCE/APPLICATION
CCTA is reliable to assess coronary disease in the setting of acute chest pain. Efforts are made to decrease radiation exposure,
including prospective ECG-triggering and tube potential lowering.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
SSE04-04
Discharge Times of Emergency Department Patients Evaluated with Coronary CT Angiography: Effect
of Observation Unit Utilization and Hours of Scan Availability
Monday, Nov. 30 3:30PM - 3:40PM Location: S504AB
Participants
Nandini M. Meyersohn, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Pedro V. Staziaki, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Harshna V. Vadvala, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Thomas Mayrhofer, Boston, MA (Abstract Co-Author) Nothing to Disclose
John T Nagurney, Boston, MA (Abstract Co-Author) Nothing to Disclose
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Brian B. Ghoshhajra, MD, Boston, MA (Presenter) Nothing to Disclose
PURPOSE
Recent trials have established that the use of coronary CT angiography (CCTA) to evaluate low- to intermediate risk emergency
department (ED) patients with acute chest pain leads to shorter discharge times for those without significant coronary artery
disease (CAD). Emergency departments are increasingly utilizing observation units (EDOUs) to address issues of health care cost
and ED overcrowding. We evaluated the effect of hours of scan availability and utilization of an EDOU on disposition times of
patients without significant CAD.
METHOD AND MATERIALS
684 total ED patients were referred for CCTA between October 2012 and March 2015. 134 patients were excluded, 116 (17%) with
significant CAD (>50% luminal stenosis) and 18 (3%) admitted as inpatients. The remaining 550 patients without significant CAD
were subdivided into three groups. Group 1 included 301 patients scanned October 2012 - June 2014 with "banker's hours" of scan
availability from 8am-3pm non-holiday weekdays only on a hospital-based scanner. Group 2 included 57 patients scanned July 2014
- September 2014 with "extended hours" of availability from 8am-7pm weekdays and 8am-12pm weekends and holidays on a
hospital-based scanner. Group 3 included 192 patients scanned September 2014 - March 2015 with "extended hours" but on a
scanner newly located physically in the ED. EDOU utilization and time from triage to discharge was compared.
RESULTS
281 patients (51%) were discharged directly from the ED and 269 (49%) via an EDOU. Statistical analysis was made using Wilcoxon
rank sum test and reported as median values with interquartile range (Figure 1). Time to discharge did not increase significantly in
either group with increased hours of scan availability. Discharge times for patients treated in an emergency department observation
unit were significantly longer than those treated in the emergency department only.
CONCLUSION
Regardless of hours of scan availability or physical location of scanner, nearly all ED patients without significant CAD evaluated with
CCTA were discharged within 24 hours of triage. Utilization of an ED observation unit, however, significantly increased time to
discharge.
CLINICAL RELEVANCE/APPLICATION
Nearly all ED patients without significant CAD evaluated with CCTA are discharged within 24 hours of triage, although utilization of
an ED observation unit significantly increases time to discharge.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
SSE04-05
A System Dynamics Model Analysis to Assess the Impact of CCTA for Chest Pain Patients on Overall
ED Performance
Monday, Nov. 30 3:40PM - 3:50PM Location: S504AB
Participants
Alexander Goehler, MD,PhD, New Haven, CT (Presenter) Nothing to Disclose
Steffen Huber, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Felix T. Nautsch, MS, BA, New Haven, CT (Abstract Co-Author) Nothing to Disclose
John T Nagurney, Boston, MA (Abstract Co-Author) Nothing to Disclose
G. Scott Gazelle, MD, PhD, Boston, MA (Abstract Co-Author) Consultant, General Electric Company Consultant, Marval Biosciences
Inc
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Hannah J Wong, Toronto, ON (Abstract Co-Author) Nothing to Disclose
PURPOSE
Coronary computed tomographic angiography (CCTA) improves triage efficiency of patients with acute chest pain; however its
impact on the Emergency Department (ED) performance for non-cardiac patients is unknown.
METHOD AND MATERIALS
We reviewed two consecutive years of ED visits at our tertiary care hospital to identify chest pain visits with chest pain suspicious
for ACS but without known CAD who were suitable for CCTA. To determine the impact of CCTA on the ED, we identified our
comparator group to be all non-cardiac patients who were placed in observation status. We developed a System Dynamics model to
simulate patient flow through the ED, incorporating patient's characteristics, imaging use, and daily/hourly trends in ED visit
volumes. The model considered two strategies (1) Standard of care as observed at our institution and (2) CCTA triage after 1st
negative Troponin and discharge of patients without CAD on CCTA. Different CCTA availabilities were considered.
RESULTS
:Among 9,400 patients who received serial troponin measurements to assess chest pain in the ED, we identified 3,594 visits (38%)
eligible for CCTA (age: 56±15 years, 52% male), accounting for 24% of all observation admissions. 3% of the patients were
ultimately diagnosed with ACS. 52% of the patients with negative serial troponin had further CAD workup, among which 16% had
obstructive CAD. The comparator cohort included 8,848 ED visits (age: 55±19 years, 47% male). 23% required cross-sectional CT
imaging including head (37%), abdominal/pelvis (21%), and CTA-PE (8%). The model predicted well the length of stay (LOS) (model
vs. observed in hours) for the current standard of care (target: 21 vs. 19, comparator: 22 vs. 25). The LOS was reduced to 14.8
hours (29%) when CCTA was available 24/7 and 10.8 (48%) when it was available M-F 7AM-4PM. At the same time, observation
unit capacity for non-cardiac patients was increased by 7% and 11%, respectively
CONCLUSION
About one third of all ED visit for chest pain could benefit from a CCTA work up. This would not only reduce the length of stay for
cardiac patients but also increase capacity for non-cardiac patients, improving overall ED performance.
CLINICAL RELEVANCE/APPLICATION
To our knowledge, this is the first study to assess CCTA in the broader ED context beyond the impact on cardiac patients.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
SSE04-06
Culprit Lesions of Acute Coronary Syndrome are Characterized by the Presence of Stenosis and Highrisk Plaque, But Not Higher Segmental Coronary Artery Calcium Score: Results from the ROMICAT II
Trial
Monday, Nov. 30 3:50PM - 4:00PM Location: S504AB
Participants
Stefan Puchner, MD, Boston, MA (Presenter) Nothing to Disclose
Thomas Mayrhofer, Boston, MA (Abstract Co-Author) Nothing to Disclose
Jakob Park, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael T. Lu, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Pal Maurovich-Horvat, MD,PhD, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Khristine Ghemigian, BA, Boston, MA (Abstract Co-Author) Nothing to Disclose
Jerome Fleg, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Maros Ferencik, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
The amount of coronary artery calcium (CAC) predicts cardiovascular events and correlates with plaque burden. However, CAC may
represent advanced stage of atherosclerosis and is not directly related to high-risk plaque. We determined the association of
stenosis, high-risk plaque and segmental CAC score with culprit lesions of ACS.
METHOD AND MATERIALS
We studied 501 patients with acute chest pain from the coronary CT angiography (CCTA) arm of the ROMICAT II trial. CCTA was
assessed for the presence of >=50% stenosis and high-risk plaque (positive remodeling, low HU plaque, napkin-ring sign, spotty
calcium) in all 17 coronary segments. Total and segmental CAC Agatston score was measured on non-contrast CT scans. Culprit
lesions were determined in subjects with ACS by the review of available records.
RESULTS
Subjects with ACS (n=37) had higher prevalence of >=50% stenosis (78% vs. 7%, p<0.001) and high-risk plaque (95% vs. 59%,
p<0.001), and higher total CAC score [median 229, 25th-75th percentile 75-517 vs. 27, 25th-75th percentile 0-99]. High-risk
plaques were more frequent in segments with lower segmental CAC score (Figure, p<0.001). In subjects with ACS, culprit (n=41)
vs. non-culprit (n=200) plaques had higher prevalence of >=50% stenosis (81% vs. 11%, p<0.001) and high-risk plaque (76% vs.
51%, p=0.005), but not higher segmental CAC score (median 22, 25th-75th percentile 4-71 vs. 14, 25th-75th percentile 0-51;
p=0.37). In multivariable multilevel mixed-effects logistic regression, >=50% stenosis (OR 40.2, 95%CI 15.6-103.9, p<0.001) and
high-risk plaque (OR 3.4, 95%CI 1.3-9.1, p=0.02), but not segmental CAC score (OR 1.0, 95%CI 1.0-1.0, p=0.47) were associated
with culprit lesions of ACS.
CONCLUSION
Prevalence of high-risk plaque is inversely related to segment amount of CAC. Culprit lesions of ACS are characterized by >=50%
stenosis and high-risk plaque, but not by higher segmental CAC. These findings suggest that local advanced calcification may
represent more stable stage of atherosclerosis, while the culprit lesions are characterized by smaller amounts of CAC.
CLINICAL RELEVANCE/APPLICATION
High calcium score indicates a higher risk for acute coronary syndrome, however the culprit lesions are characterized by smaller
amounts of coronary artery calcium.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
MSMC24
Cardiac CT Mentored Case Review: Part IV (In Conjunction with the North American Society for Cardiac
Imaging) (An Interactive Session)
Monday, Nov. 30 3:30PM - 5:30PM Location: S406A
CA
VA
CT
AMA PRA Category 1 Credits ™: 2.00
ARRT Category A+ Credits: 2.00
Participants
Pamela K. Woodard, MD, Saint Louis, MO (Director) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
David A. Bluemke, MD, PhD, Bethesda, MD (Moderator) Research support, Siemens AG
Vincent B. Ho, MD, MBA, Bethesda, MD (Moderator) In-kind support, General Electric Company
LEARNING OBJECTIVES
1) To understand the clinical indications for retrospective ECG gated cardiac CT. 2) To illustrate methods to assess myocardial
function from cine cardiac CT images. 3) To illustrate methods to assess normal and abnormal valvular function from cine cardiac
CT images.
ABSTRACT
The mentored case review provides the opportunity for the attendees to learn the image acquistion, post-processing, and diagnosis
for a wide variety of cardiac diseases commonly encountered in CT.
Sub-Events
MSMC24A
Coronary Artery Disease and Incidental Noncardiac Findings
Participants
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Presenter) Research Grant, Toshiba Corporation;
LEARNING OBJECTIVES
1) To review coronary CTA principles, including details related to image acquisition. 2) Demonstrate examples of CAD as depicted by
CT. 3) Discuss strategies to assess the hemodynamic significance of individual coronary lesions. 4) Illustrate non-cardiac findings
on coronary CTA images.
ABSTRACT
CT Angiography (CTA) is a guideline endorsed strategy to assess symptomatic patients with low to intermediate risk of coronary
artery disease in both the non-emergent and emergent settings. Coronary CTA uses ECG gating to freeze cardiac motion and
enables assessment of the lumen for stenosis. Coronary CTA has a high negative predictive value, but suffers when a lesion is
detected with a moderate stenosis. Emerging CT methods are also exploring the role of CT to assess individual lesions, including
ones that have been problematic, for hemodynamic significance. The clinical relevance relates to the fact that only lesions that are
hemodynamically significant should undergo intervention, for example with balloon angioplasty and stenting. In addition, each
coronary CTA should include images reconstructed "skin to skin" over the entire craniocaudal field of view that encompasses the
heart. Thus, incidental lesions can and should be reported for all coronary CTA studies.
MSMC24B
Congenital Heart Disease
Participants
Dianna M. Bardo, MD, Seattle, WA (Presenter) Speaker, Koninklijke Philips NV; Consultant, Koninklijke Philips NV; Author, Thieme
Medical Publishers, Inc
LEARNING OBJECTIVES
1) Recognize the most common congenital heart disease (CHD) findings found in adults with unsuspected CHD. 2) Recognize and
understand findings of CHD in patients with known CHD and the findings which may trigger surgical intervention. 3) Recognize the
CT findings of commonly performed surgical procedures for palliation of CHD. 4) Develop an organized pattern for search and
reporting of CHD findings. 5) Understand why CT is chosen as the advanced imaging modality over MR.
ABSTRACT
Adults with congenital heart disease (CHD) now outnumber children with CHD two to one. This phenomenon is due to the success
of surgical palliation and medical management of patients with even the most severe forms of CHD. Surgical intervention is often
performed at the time of diagnosis and in patients with residual hemodynamic lesions is often required throughout life. Though
echocardiography is typically the initial imaging modality of choice, diagnosis and imaging surveillance of complex hemodynamic and
anatomic CHD lesions is now most often accomplished with CT and MR. CT and CTA imaging techniques may be used to show
detailed anatomic and functional images of the heart, postoperative changes and long term consequences of CHD.An organized,
reproducible approach to identify cardiac anatomy of CHD lesions and surgical palliation should be adopted in order to accurately
and thoroughly describe findings.
Active Handout:Dianna M. Ehrhart Bardo
http://abstract.rsna.org/uploads/2015/9001152/MSMC24B.pdf
MSMC24C
Coronary Atherosclerosis and Bypass Grafts
Participants
Gautham P. Reddy, MD, Seattle, WA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify focal areas of stenosis in the coronary arteries on CT. 2) Describe the appearance of bypass graft stenosis on coronary
CT. 3) Review the diagnosis of aneurysms in the native coronary arteries and in bypass grafts.
ABSTRACT
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Gautham P. Reddy, MD - 2014 Honored Educator
MSMI24
Molecular Imaging Symposium: Case-based MI
Monday, Nov. 30 3:30PM - 5:00PM Location: S405AB
CA
NR
VA
MI
RO
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Vikas Kundra, MD, PhD, Houston, TX (Moderator) License agreement, Introgen Therapeutics, Inc
Jeffrey T. Yap, PhD, Salt Lake City, UT (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) ldentify molecular imaging. 2) Comprehend the basis of aspects of molecular imaging. 3) Describe molecular imaging performed in
a radiology setting.
ABSTRACT
This course will describe molecular imaging, identify the mechanisms of some aspects of molecular imaging, and give examples of
molecular imaging in oncology. Cases will include those from current practice. Mechanisms and scientific basis of examples will be
discussed. Sample applications will be discussed and illustrated. Translational examples, including those that have good potential for
clinical application, will be used to illustrate interesting aspects of molecular imaging in oncology.
Sub-Events
MSMI24A
Oncology
Participants
Vikas Kundra, MD, PhD, Houston, TX (Presenter) License agreement, Introgen Therapeutics, Inc
LEARNING OBJECTIVES
View learning objectives under main course title.
MSMI24B
Neurology
Participants
Rathan M. Subramaniam, MD, PhD, Baltimore, MD, (rsubram4@jhmi.edu) (Presenter) Travel support, Koninklijke Philips NV
LEARNING OBJECTIVES
View learning objectives under main course title.
MSMI24C
Cardiology
Participants
Robert J. Gropler, MD, Saint Louis, MO (Presenter) Advisory Board, Bracco Group Advisory Board, GlaxoSmithKline plc Advisory
Board, Pfizer Inc Advisory Board, Bayer AG Research Grant, GlaxoSmithKline plc Research Grant, Pfizer Inc Research Grant, Clinical
Data, Inc Research Grant, Lantheus Medical Imaging, Inc
LEARNING OBJECTIVES
View learning objectives under main course title.
MSMI24D
Vascular Inflammation
Participants
Chun Yuan, PhD, Seattle, WA (Presenter) Research Grant, Koninklijke Philips NV; Consultant, Koninklijke Philips NV; ;
LEARNING OBJECTIVES
View learning objectives under main course title.
MSMI24E
Instrumentation
Participants
Jeffrey T. Yap, PhD, Salt Lake City, UT (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
View learning objectives under main course title.
ED002-TU
Cardiac Tuesday Case of the Day
Tuesday, Dec. 1 7:00AM - 11:59PM Location: Case of Day, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Rahul N. Sawlani, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Presenter) Nothing to Disclose
TEACHING POINTS
1) Identify pertinent findings and generate differential diagnosis for cardiac imaging studies. 2) Develop differential diagnoses based
on the clinical information and imaging findings. 3) Recommend appropriate management for patients based on imaging findings.
SPDL30
RSNA Diagnosis Live™: 'Tic Tac D'Oh' - Test Your Diagnostic Skills at the Crack of Dawn
Tuesday, Dec. 1 7:15AM - 8:15AM Location: E451B
CA
GI
HN
MK
NR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Adam E. Flanders, MD, Penn Valley, PA (Presenter) Nothing to Disclose
Christopher G. Roth, MD, Philadelphia, PA (Presenter) Nothing to Disclose
Sandeep P. Deshmukh, MD, Philadelphia, PA, (sandeep.deshmukh@jefferson.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The participant will be introduced to a series of radiology case studies via an interactive team game approach designed to
encourage "active" consumption of educational content. 2) The participant will be able to use their mobile wireless device (tablet,
phone, laptop) to electronically respond to various imaging case challenges; participants will be able to monitor their individual and
team performance in real time. 3) The attendee will receive a personalized self-assessment report via email that will review the
case material presented during the session, along with individual and team performance. This interactive session will use RSNA
Diagnosis Live™. Please bring your charged mobile wireless device (phone, tablet or laptop) to participate.
RC303
Cardiac Series: Imaging of Coronary Artery Disease
Tuesday, Dec. 1 8:30AM - 12:00PM Location: S405AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 3.25
ARRT Category A+ Credits: 4.00
FDA
Discussions may include off-label uses.
Participants
Arthur E. Stillman, MD, PhD, Atlanta, GA (Moderator) Nothing to Disclose
Robert M. Steiner, MD, Philadelphia, PA (Moderator) Consultant, Educational Symposia; Consultant, Johnson & Johnson
Suhny Abbara, MD, Dallas, TX (Moderator) Author, Reed Elsevier; Editor, Reed Elsevier; Institutional research agreement, Koninklijke
Philips NV; Institutional research agreement, Siemens AG
Sub-Events
RC303-01
MRI of Coronary Ischemia (Coronary MRA, Stress Perfusion)
Tuesday, Dec. 1 8:30AM - 9:10AM Location: S405AB
Participants
David A. Bluemke, MD, PhD, Bethesda, MD (Presenter) Research support, Siemens AG
LEARNING OBJECTIVES
1) Describe the role of CMR for evaluation of myocardial perfusion. 2) Describe the results of CMR for evaluation of myocardial
ischemia. 3) Indicate potential uses and methods for coronary artery evaluation by CMR.
ABSTRACT
Cardiac MRI (CMR) is an established modality for evaluation of ischemic myocardial disease; appropriateness criteria increasingly
recognize the role of CMR in this role. CMR has outstanding temporal resolution allowing for accurate representation of myocardial
volumes and function. Excellent soft issue contrast for myocardial ischemia evaluation is achieved with the use of a gadolinium
contrast agent. Stress perfusion CMR during adenosine infusion compares favorably to nuclear medicine methods but can
additionally assess volumes and mass very accurately. Stress CMR is used in combination with late gadolinium enhancement (LGE)
techniques to depict viable myocardium to improve the specificity of the method. Coronary artery imaging with CMR is best
performed at 1.5 T and is useful to assess for anomalous coronary artery imaging and confirm perfusion results. This session will
describe the techniques, indications, results and interpretation of CMR for evaluation of ischemic disease of the myocardium.
Active Handout:David A. Bluemke
http://abstract.rsna.org/uploads/2015/15003318/RC303-01 Bluemke RSNA coronary and stress CMR.pdf
RC303-02
Evaluation of Obstructive Coronary Artery Disease in Patients with Agatston Score More than 500:
Comparison of Computed Tomographic Angiography and Magnetic Resonance Angiography
Tuesday, Dec. 1 9:10AM - 9:20AM Location: S405AB
Participants
Makoto Amanuma, MD, Takasaki, Japan (Presenter) Nothing to Disclose
Takeshi Kondo, Takasaki, Japan (Abstract Co-Author) Nothing to Disclose
Hideyuki Matsutani, Takasaki, Japan (Abstract Co-Author) Nothing to Disclose
Takako Sekine, Takasaki, Japan (Abstract Co-Author) Nothing to Disclose
Tomoko Miyata, Saitama, Japan (Abstract Co-Author) Employee, Toshiba Corporation
Shigehide Kuhara, MS, Otawara, Japan (Abstract Co-Author) Nothing to Disclose
Shinichi Takase, Takasaki, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
One of the limitations of coronary computed tomographic angiography (CCTA) is poor diagnostic accuracy for segments with severe
calcification. On the other hand, the effect of calcification is considered limited on coronary magnetic resonance angiography
(CMRA). The purpose of this study was to compare clinical feasibility of CCTA and CMRA for evaluation of obstructive coronary
artery disease in patients with severe calcification.
METHOD AND MATERIALS
Written informed consent was obtained from all patients. In 29 patients(72±12 years,M:F=21:8)with high grade calcification
(Agatston score>500) CCTA and CMRA findings were compared with the ICA findings as a reference standard. A 320-row area
detector CT system (Aquilion ONE/ViSION Edition, Toshiba) was used for CCTA and a 1.5T MR unit (Vantage Titan, Toshiba) was
used to obtain CMRA. For CCTA prospective one or two-beat scanning targeted at mid diastole was performed with the cardiac
phase for scanning set to R-R 75%. For CMRA non-contrast 3D steady-state gradient echo technique with ECG gating and
respiratory navigation technique was used. The coronary arteries were divided to 7 proximal segments (#1-#3, #5-#7, #11) based
on the AHA classification and evaluated. Luminal stenosis (>50%) was judged both on CCTA and CMRA by consensus of two
experienced readers with the ICA findings as a reference standard.
RESULTS
The mean Agatston score of the 29 patients was 1763 (SD: 1092, Range: 502-4674, median: 1348). With non-assessable segments
considered to be stenotic, the diagnostic accuracy of CCTA and CMRA was 76.6% and 83.6% on a per-segment basis. When nonassessable segments were considered to be an incorrect diagnosis, the diagnostic accuracy of CCTA and CMRA was 72.1% and
82.6%, showing no statistically significant difference. When evaluation was limited to the segments with severe calcification
involving 50% or more of the vessel wall, accurately assessable segment was 49.1% on CCTA and 78.4% on CMRA, showing a
statistically significant difference (p=0.0001).
CONCLUSION
CMRA provides a higher diagnostic accuracy than does CCTA in patients with severe calcification.
CLINICAL RELEVANCE/APPLICATION
Coronary MRA provides a high diagnostic accuracy and recommended for evaluation of obstructive coronary arterial disease in
patients with severe calcification.
RC303-03
Rosuvastatin Effect on Coronary Atherosclerosis Plaques Evaluated by 64-detector CT in Patients
with Stable Coronary Heart Disease and Hyperlipidemia
Tuesday, Dec. 1 9:20AM - 9:30AM Location: S405AB
Participants
Jian-Xing Qiu, MD, Beijing, China (Presenter) Nothing to Disclose
Xiaoying Wang, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Xiaochao Guo, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the coronary atherosclerosis plaque changes by 64-detector CT on the follow-up examination of the patients, who
treated by rosuvastain, with stable coronary heart disease and hyperlipidemia.
METHOD AND MATERIALS
The study included 30 patients, (27 males and 3 females), with stable coronary heart disease (stable angina for more than one
month) and hyperlipidemia (LDL-C≥130 mg/dl without treatment, LDL-C≥100 mg/dl with treatment). Every patient underwent 64detector CT coronary angiography twice before and after 76 weeks treatment with Rosuvastatin 20 mg q.d. The initial CT
angiography at least detected one or more soft plaques with lumen stenosis ≥25%. We detected 35 target plaques totally. The
volume of target plaques, the maximum sectional area(MASA) of plaques, the mean CT value(MCTV),the stenosis degree caused by
the target plaques were measured on the initial and the follow-up CT examinations using the semi-automatic atherosclerosis plaque
analysis software. The paired-samples t test was used to analyze the measurements in SPSS 10.0.
RESULTS
After Resuvastatin treatment for 76 weeks, the volume of target plaques decreased significantly from 53.8±38.9 mm³ to 41.5±27.4
mm³(p=0.011)after Rosuvastatin treatment, the MASA of target plaques decreased from 7.56±3.86 mm² to 6.11±2.81 mm²
(p=0.038). the MCTV of target plaques had nonsignificant decrease from 66.42±28.62 Hu to 60.99±39.18 Hu (p=0.687), the
stenosis degree caused by the target plaques decreased significantly from 55% to 46%.
CONCLUSION
The measurement change of target plaques demonstrated by 64-detector CT coronary angiography for the patients with stable
coronary heart disease and hyperlipidemia include a decrease of the plaque volume, the maximum sectional area, and the stenosis
degree.
CLINICAL RELEVANCE/APPLICATION
The 64-detector CT coronary angiography could analyze the effect of Statin for coronary atherosclerosis plaque.
RC303-04
Late Gadolinium Enhancement
Tuesday, Dec. 1 9:30AM - 10:10AM Location: S405AB
Participants
Scott D. Flamm, MD, Cleveland, OH, (flamms@ccf.org) (Presenter) Medical Director, Precision Image Analysis, Inc; Board of
Directors, Precision Image Analysis, Inc;
ABSTRACT
Learning Objectives:1. Understand the distinct advantages of late gadolinium enhancement imaging by cardiac MRI.2. Articulate the
mechanisms responsible for the increased signal intensity in irreversibly damaged myocardium. 3. Recognize the clinical situations
appropriate for cardiac MRI late gadolinium enhancement imaging. Abstract:CMR has the unique ability to evaluate several markers
of myocardial viability that are of proven value. Reliable and accurate assessment of myocardial scar burden, coronary perfusion,
and contractile reserve by CMR are all well established.Direct imaging of myocardial fibrosis has been possible for well over a decade
using an inversion-recovery prepared T1-weighted sequence following the intravenous administration of a gadolinium-chelate (Gd).
This CMR technique has been named "late gadolinium enhancement" (LGE) and demonstrates non-viable tissue as "hyperenhanced"
or bright. Both interstitial and replacement fibrosis enhance similarly with LGE for reasons described below. The hyperenhancement
of interstitial fibrosis is more commonly seen in infiltrative entities such as hypertrophic cardiomyopathy and amyloidosis, where the
issue of viability is less prominent.The excellent spatial resolution and tissue characterization afforded by CMR makes it ideal for
both: 1) quantification of significant areas of viable myocardium, and 2) defining discrete regions of non-viability. Accurate
quantification of areas of scar and viable tissue is clearly important in predicting mortality as the benefits of revascularization rise
steeply when the area of dysfunctional but viable myocardium reaches a critical size. Further, characterization of non-ischemic
patterns of LGE allows differentiation of the breadth of non-ischemic cardiomyopathies, and quantification may similarly provide
prognostic information.This presentation will review the LGE technique in its various forms, define evaluation of both ischemic and
non-ischemic cardiomyopathies, and address where LGE fits within the diagnostic and prognostic pathways in patients with
cardiovascular diseases.
RC303-05
Coronary CT Angiography and Perfusion/Scar Imaging
Tuesday, Dec. 1 10:20AM - 11:00AM Location: S405AB
Participants
U. Joseph Schoepf, MD, Charleston, SC, (schoepf@musc.edu) (Presenter) Research Grant, Bracco Group; Research Grant, Bayer
AG; Research Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
LEARNING OBJECTIVES
1) Identify suitable CT techniques for the comprehensive assessment of ischemic heart disease. 2) Discuss different CT approaches
for evaluating myocardial perfusion. 3) Compare CT to other modalities for determining the hemodynamic significance of coronary
artery stenosis.
ABSTRACT
Appropriate non-invasive evaluation of patients with suspected coronary artery disease (CAD) has traditionally rested on the two
pillars of morphological assessment for coronary artery stenosis and functional evaluation for determining the downstream
hemodynamic significance of lesions. This approach has been informed by the fundamental realization that morphological
assessment of coronary artery stenoses rarely reflects the actual level of myocardial ischemia. Further, patient evaluation,
prognostication, and management are more reliable and effective when functional and morphological assessments are used in
concert.Due to recent advancements in CT technology, coronary CTA (cCTA) has become an integral part of the non-invasive
diagnostic work-up for the anatomic evaluation of the coronary arteries of patients with suspected CAD. According to the current
appropriate use criteria, cCTA is the method of choice for the exclusion of significant coronary artery stenosis in patients with low
and intermediate CAD risk profiles. The diagnostic accuracy of cCTA has been demonstrated by its high sensitivity (96%) and
specificity (86%). Furthermore, cCTA can provide global and regional functional evaluation if acquired with an ECG-synchronization
technique. In addition to its role in assessing coronary morphology and left ventricular function, cCTA has been utilized in the
evaluation of a third aspect in the diagnostic algorithm of ischemic heart disease - myocardial perfusion. As cCTA may provide
diagnostic information for each of these three cornerstones of ischemic heart disease management, this emerging technology has
the potential to become the stand-alone method for the evaluation of patients with suspected CAD with a single modality, and
within a single imaging session.The purpose of this presentation is to review the growing body of evidence on the CT assessment of
myocardial perfusion and provide a systematic overview of presently available techniques.
RC303-06
Reduced-Dose Dual-Source Coronary Computed Tomography Angiography (CCTA): Is Raw-DataBased Iterative Reconstruction Able to Maintain the Diagnostic Confidence?
Tuesday, Dec. 1 11:00AM - 11:10AM Location: S405AB
Participants
Francois Pontana, MD, PhD, Lille, France (Abstract Co-Author) Nothing to Disclose
Isabel A. Castellano, PhD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Tevfik F. Ismail, PhD,MRCP, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Natalie Gartland, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Michael B. Rubens, MBBS, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Edward Nicol, MBBS, London, United Kingdom (Presenter) Nothing to Disclose
PURPOSE
To evaluate image quality and diagnostic confidence of a raw-data-based iterative reconstruction technique (SAFIRE) in reduceddose CCTA images in comparison with standard-dose filtered back projection (FBP) images.
METHOD AND MATERIALS
107 consecutive patients (72 males; 35 females), referred for a CCTA were prospectively included using a dual source CT system in
a high pitch (n=51) or a sequential prospective gating scanning mode (n=56) according to the heart rate (mean DLP value = 204.6
mGy.cm). From each acquisition 4 series of images were reconstructed: (a) standard-dose images, reconstructed with FBP
considered as the reference standard (Group 1) and (b) 3 series of reduced-dose images, obtained with a prototype software which
virtually increased the level of noise simulating a 30% dose reduction, and reconstructed with FBP (Group 2) and SAFIRE with a
preset strength of 3 (Group 3) and 5 (Group 4). Two readers blindly evaluated each series for (a) objective noise and CNR ; (b)
coronary border sharpness, lesion detection and (c) diagnostic confidence level using a 5-point scale.
RESULTS
In Group 2, there was a significant increase in the mean level of objective noise compared to Group 1 (36.8 ±6.7 vs 30.4 ±5.2;
p<0.0001) and an impairment of the CNR (15.6 ±4.3 vs 18.7 ±4.5; p<0.0001), which hampered the detection of 9 plaques. In Group
3 and 4, despite the 30% dose reduction, all the lesions depicted in Group 1 were seen and SAFIRE restored or improved the
objective image quality respectively: (a) mean noise= 31.1 ±5.4; p=0.1 and 22.3 ±4.2; p<0.0001, and (b) CNR= 18.5 ±5.0; p=0.9
and 25.8 ±7.0; p<0.0001. However the diagnostic confidence was altered when compared with Group 1 (p<0.0001), mainly rated as
moderate with a blurred aspect of the coronary borders (81/107; 75.7% and 103/107; 96.3%)(p<0.0001) and a significant number
of artefactual non stenosing soft plaques described in vessels considered as normal in Group 1 (105/222; 47.3% and 194/222;
87.4%)(p<0.0001).
CONCLUSION
Raw-data-based iterative reconstruction allowed significant image noise reduction but may be associated with blurring of the
coronary luminal borders, which can decrease diagnostic confidence.
CLINICAL RELEVANCE/APPLICATION
When reporting reduced-dose CCTA with iterative reconstruction, blurred-border and false smooth plaque artifacts must be
considered in diagnostic assessment and subsequent patient management.
RC303-07
Prognostic Value of CT Coronary Angiography in Asymptomatic Patients with Suspected Coronary
Artery Disease. Meta-Analysis of Observational Studies
Tuesday, Dec. 1 11:10AM - 11:20AM Location: S405AB
Participants
Michele Fusaro, MD, Treviso, Italy (Presenter) Nothing to Disclose
Salvatore Cassese, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Massimiliano Fusaro, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Giovanni Balestriero, Treviso, Italy (Abstract Co-Author) Nothing to Disclose
Leonardo E. La Torre, MD, TREVISO, Italy (Abstract Co-Author) Nothing to Disclose
Giovanni Morana, MD, Tresiso, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the prognostic value of CCTA as a screening tool in asymptomatic patients with suspected coronary artery disease
(CAD).
METHOD AND MATERIALS
A meta-analysis of observational coronary computed tomographic angiography (CCTA) imaging studies was conducted, by means of
search in electronic scientific databases for studies investigating the use of CCTA in asymptomatic patients with suspected CAD.
The endpoints were the incidence of acute coronary syndrome (ACS) requiring hospitalization, revascularization and cardiac death.
Exclusion criteria were composite outcomes and duplicated data. Odds ratio (OR) with 95% confidence interval [CI 95%] was used
as summary statistic.
RESULTS
A total of 7,931 asymptomatic patients from 6 studies received a CCTA for suspected CAD. The proportion of patients without CAD,
with CAD<50% and with CAD>50% was 78%, 14% and 8%, respectively.After a median follow-up of 27.1 months [22.0-31.2],
Patients without CAD did not show any of the endpoints. Compared to patients with CAD>50%, patients with CAD<50% showed a
similar risk of ACS (0.16 [0.02-1.50]; P=0.11) but a lower risk of revascularization (0.04 [0.02-0.10]; P<0.001) and death (0.05
[0.01-0.44]; P=0.007).
CONCLUSION
Two-third of asymptomatic patients receiving CCTA for suspected CAD had no evidence of disease and no events at follow-up. The
presence of CAD>50% significantly increases the risk of revascularization and death as compared to CAD<50%, although the
percentage is quite low. Nevertheless, patients with CAD>50% have a risk of ACS comparable to those with CAD<50%.
CLINICAL RELEVANCE/APPLICATION
In asimptomatic patients there is not evidence of the utility of CCTA as a screening tool.
RC303-08
The Role of Imaging for Management of Coronary Artery Disease - State of the Evidence
Tuesday, Dec. 1 11:20AM - 12:00PM Location: S405AB
Participants
Leslee Shaw, PhD, Atlanta, GA (Presenter) Nothing to Disclose
RC350
CTA from Head to Toe
Tuesday, Dec. 1 8:30AM - 10:00AM Location: S404AB
CA
CT
VA
IR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Alison Wilcox, MD, Los Angeles, CA (Moderator) Speaker, Toshiba Corporation
Sub-Events
RC350A
Cardiac CT- Pre, Peri and Post Procedural Management
Participants
Cameron Hassani, MD, Los Angeles, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Review pre-procedural patient preparation including appropriate patient selection, beta blockade, contraindications and
alternatives to beta blockers 2) Discuss how to manage non-standard scenarios (atrial fibrillation, pacemaker, young adults) 3)
Peri-procedural issues including vasodilation, continued heart rate control, and breathholding requirements. 4) Image acquisition
including radiation dose reduction techniques, technique choice, and post CABG patient. 5) Postprocedural complications include
contrast reactions and their management.
ABSTRACT
Cardiac CTA involve slightly more preparation than the standard CT acquisition. Heart rate control is the most important aspect
that needs to be addressed prior to the patient arriving in the radiology department. Periprocedural issues mostly involved how to
optimize technique while having the lowest radiation dose especially in the new age of dose reduction. Almost as important as heart
rate management is how to treat postprocedural complications especially contrast reactions. This presentation will discuss these
aspects and include treatment options as well as their alternatives.
RC350B
TEVAR/EVAR- Pre, Post and Periprocedural Evaluation
Participants
Alison Wilcox, MD, Los Angeles, CA (Presenter) Speaker, Toshiba Corporation
LEARNING OBJECTIVES
1) What are some clinical indications for acute aortic imaging. 2) What are some CT parameters that can aid in various diagnosis?
3) What are some of common complications seen in TEVAR and EVAR? 4) What are the important measurements and vessel variants
that help guide surgical approach. 5) New suggestions for type B management. 6) What are some imaging problems and pitfall and
some methods to assist. 7) Briefly discuss TAVR acquisition.
ABSTRACT
The acute aorta is part of a syndrome of diseases affecting the aorta with significant overlap of findings and clinical presentations.
Clinically the diagnosis is difficult as there is overlap between patients with suspected coronary disease, pulmonary embolism and
acute aortic syndrome. In the past several years, minimally invasive surgery with Thoracic Endovascular Aortic Repair (TEVAR) or
Endovascular Aortic Repair (EVAR) have become increasingly popular. The images choices include gated vs non gated studies, noncontrast imaging, and delayed imaging. The literature is mixed on how and when to use these modalities. The complications of
these procedures is often complex and subtle as well. Knowledge of these vascular complications is imperative for patient
management. In addition, these patients often have significant atherosclerotic disease elsewhere that might be limiting factors for
stent placement, including renal insufficiency. Newer scanners and imaging techniques can reduce radiation dose, and limit the
amount of contrast delivery to preserve renal function while preserving image quality. TAVR is an example of another minimally
invasive technique gaining popularity that has imaging challenges. Again, newer scanning techniques with limited contrast delivery
can provide excellent image quality while limiting radiation dose and preserving renal function.
RC350C
Peripheral CTA-A How-to
Participants
Ilya Lekht, MD, los angeles, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Enhance knowledge of normal and abnormal coronary and cardiac anatomy, with an emphasis on differentiating benign from
significant variants. 2) Demonstrate the spectrum of nonatherosclerotic congenital and acquired diseases that may affect the
coronary arteries. 3) Demonstrate the spectrum of non-atherosclerotic congenital and acquired diseases that may affect the heart.
ABSTRACT
A variety of non-atherosclerotic conditions are detectable on cardiac CT scans, including diseases of the heart, and disease
processes which may affect the coronary arteries, or other vascular structures. Cardiac CT has a number of unique advantages in
detecting non-atherosclerotic conditions, including congenital and acquired diseases. The focus of this presentation will be nonatherosclerotic conditions of the coronary arteries and of the heart. Variants of normal and abnormal anatomy of the coronary
arteries will be discussed, including tips for identifying when coronary anatomic variants are significant. Acquired, nonatherosclerotic diseases of the coronary arteries will also be discussed. This presentation will also discuss the spectrum of non-
atherosclerotic diseases of the heart which may be detected at cardiac CT, including congenital and acquired valvular and cardiac
diseases. At the end of this exhibit, the viewer will have a better appreciation for abnormal coronary and cardiac anatomy and the
broad spectrum of non-atherosclerotic cardiovascular diseases which may be seen at cardiac CT.
RCC32
Clinical Applications of 3D Printing
Tuesday, Dec. 1 10:30AM - 12:00PM Location: S501ABC
CA
NR
ED
IN
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Shi-Joon Yoo, MD, Toronto, ON (Moderator) Owner, 3D HOPE Medical; CEO, IMIB-CHD;
Vincent B. Ho, MD, MBA, Bethesda, MD (Moderator) In-kind support, General Electric Company
Sub-Events
RCC32A
Role of 3D Printing in Congenital Heart Disease
Participants
Shi-Joon Yoo, MD, Toronto, ON (Presenter) Owner, 3D HOPE Medical; CEO, IMIB-CHD;
LEARNING OBJECTIVES
1) Understand 3D printing process for heart models. 2) Know how 3D printing helps pediatric cardiac surgery, with case examples.
3) Know the future directions of 3D printing for cardiac surgery.
ABSTRACT
Using rapid prototyping or 3D printing, physical replicas of the hearts can be provided to surgeons before their surgical decision and
procedure. The replicas fill the gap between the imagination from the medical images and the reality. By having the replicas in
hands, the surgeons can make optimum surgical decision and simulate the intended procedures on the replica prior to the
procedure. This allows precise surgical procedures with reduced procedure and anasthesia time. In canses in the grey zone for
biventricular versus univentricular repair, the replicas are of tremendous help in a binary decision. The presentation will include a
few clincal cases where 3D printing played a crucial role in surgical decision making.
RCC32B
3D Surgical Planning Using Printed Models: The Surgeon's Perspective
Participants
Edward J. Caterson, MD, PhD, Boston, MA (Presenter) Nothing to Disclose
RCC32C
3D Surgical and Treatment Planning Using Printed Models
Participants
Frederik L. Giesel, MD, MBA, Heidelberg, Germany (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) History of 3D-Printing. 2) Imaging modalities and post-processing procedures to provide data surrogates for 3D-printing. 3)
Concept of 3D-printing for improved clinical services. 4) Limitations and challanges of 3D-printing in surgical planning.
ABSTRACT
This presentation outlines the impact of 3D-printing in the imaging environment. Applications in the medical field are reviewed and
growing clinical applications are discussed. Starting with an overview of current 3D-printing technologies including fused deposition
modelling (FDM), selective laser sintering (SLS), and stereolithography (SLA) common techniques for generating 3D object models
based on medical imaging are illustrated. Typically, imaging source data from different modalities are post-processed using
dedicated algorithms and software in order to generate triangle mesh surface data. These surface data are usually exported to
STL-files that are commonly understood by current 3D printing machines. 3D-printed objects are most often made from plastic,
such as ABS, PA, or PLA, but metal or other material is even possible. Finally the presentation will demonstrate how 3D-printed
objects are valuable for treatment planning, treatment procedures in several clinical subspecialties, intra-operative surgical
navigation, or for prosthesis production. However, medical applications of 3D-printing are still in a very early phase but the growing
awareness in the medical and non-medical field nowadays support the promising utilization and development in the very near future.
RCC32D
Validation of Coronary Contrast Gradients Using 3D Coronary Phantoms
Participants
Dimitris Mitsouras, PhD, Boston, MA (Presenter) Research Grant, Toshiba Corporation; Speakers Bureau, Toshiba Corporation
LEARNING OBJECTIVES
1) Learn about which 3D printing technologies can produce physiological compliant vascular phantoms. 2) Recognize those in vivo
imaging techniques that can be translated into vascular models that can be 3D printed. 3) Be able to describe the steps required in
developing an in silico plus in vitro experiment to explain an imaging finding. 4) Be able to explain the reason for the coronary
contrast enhancement gradient seen in standard coronary CT angiography.
ABSTRACT
3D-printed cardiovascular models are poised to become a disruptive force in the development of novel functional CT and MR imaging
techniques. With 3D printing, patient-specific models can be produced for physiologically accurate - with respect to both
pathophysiology and underlying physics - validation studies that are not otherwise feasible due to e.g., radiation burden, scan time,
and cost. Multiple 3D printing technologies are key for such applications, particularly regarding vascular compliance and
incorporation of hard materials for e.g., calcifications. Similarly, multiple imaging techniques such as rotational DSA, CT and MRI can
be used to produce such models. A particularly important application is validation of in silico computational fluid dynamics (CFD)
simulations that have been used to advance our understanding of cardiovascular disease and imaging methods developed to
diagnose it in the last two decades. A given patient-specific model simulated with CFD can now concurrently be realized for
identical in vitro flow experiments to validate conclusions drawn from the numerical model. Two examples are the coronary
Transluminal Attenuation Gradient (TAG) and simulated fractional flow reserve (FFR) being developed for the non-invasive detection
of significant coronary artery disease from standard CT angiography. We will showcase in vitro CTA experiments to elucidate the
intra-luminal kinetics of iodinated contrast that give rise to TAG as an example of the steps from in vivo image acquisition, to lumen
segmentation and preparation for 3D printing, and in vitro experimentation. Just as numerical 3D modeling has been a disruptive
application of computational fluid dynamics methods with the potential to bridge the gap between understanding anatomy and
function, 3D printing is poised to be a disruptive application of in vivo imaging and additive manufacturing to advance our
understanding of pathophysiology, and new imaging techniques and devices.
RCC32E
Blood Flow in the Thoracic Aorta Elucidated with 3D Models
Participants
Michael Markl, PhD, Chicago, IL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the use of 3D models of the aorta for the in-vitro simulation of aortic hemodynamics. 2) Explain the potential of in-vitro
4D flow MRI for the modeling and systematic analysis of the influence of common aortic pathologies on local and global 3D flow
patterns in the aorta.
ABSTRACT
Flow sensitive MRI offers the ability to assess anatomy as well as flow characteristics in healthy and pathological blood vessels and
is therefore an attractive tool for the diagnosis of vascular diseases. However, in-vivo studies do not allow the prediction of
hemodynamic changes due to vascular modifications. Realistic vascular in-vitro 3D phantoms in combination with MRI flow
measurements allow to model different vascular deformations and evaluate their effect on blood flow dynamics. This presentation
will provide a review of the methods for the in-vitro simulation of aortic 3D blood flow with realistic boundary conditions and review
previously reported application for the simulation of common aortic pathologies and their impact on aortic hemodynamics.
SSG02
Cardiac (MRI/CT Outcomes and Risk Stratification)
Tuesday, Dec. 1 10:30AM - 12:00PM Location: S504AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Bernd J. Wintersperger, MD, Toronto, ON (Moderator) Speakers Bureau, Siemens AG; Research support, Siemens AG
David A. Bluemke, MD, PhD, Bethesda, MD (Moderator) Research support, Siemens AG
Sub-Events
SSG02-01
Predictive Value of Cardiovascular Magnetic Resonance-Derived Myocardial Strain for Poor Outcome
in Patients with Acute Myocarditis
Tuesday, Dec. 1 10:30AM - 10:40AM Location: S504AB
Participants
Minkyu Kwak, MD, Busan, Korea, Republic Of (Presenter) Nothing to Disclose
Ji Won Lee, MD, Busan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Joo Jeong, MD, Busan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Geewon Lee, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jin You Kim, MD, Busan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Suk Kim, MD, Pusan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ki Seok Choo, MD, Yangsan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the value of cardiovascular magnetic resonance (CMR)-derived myocardial strain for predicting poor outcome in
patients with acute myocarditis.
METHOD AND MATERIALS
We retrospectively included 37 consecutive patients with acute myocarditis who performed CMR (23 male, mean age 41.5 yrs).
Myocardial strain parameters, left ventricular (LV) end-diastolic and end-systolic volumes, LV myocardial mass, LV ejection fraction
(EF) and right ventricular EF were derived from CMR. Presence of late gadolinium enhancement (LGE) was also recorded. Primary
outcome was major adverse cardiovascular events (MACE). Incomplete LV functional recovery was used as secondary outcome in
the group of patents who performed follow-up echocardiography after 1 year.
RESULTS
During an average follow-up of 41 ± 34 months, 11 of 37 patients (29.7%) suffered MACE, including cardiac death (n = 2), heart
transplantation (n = 1), cardiac pacemaker (n = 1), rehospitalization due to cardiac events (n = 4) or embolic stroke (n = 3).
Multivariable Cox proportional hazard regression analysis revealed the presence of LGE (hazard ratio 42.88, p = 0.014) and radial
strain obtained from the long axis views (ErrLax, hazard ratio 0.77, p = 0.004) were significant predictors of MACE. Kaplan-Meier
analysis showed worse outcome in patients with LGE or ErrLax ≤9.48. Thirty one of 37 patients (83.7%) performed follow-up
echocardiography. Multivariable backward stepwise regression analysis revealed ErrLax was the sole significant predictor of LV
functional recovery (hazard ratio 1.87, p = 0.042). Receiver operating characteristic curve of ErrLax was used to find optimal cutoff values for prediction of incomplete LV functional recovery, with corresponding area under the curve of 0.96. Cut-off value with
the best combination of sensitivity and specificity for ErrLax was ≤14.86 (sensitivity 88.9%, specificity 95.5%).
CONCLUSION
CMR-derived ErrLax can predict poor outcome such as MACE or incomplete LV functional recovery in the patients with acute
myocarditis.
CLINICAL RELEVANCE/APPLICATION
CMR-derived ErrLax can predict poor outcome in the patients with acute myocarditis. Furthermore, presence of scar indicated by
LGE is also the good independent predictor of MACE. This results support the necessity for future large longitudinal follow-up
studies to establish LGE and CMR-derived myocardial strain as an independent predictor of MACE in acute myocarditis.
SSG02-02
Characterization of the Right Ventricle by T1-mapping and T2-mapping in Patients with Pulmonary
Arterial Hypertension
Tuesday, Dec. 1 10:40AM - 10:50AM Location: S504AB
Participants
Celia P. Corona-Villalobos, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Yan Zhang, MD, PhD, Jinan, China (Abstract Co-Author) Nothing to Disclose
Kristin Porter, MD, PhD, Baltimore, MD (Abstract Co-Author) Stockholder, Pfizer Inc
Paul M. Hassoun, MD, Baltimore, MD (Abstract Co-Author) Scientific Advisory Board, Gilead Sciences, Inc
Stephen M. Mathai, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Ihab R. Kamel, MD, PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Stefan L. Zimmerman, MD, Baltimore, MD (Presenter) Nothing to Disclose
Rachel Damico, MD,PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Todd Kolb, MD,PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
PURPOSE
Right ventricular (RV) function is a major determinant of prognosis in pulmonary arterial hypertension. Pressure overload triggers
compensatory mechanisms such as RV hypertrophy, dilatation, fibrosis and RV failure.Diffuse myocardial fibrosis and inflammation
have been detected in the left ventricle non-invasively by T1 and T2-mapping using cardiac magnetic resonance (CMR) imaging.
The purpose of our study was to evaluate whether T1- and T2-mapping could detect myocardial fibrosis and/or edema of the RV in
patients with pulmonary arterial hypertension (PAH).
METHOD AND MATERIALS
A prospective, IRB-approved, HIPAA-compliant study identified from February of 2013 to March of 2015, 34 (6 males and 33 females
with mean age of 58±15 years) subjects with PAH (24 subjects had scleroderma-induced PAH (SSc-PAH) and 10 had idiopathic PAH
(IPAH). Fifteen age-matched normal controls underwent the same CMR protocol. Standard multi-sequence CMR protocol including
pre-contrast (native) short-MOLLI and T2-mapping was performed. Images were processed on a dedicated workstation by drawing
a region of interest on the RV inferior wall. Reproducibility was assessed by independently blinded by a second reader.
RESULTS
Right ventricular inferior wall native T1 and T2 times were significantly higher in patients compared to controls (T1: 1017 ± 96 ms
vs. 930 ± 94 ms, p=0.009; T2: 55 ± 6 ms vs. 49 ± 6 ms, p<0.001). Both measures were reproducible with strong repeated measure
linear regression correlations for interobserver analysis (T1: r=0.79, p<0.001; T2: r=0.72, p<0.001). There was a weak correlation
between T1 values and pulse pressure (r=0.37,p<0.05). No significant correlation was found between T1 or T2 values with CMRderived RV-ejection fraction, RV-end diastolic volume and RV wall thickness or hemodynamic measures of PAH severity from RHC
such as mean pulmonary artery pressure and pulmonary vascular resistance.
CONCLUSION
T1- and T2-maping of the right ventricle is feasible and shows high reproducibility. Future studies with a larger sample size are
needed to determine its clinical utility.
CLINICAL RELEVANCE/APPLICATION
T1 and T2-mapping of the RV are potentially novel measures of fibrosis and edema for the assessment of pulmonary arterial
hypertension.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ihab R. Kamel, MD, PhD - 2015 Honored Educator
Stefan L. Zimmerman, MD - 2012 Honored Educator
Stefan L. Zimmerman, MD - 2015 Honored Educator
SSG02-03
The Prognostic Value of Coronary Computed Tomography Angiography in Asymptomatic Adults at
Intermediate Risk
Tuesday, Dec. 1 10:50AM - 11:00AM Location: S504AB
Participants
Su Jin Hong, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Yeo Koon Kim, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jae Yeon Wi, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Eun Ju Chun, MD, PhD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang Il Choi, MD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
The risk stratification methods based on conventional risk factors have limitations to predict the coronary artery disease. The
purpose of this study is to evaluate the prognostic value of coronary CT angiography (CCTA) over traditional risk factors and
coronary artery calcium score (CACS) in asymptomatic subjects at intermediate risk.
METHOD AND MATERIALS
From January 2006 to December 2007, 1156 asymptomatic patients at intermediate risk who underwent both CACS and CCTA for
health surveillance were included. Basic demographic data, medical history, family history, laboratory data were acquired for risk
factor assessment. CCTA images were analyzed by 2 cardiac radiologists in consensus. Analysis included degree of stenosis and
type of plaque. The follow-up information was obtained from the hospital medical records or data on National health insurance
review and assessment service by two trained researchers. Follow-up was made for cardiac events (cardiac death, nonfatal
myocardial infarction, unstable angina requiring hospital stay, or revascularization later than 90 days after CCTA).
RESULTS
During a median 76 months of follow-up, the cardiac event occurred in 5.2% (n=60). For the prediction of both cardiac events and
major adverse cardiac events (MACE; cardiac death, myocardial infarction and unstable angina), all of the CCTA parameters
correlated significantly with outcome (all p<0.01). For the prediction of all cardiac events, the area under curves(AUCs) of
Framingham risk score(FRS), FRS with CACS, and FRS with CCTA showed gradual increase (AUC 0.64 for FRS alone, 0.81 for FRS +
CACS and 0.91 for FRS + CCTA; all p<0.05). However, the addition of CACS on CCTA with FRS did not add the prediction power
(AUC 0.90) to the CCTA with FRS (AUC 0.91). The results for the prediction of MACE were similar. The addition of CACS or CCTA to
FRS had the incremental predictive power than FRS alone (AUC 0.65 for FRS alone, 0.80 for FRS + CACS, and 0.91 for FRS + CCTA.
all p<0.05). The CACS did not have the incremental value over FRS with CCTA (AUC 0.90 for FRS + CACS + CCTA and 0.91 for FRS
+ CCTA).
CONCLUSION
CCTA has incremental prognostic value over FRS and CACS in the asymptomatic subjects at intermediate risk.
CLINICAL RELEVANCE/APPLICATION
CCTA has a potential to replace the screening role of CACS in the asymptomatic subjects at intermediate risk.
SSG02-04
Assessment of Semi-automatic Quantification of Non-Calcified Plaque as a Predictor of Outcome in
Acute Chest Pain Patients at Coronary CT Angiography
Tuesday, Dec. 1 11:00AM - 11:10AM Location: S504AB
Participants
Andreas Bucher, MD, Frankfurt, Germany (Presenter) Nothing to Disclose
Rui Wang, Beijing, China (Abstract Co-Author) Nothing to Disclose
Felix G. Meinel, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Julian L. Wichmann, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Carlo N. De Cecco, MD,PhD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Aleksander Krazinski, Charleston, SC (Abstract Co-Author) Nothing to Disclose
James Spearman, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Justin R. Silverman, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Paul Apfaltrer, MD, Charleston, SC (Abstract Co-Author) Nothing to Disclose
Thomas J. Vogl, MD, PhD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the predictive value of quantified non-calcified plaque volume on clinical outcome in acute chest pain patients.
METHOD AND MATERIALS
Total plaque volume was analyzed using semi-automated segmentation software from CTA datasets of 151 acute chest pain
patients (90 female; age 59.1±11.0 years). CT series were acquired on a 64 dector-row dual source CT system and reconstructed
in 0.75 mm slice thickness. Non-calcified plaque volume (ncPV) was sub-categorized by density: necrotic plaque volume (nPV): 30-75 HU; fibrous fatty plaque volume (ffPV): 76-130 HU; fibrous plaque volume (fPV): 131-350 HU. As a primary endpoint, major
adverse cardiac events (MACE) were recorded on follow-up. Total plaque burden (TPB) was calculated as sum of all analyzed
coronary segments. Cox proportional-hazards regression, correlation coefficient and student-t tests were used for statistical
evaluation.
RESULTS
Twenty-one MACE (14.4% of cases) occurred during follow-up (mean follow-up: 12.1±6.2 months). In patients who experienced
MACE ncPV was significantly higher (median: 760.5 mm³; inter-quartile range: 535.7-873.2 mm³) compared to patients without
MACE (median: 607.2 mm³; inter-quartile range: 448.8-760.5 mm³; P=0.024), while TPB was comparable (P=0.220). ffPV was a
statistically significant predictor of MACE (P=0.001). Necrotric and fibrous plaque volume did not show significant predictive value
(P>0.1).
CONCLUSION
Non-calcified fibrous fatty plaque volume was a significant predictor of subsequent MACE events in acute chest pain patients.
CLINICAL RELEVANCE/APPLICATION
Semi-automated non-calcified plaque quantification might provide reproducible predictive parameters in acute chest pain patients
to predict outcome.
SSG02-05
Benefit of Four-Dimensional Computed Tomography Derived Ejection Fraction of the Left Atrial
Appendage to Predict Thromboembolic Risk in the Patients with Valvular Heart Disease
Tuesday, Dec. 1 11:10AM - 11:20AM Location: S504AB
Participants
In-Cheol Kim, MD,PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyuk-Jae Chang, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Iksung Cho, New York, NY (Presenter) Nothing to Disclose
Ran Heo, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyung Bok Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
In-Jeong Cho, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Chi Young Shim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Geu-Ru Hong, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jong-Won Ha, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young-Jin Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Byoung Wook Choi, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Namsik Chung, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence
of thrombus in LAA and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and
after surgery. The aim of this study is to investigate the role of four-Dimensional (4D) CT performed for the evaluation of valvular
heart disease to predict the risk of thrombus formation.
METHOD AND MATERIALS
Between March 2010 to March 2015, total of 62 patients who underwent 4D CT scan and TEE for cardiac valve evaluation before
surgery in Younsei Cardiovascular Hospital were retrospectively included in the current study. LAA was observed during TEE
between 45 to 90 degree. Fractional area change (FAC) in TEE view (FACTEE) and emptying velocity at LAA (VeTEE) was
measured. Ejection fraction (EF) of LAA (EFCT) was calculated by 4D CT with full volume analysis. The best cut-off value of EFCT
to predict the presence of SEC or thrombus and correlation between the parameters were also estimated.
RESULTS
Mean age was 60 ± 15 years old and 53.2% were male. Spontaneous echo contrast (SEC) or thrombus was observed in 45.2%.
Correlation between EFCT and VeTEE was noted (r=0.452, p<0.001). However, FACTEE was not significantly related to VeTEE
(r=0.085, p=0.512). EFCT < 37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4D CT and
TEE (AUC = 0.654, p = 0.038, sensitivity = 0.824, specificity = 0.536).
CONCLUSION
In the patients who are undergoing 4D CT before surgery, LAA EF by volume analysis might provide additional benefit to predict the
risk of thromboembolic event.
CLINICAL RELEVANCE/APPLICATION
Valve CT with 4D reconstruction might provide useful information predicting SEC or thrombus.
SSG02-06
A Prospective Observational Single Blinded Study on the Role of Preoperative Computed Tomography
Coronary Angiogram in Cardiac Risk Stratification in Non-Cardiac Surgery
Tuesday, Dec. 1 11:20AM - 11:30AM Location: S504AB
Participants
Eric You-Ten, MD,PhD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Scott Beattie, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Duminda Wijeysundera, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Jo Carroll, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Deep Grewal, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Narinder S. Paul, MD, Richmond Hill, ON (Presenter) Research Grant, Toshiba Corporation; Research Grant, Carestream Health, Inc
PURPOSE
To determine the role of wide volume CT Coronary Angiography (CTCA) in assessing the cardiac risk of patients undergoing
intermediate and high risk surgery.
METHOD AND MATERIALS
Prospective recruitment of 91 patients undergoing elective intermediate-major non-cardiac surgery and vascular surgery. All
patients were seen and assessed in a pre-operative high risk clinic and assigned a Revised Cardiac Risk Index (RCRI). Patients with
a RCRI ≥ 1 were eligible for inclusion in the trial. Patients had 12 lead ECG, cardiac stress tests and/or TTE; and all patients had
preoperative CTCA using 320x0.5mm detector rows (AqONE, TMS, Japan), 0.35ms GR, 80-135kVp and 350-580mA depending on xray absorption profile. MACE were assessed on postoperative days: 0 - 3 and 30 using elevated blood Troponin I plus positive ECG
changes, and/or cardiac symptoms, and by telephone for cardiac symptoms requiring medical attention on day 30 (if discharged at
home). The results of CTCA were blinded to the clinical team unless high grade disease; severe stenosis (≥ 50%) of left main,
critical stenosis (≥70%) of proximal LAD, and/or critical stenosis in ≥ 2 major coronary arteries (2VD)
RESULTS
The physical characteristics, risk factors and medications were similar between patients who were positive for MACE (n=12) and
those who were not (n=79). Preoperative CTCA was unblinded in 5 patients of low-intermediate cardiac risk with high grade lesions;
left main (2), LAD (2), and 2VD (1). After intervention these 5 patients had their surgery without experiencing MACE. Six blinded
patients experienced MACE with an elevated troponin and ischemic ECG within 3 days post-surgery. In these patients, CTCA
showed severe 2VD (1 patient) and 3VD (1 patient) and non-significant stenosis (4 patients). One patient died of a fatal MI on
postoperative day 31 and CTCA showed non-significant stenosis.
CONCLUSION
CTCA can detect severe and high grade disease in patients assessed as low to intermediate cardiac risk (1-2 RCRI) with
conventional methods.
CLINICAL RELEVANCE/APPLICATION
Preoperative CTCA has a promising role in cardiac risk stratification and may lead to development of optimization strategies that
improve patient outcome and safety
SSG02-07
CMR in Pulmonary Arterial Hypertension before and after Therapy in Systemic Sclerosis-Induced
Pulmonary Arterial Hypertension
Tuesday, Dec. 1 11:30AM - 11:40AM Location: S504AB
Participants
Celia P. Corona-Villalobos, MD, Baltimore, MD (Presenter) Nothing to Disclose
Kristin Porter, MD, PhD, Baltimore, MD (Abstract Co-Author) Stockholder, Pfizer Inc
Paul M. Hassoun, MD, Baltimore, MD (Abstract Co-Author) Scientific Advisory Board, Gilead Sciences, Inc
Stephen M. Mathai, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Rachel Damico, MD,PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Todd Kolb, MD,PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Ihab R. Kamel, MD, PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Stefan L. Zimmerman, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
PURPOSE
Pulmonary arterial hypertension (PAH) is one of the most lethal complications of systemic sclerosis (SSc) and RV function is the
Pulmonary arterial hypertension (PAH) is one of the most lethal complications of systemic sclerosis (SSc) and RV function is the
major determinant of prognosis. Management of systemic sclerosis induced PAH (SSc-PAH) is challenging and despite therapeutic
advances, there is still limited evidence that these therapies improve RV function. The purpose of our study was to evaluate
whether CMR can identify RV functional changes in response to treatment in patients with SSc-PAH.
METHOD AND MATERIALS
Prospective, multicenter, IRB-approved, HIPAA-compliant study. Twenty-four treatment naïve subjects with SSc-PAH underwent
right heart catheterization (RHC) and CMR assessment at baseline and after 36 weeks of treatment with tadalafil (40 mg daily) and
ambrisentan (10mg daily). A standard multi-sequence CMR was acquired. All images were analyzed by a single reader on a
dedicated workstation for both LV and RV quantitative volumes and function.
RESULTS
Treatment had a significant impact on CMR measurements such as RV end-systolic (ES) volume index, RV stroke volume (SV), RV
ejection fraction (EF), RV cardiac index (CI), LV end-diastolic (ED) volume index, LV SV and LV CI. There was also a significant
reduction of mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output by RHC. Exercise
capacity improved significantly after treatment in this cohort (Table 1).
CONCLUSION
Patients treated for SSc-PAH demonstrated significant improvements in RV volumes and function by CMR with corresponding
improved hemodynamics on RHC and improved exercise capacity.
CLINICAL RELEVANCE/APPLICATION
CMR can be used to non-invasively monitor improvements in RV function in patients undergoing treatment for SSc-PAH.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ihab R. Kamel, MD, PhD - 2015 Honored Educator
Stefan L. Zimmerman, MD - 2012 Honored Educator
Stefan L. Zimmerman, MD - 2015 Honored Educator
SSG02-08
Clinical Significance of Coexistent Coronary Artery Disease in Hypertrophic Cardiomyopathy Using
Coronary CT Angiography
Tuesday, Dec. 1 11:40AM - 11:50AM Location: S504AB
Participants
Yoon Joo Shin, MD, Seongnam, Korea, Republic Of (Presenter) Nothing to Disclose
Jae Hwan Lee, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeo Koon Kim, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang Il Choi, MD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Eun Ju Chun, MD, PhD, Seongnam-Si, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the prevalence and clinical significance of coexistent coronary artery disease (CAD) in patients with hypertrophic
cardiomyopathy (HCM) using coronary CT angiography (CCTA).
METHOD AND MATERIALS
Among the CCTA data registry which was composed of 41,588 consecutive patients with suspected CAD, a total of 248 patients
with HCM diagnosed by clinical findings, electrocardiography, and echocardiography were retrospectively enrolled. Using CCTA, we
evaluated the obstructive CAD (>50% stenosis) and plaque types (calcified, non-calcified, high-risk plaque [HP]) according to the
16-segment model. HP was defined as plaque density with <30HU and positive remodeling with >1.1, napkin ring sign and spotty
calcification. Clinical risk factors and echocardiographic functional parameters were also evaluated from all the patients. The
endpoint was defined as cardiac death, myocardial infarction, unstable angina requiring hospitalization, revascularization after 90
days from CCTA, or implantable cardioverter defibrillator insertion.
RESULTS
In patients with HCM, the prevalence of obstructive and non-obstructive CAD was 16.5% and 42.7%, respectively. During the
median of 37-months observation period (range; 3-108 months), total cardiac events were occurred in 11.7% of patients with HCM.
Using univariate Cox regression analysis, age, family history of previous heart disease, atrial fibrillation, lower ejection fraction (EF <
55%), Framingham risk score, calcium scoring, obstructive CAD and HP were significantly related with cardiac events (all p<0.05).
After adjustment of these factors, lower EF (hazard ratio [HR], 5.7) and obstructive CAD (HR, 7.3) were independent factors (all
p<0.001).
CONCLUSION
The prevalence of obstructive CAD was approximately one-fifth of the HCM population, and the presence of obstructive CAD was
one of the independent factor for cardiac events. Therefore, the evaluation of CAD should not be overlooked.
CLINICAL RELEVANCE/APPLICATION
In our study, the coexistent CAD was one of the prognostic factor for cardiac events in HCM. In this regard, CCTA is helpful to
provide the information not only myocardial hypertrophy but also CAD.
SSG02-09
Association between Late Gadolinium Enhancement and Three Types of Ventricular Tachyarrhythmia
in Patients with Hypertrophic Cardiomyopathy
Tuesday, Dec. 1 11:50AM - 12:00PM Location: S504AB
Participants
Yasuo Amano, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Fumi Yamada, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Mitsunobu Kitamura, Inba, Japan (Abstract Co-Author) Nothing to Disclose
Shogo Imai, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Masaki Tachi, MD, PhD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Morimasa Takayama, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shinichiro Kumita, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Myocardial scarring may be related to ventricular tachyarrhythmia, one of the most serious complications associated with
hypertrophic cardiomyopathy (HCM). We aimed to assess the association between late gadolinium enhancement (LGE) on MRI and 3
types of ventricular tachyarrhythmia, including ventricular fibrillation (VF), sustained ventricular tachycardia (SVT) and nonsustained ventricular tachycardia (NSVT), in patients with HCM.
METHOD AND MATERIALS
LGE MRI was performed in 167 patients with HCM. We assessed the association between the 3 types of ventricular tachyarrhythmia
and the myocardial LGE, clinical risk markers (e.g., family history of sudden cardiac death [SCD], syncope) and cine MRI data (e.g.,
ejection fraction, myocardial mass). The myocardial LGE was defined as the region with the mean signal intensity ≥ 6 SD above the
remote myocardium. Extent of LGE was estimated based on the American Heart Association (AHA) 17-segment model.
RESULTS
Of the 167 patients with HCM, 8, 4, and 23 had VF, SVT and NSVT, respectively. The remaining 132 patients had no ventricular
tachyarrhythmia. Overall, 104 patients (62.3%) had myocardial segments displaying LGE. The patients with NSVT frequently showed
a family history of SCD, more risk markers, and more presence and wider extent of LGE compared with patients without
tachyarrhythmia (P < 0.05). The LGE extent, a family history of SCD and risk markers were significantly related to NSVT (P < 0.01),
whereas there were no apparent MRI findings related to VF and SVT. The LGE extent ≥ 3 segments was related to the family
history of SCD, episode of cardiac arrest and prevention ICD installation for NSVT.
CONCLUSION
There is a significant association between the extent of LGE and NSVT in patients with HCM, but we find no apparent relationship
between MRI findings and VF or SVT. We should discriminate between NSVT and the other types of ventricular tachyarrhythmia and
be vigilant for the LGE extent when applying LGE MRI to risk stratification for HCM with NSVT.
CLINICAL RELEVANCE/APPLICATION
Extent of late gadolinium enhancement is associated with non-sustained ventricular tachycardia among the 3 types of ventricular
tachyarrhythmia in patients with hypertrophic cardiomyopathy.
CAS-TUA
Cardiac Tuesday Poster Discussions
Tuesday, Dec. 1 12:15PM - 12:45PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Scott R. Akers, MD, PhD, Philadelphia, PA (Moderator) Nothing to Disclose
Sub-Events
CA212-SDTUA1
Computed Tomography Coronary Angiography versus Stress Cardiac Magnetic Resonance for the
Management of Symptomatic Revascularized Patients: A Cost-Effectiveness Study (STRATEGY Study)
Station #1
Participants
Gianluca Pontone, MD, Milan, Italy (Presenter) Speakers Bureau, General Electric Company; Consultant, General Electric Company;
Research Consultant, HeartFlow, Inc; Speakers Bureau, HeartFlow, Inc; Speakers Bureau, Medtronic, Inc; Speakers Bureau, Bayer
AG
Daniele Andreini, MD, Milan, Italy (Abstract Co-Author) Consultant, General Electric Company
Cristina Rota, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Marco Guglielmo, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Saima Mushtaq, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Baggiano, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Virginia Beltrama, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Anna Solbiati, Milan, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Computed tomography coronary angiography (CTCA) and stress cardiac magnetic resonance (stress-CMR) are both suitable for
diagnosing obstructive coronary artery disease (CAD) in symptomatic patients for chest pain with previous history of
revascularization.The aim of this study is to compare the clinical and economic outcomes of using anatomical (CTCA) versus a
functional strategy (stress-CMR) in revascularized symptomatic patients for chest pain.
METHOD AND MATERIALS
Four-hundred revascularized symptomatic patients for chest pain were addressed to CTCA (n: 200, mean age 68±10 yo, male 168)
or stress-CMR (n: 200, mean age 66±9 yo, male 177) and followed-up in terms of downstream non-invasive tests, invasive
coronary angiography (ICA) and revascularization procedure, medical costs for CAD management, cumulative effective radiation
dose and major adverse cardiac events (MACEs) defined as composite endpoints of non fatal myocardial infarction and cardiac
death.
RESULTS
All patients performed both tests successfully. The mean follow-up for CTCA and stress-CMR groups were similar (772±398 vs.
794±345 days, p:ns). Compared with stress-CMR strategy, CCTA was associated with an increased likelihood of subsequent mean
number of further non-invasive test (1.04 vs. 0.81, p<0.01), cardiac catheterization (40% vs. 30%, p<0.05). No differences were
found in terms of subsequent percutaneous coronary interventions (PCI) (30% vs. 26%, p:0.37) but stress-CMR group was
associated with a favorable trend of PCI/ICA rate (86% vs. 75%, p: 0.08) and MACEs (4% vs. 8.5%, p:0.06). Moreover, CTCA
strategy showed a higher mean cost per patient [2329.46 vs. 2617.47 Euro (-11%), p<0.05] and a lower mean effective radiation
dose [22 vs. 4.4 mSv (-80%), p<0.01].
CONCLUSION
Despite similar or risk profiles, revascularized patients initially evaluated with CTCA after PCI had more downstream non invasive and
invasive testing, higher CAD-related spending and effective radiation exposure as compared to patients evaluated with stress-CMR
with comparable (MACEs).
CLINICAL RELEVANCE/APPLICATION
Patients evaluated with CTCA after PCI had more downstream non invasive and invasive testing, higher CAD-related spending and
effective radiation exposure as compared to patients evaluated with stress-CMR with comparable MACEs.
CA225-SDTUA2
Clinical Usefulness of Subtraction Coronary Computed Tomography Angiography (CCTA) for
Improvement of in-STENT Lumen Visibility, Influence of Calcification and Image Reconstruction
Methods
Station #2
Participants
Takayoshi Yamaguchi, Sapporo, Japan (Presenter) Nothing to Disclose
Daichi Takahashi, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Mari Morita, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Tomonori Fujii, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Teppei Sugaya, MD, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Jyungo Furuya, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Keiichi Igarashi, Sapporo, Japan (Abstract Co-Author) Nothing to Disclose
Katsuhiro Ichikawa, PhD, Kanazawa, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Aim of this study is to assess whether the distribution of the calcification and image reconstruction methods influence the ability of
the in-stent lumen visibility by subtraction CCTA(SCCTA).
METHOD AND MATERIALS
We evaluated 127 patients with 400 or more Agatston units or STENT treatment history using area detector CT scanner. Single
breath-hold method was used to obtain pre- and post-contrast image. These image sets were reconstructed by use of the half or
full data. If a motion artifact did not appear, full data reconstruction was adopted. Coronary subtraction was performed using the
scanner's embedded software. The image quality (IQ) was assessed using 4-point scale (1:uninterpretable, 2:poor, 3:moderate,
4:good) in the calcification (CALC) segment (calcified plaque distribution more than 90 degree in the short axis) and STENT
implantation segment.
RESULTS
206 CALC segments and 187 STENT implantation segments(with CALC; 134, without CALC; 53) were registered. IQ score of SCCTA
in all segments was significantly higher than conventional CCTA (3.6±0.6 vs. 2.5±1.0: p<0.0001). Each IQ score of CALC, STENT
with CALC and STENT without CAL were 2.4±1.0, 2.3±1.0 and 3.4±0.9 in conventional CCTA, respectively, and those were 3.6±0.5,
3.6±0.6 and 3.7±0.6 in SCCTA, respectively. The improvement of IQ score of STENT segment with CALC and CALC segment was
higher than STENT segment without CALC. Also the IQ score of SI using full data reconstruction was significantly higher than that
using half data reconstruction (3.7±0.5 vs. 3.4±0.5: p<0.001).
CONCLUSION
SCCTA improved IQ of STENT segment like CALC segment compared to conventional CCTA, and its effect was higher of STENT with
calcification. Moreover, there is a possibility that use of full data reconstruction contributes to improvement of the IQ score.
CLINICAL RELEVANCE/APPLICATION
CCTA provides the essential information for stenotic lesions with high diagnostic accuracy. However, extensive calcified lesion and
in-stent lumen visibility remain problematic.
CA226-SDTUA3
The Impact of Computational Fluid Dynamic (CFD) Boundary Conditions (BCs) on Coronary
Computed Tomography Angiography (CCTA) - Derived Endothelial Shear Stress (ESS) Calculations
for the Prediction of Coronary Plaque Progression
Station #3
Participants
Andreas Giannopoulos, MD, Boston, MA (Presenter) Nothing to Disclose
Yiannis M. Chatzizisis, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Antonios Antoniadis, Boston, MA (Abstract Co-Author) Nothing to Disclose
Pal Maurovich-Horvat, MD,PhD, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Abstract Co-Author) Research Grant, Toshiba Corporation;
Udo Hoffmann, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael L. Steigner, MD, Boston, MA (Abstract Co-Author) Speaker, Toshiba Corporation
Dimitris Mitsouras, PhD, Boston, MA (Abstract Co-Author) Research Grant, Toshiba Corporation; Speakers Bureau, Toshiba
Corporation
PURPOSE
Low ESS is associated with coronary plaque progression and high-risk plaque features. It is often modeled from CCTA using various
CFD BC assumptions, eg, commonly excluding side branches. We assessed whether typical BC assumptions alter determination of
the arterial regions subjected to low ESS.
METHOD AND MATERIALS
Coronaries of 5 human hearts were filled with 3% contrast (Isovue 370) methylcellulose mixture and imaged <10hrs postmortem
using 64-row CT (GE Discovery 750HD). Vessels > 1mm diameter were automatically segmented (Toshiba Cardiac Analysis Package)
and left/right coronary trees were reconstructed (Matlab 2013b) with and without side branches. CFD analysis was performed using
commercial software (Fluent 15, ANSYS) with BCs of no-slip walls, physiologic inlet flow rate (156 ml/min for left, 113 ml/min for
right trees), zero-gauge outlet pressures, and steady laminar flow. ESS was calculated for 3 models: a) the entire coronary tree
(with branches) and non-Newtonian blood (power law model for HCT=45); b) the entire tree and Newtonian blood (fixed viscosity
for HCT=45), and c) major coronaries only (no branches) and non-Newtonian blood. The 10% of endoluminal surface with the
lowest ESS values in each major artery (LAD, LCX, RCA) was used to assign each 3mm segment a binary outcome depending on
whether it contained a low ESS region or not. Sensitivity and specificity to identify low ESS segments in the reference standard
model (a) were calculated for the two simplified models (b, c).
RESULTS
With no side branches, sensitivity and specificity to identify low ESS segments were 78% and 88%. Sensitivity was lowest for LADs
(67%) and highest for RCAs (85%); specificity was lowest for RCAs (81%) and highest for LADs (92%). With Newtonian blood and
branches, sensitivity and specificity were 89% and 98%, with sensitivity lowest for RCAs (83%) and highest for LCXs (96%), and
specificity lowest for LADs (98%).
CONCLUSION
ESS is typically modeled from CCTA excluding side branches and often assuming blood a Newtonian fluid as non-Newtonian models
present difficulties in modeling turbulence. We found that side branches are important for identifying areas of low ESS while the
blood model has negligible effect.
CLINICAL RELEVANCE/APPLICATION
CTA-derived fluid dynamic simulations used to associate blood flow characteristics such as ESS with high-risk plaques in coronary
arteries should include side branches.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Udo Hoffmann, MD - 2015 Honored Educator
CA227-SDTUA4
New Imaging Method for the Detection of Coronary Vasospasm: Double Acquisition of CCTA in the
Presence or Absence of IV Nitrate Infusion
Station #4
Participants
Eun-Ju Kang, Busan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Moo Hyun Kim, Busan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Won Jin Choi, MD, Busan, Korea, Republic Of (Presenter) Nothing to Disclose
Ki-Nam Lee, MD, PhD, Pusan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jongmin J. Lee, MD, PhD, Daegu, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Limited data exists regarding the efficacy of multidetector CT for CCTA diagnosis in patients with vasospastic angina. The purpose
of our study was to evaluate the feasibility of double acquisition of coronary CT angiography (CCTA) for the diagnosis of
vasospastic angina.
METHOD AND MATERIALS
This study included 20 consecutive patients with a high clinical probability of vasospastic angina. All subjects underwent CCTA
('baseline CT') without a vasodilator early in the morning before the ergonovine provocative spasm test. Within 1 week after
baseline CCTA, all patients underwent another CCTA ('IV nitrate CT') during which a continuous injection of intravenous vasodilating
agent was administered. We analyzed the results of the provocative spasm test and CCTA images for each patient, with vessel and
segment stratification to compare the diagnostic accuracy.
RESULTS
Fifteen patients had positive results in the spasm provocation test. Among them, 11 patients showed positive results and 4
patients showed false negative results in the CCTA findings. All 5 patients who showed negative results in the spasm provocation
test also had negative results on the CCTAs. The diagnostic accuracy of CCTA 'per patient' showed a sensitivity of 73%, specificity
of 100%, positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 56%. A total of 36 coronary vessels
were compared, and the diagnostic accuracy 'per vessel' showed a sensitivity of 71%, specificity of 95%, PPV of 92%, and NPV of
78%. The diagnostic accuracy 'per segment' (n=154) showed a sensitivity of 53%, specificity of 94%, PPV of 81%, and NPV of
81%.
CONCLUSION
The double acquisition CCTA showed a relatively superior detection rate for coronary spasm than prior reported studies and 100%
specificity and PPV in the per patient analysis.
CLINICAL RELEVANCE/APPLICATION
It is still insufficient to diagnose coronary spasm using CCTA without the provocation test, and additional radiation exposure and
contrast media is required. We speculate that the double acquisition of CCTA can be selectively used in patients who are highly
suspected of having vasospastic angina and who do not wish to go invasive coronary angiography, or who have previous history of
insignificant coronary artery narrowing.
CA228-SDTUA5
Is Bypass Grafting Beneficial for the Older Adult with an Anomalous Coronary Artery Demonstrating
an Interarterial Coronary Course
Station #5
Participants
Robert Layser, MD, Collingswood, NJ (Presenter) Nothing to Disclose
Michael Savage, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Ethan J. Halpern, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
PURPOSE
An anomalous coronary artery with an interarterial course (IAC) is a recognized cause of sudden death in children and young adults.
Surgical interventions, including coronary bypass grafting (CABG) is often recommended, especially for a left IAC. However, the
largest published review evaluated 54 subjects with an IAC and failed to demonstrate a long-term benefit from CABG (Krasuski et al.
Circ 2011;123(2):154-62). Given the increasing number of older adults with an IAC seen on coronary CT angiography (cCTA), we
evaluated the association of IAC +/- CABG with subsequent cardiac events in adults over age 35.
METHOD AND MATERIALS
Retrospective review of cCTA and conventional arteriograms from our institution identified 173 patients (mean age: 64.9 years;
range: 37-96) with an anomalous coronary artery origin from the opposite coronary sinus, including 80 patients with an IAC (mean
age: 64.4 years). Chart review provided a mean follow-up time of 4.9 years. Outcome data was evaluated for hard outcomes
(myocardial infarction or cardiac death) and soft outcomes (persistent angina).
RESULTS
Although the frequency of coronary artery disease (CAD) was lower among patients with an IAC vs those without an IAC (43% vs
59%, p<0.05), the frequency of CABG was marginally higher among those with an IAC (21/80) 26% vs without an IAC (16/93) 17%
(p=0.15). Hard outcomes were equally frequent among IAC patients (12/80) 15% vs those without an IAC (16/93) 17% (p=0.7),
and were marginally higher among patients with a right IAC (11/69) 16% versus a left IAC (1/11) 9% (p=0.56). Among patients with
an IAC, the frequency of hard outcomes was similar with CABG (4/21) 19% vs without CABG (8/59) 14% (p=0.55). The frequency
of soft events among patients with an IAC was also similar with CABG (9/21) 43% vs without CABG (18/59) 31% (p=0.3). On
multivariate regression, extent of coronary disease was the only significant predictor of hard or soft outcome (presence of IAC,
CABG and left vs right IAC were not significant, p>0.4).
CONCLUSION
The frequency of adverse cardiac outcomes in our adult population was not related to the presence of an IAC. In patients with an
IAC, CABG was not associated with lower risk of cardiac death or nonfatal myocardial infarction.
CLINICAL RELEVANCE/APPLICATION
As an increasing number of IAC's are identified with cCTA, it is important to recognize that CABG does not have a proven benefit for
the treatment of an IAC in the older adult patient.
CA229-SDTUA6
Pressure Gradient using Phase Contrast MR at Three Different Aortic Valve Levels in Patients with
Aortic Stenosis: Compared with Transthoracic Doppler Echocardiography
Station #6
Participants
So Hyeon Bak, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Sung Mok Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Jung Yoon, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hae Jin Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Moon Young Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Hyeon Choe, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of our study was to compare pressure gradient (PG) using phase-contrast (PC) MR at three different aortic valve
levels with the mean pressure gradient of transthoracic echocardiography (TTE).
METHOD AND MATERIALS
This study included 55 patients with severe AS and normal left ventricular ejection fraction who underwent TTE and cardiovascular
magnetic resonance (CMR) including PC sequence. PC imaging was performed at three aortic valve levels (level 0 mm at aortic
leaflets, level +6 mm at distal to the level 0 mm, and - 6 mm at proximal to the level 0 mm). Peak velocity, peak PG and mean PG
were calculated using PC imaging. Peak estimates at each level were collected as a combined group. Peak velocity and mean PG
from TTE were used as a reference standard. CMR parameters in each levels and the combined group were compared with
estimates of TTE.
RESULTS
The combined group was consisted of 26 estimates (level 0 mm), 24 estimates (level + 6 mm), and 5 estimates (level - 6 mm). In
comparison of peak velocity, the estimates of CMR were correlated with that of TTE as follows: level 0 mm, r = 0.673; level + 6
mm, r = 0.535; level -6 mm, r = 0.447; combination group, r = 0.734; all ps < 0.001. In comparison of peak PG, the estimates of
CMR were correlated with mean PG of TTE as follows: level 0 mm, r = 0.692; level + 6 mm, r = 0.560; level -6 mm, r = 0.499;
combination group, r = 0.780; all ps < 0.001. In comparison of mean PG, the estimates of CMR showed weak correlation with mean
PG of TTE as follows: level 0 mm, r = 0.346, p < 0.01; level + 6 mm, r = 0.069, p = 0.614; level -6 mm, r = 0.420, p = 0.001;
combination group, r = 0.394, p = 0.003.
CONCLUSION
Among the three valve levels, peak velocity and peak PG of PC imaging at leaflets level showed higher correlation with peak velocity
and mean PG of TTE. The combination group showed better correlation than the leaflets level.
CLINICAL RELEVANCE/APPLICATION
Our finding supports that it is useful to obtain the velocity and gradient of PC imaging at three valve levels.
CA230-SDTUA7
Diagnostic Implications of Magnetic Resonance Feature Rracking Derived Myocardial Strain
Parameters in Patients with Clinically Suspected Acute Myocarditis but Inconspicuous CMR
Station #7
Participants
Bettina Baessler, MD, Cologne, Germany (Presenter) Nothing to Disclose
Frank Schaarschmidt, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Guido Michels, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
Anastasia Dick, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
David C. Maintz, MD, Koln, Germany (Abstract Co-Author) Nothing to Disclose
Alexander C. Bunck, Koln, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic value of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain-analysis of the left and
right ventricle in patients with clinically suspected acute myocarditis (ACM) but inconspicuous CMR.
METHOD AND MATERIALS
CMR data of 16 patients clinically diagnosed with ACM according to the current guidelines were retrospectively analyzed. All
patients demonstrated inconspicuous CMR findings without any wall motion abnormalities, signs of edema or early and late
gadolinium enhancement. 20 age-matched healthy volunteers (HV) served as a control. Analysis of global longitudinal,
circumferential (circ.) and radial strain and strain rate (SR) of both ventricles was performed in one long-axis and three short-axis
slices using a dedicated FT-software (TomTec). Statistical analysis was conducted using Wilcoxon rank-sum-test, one-way robust
ANOVA with bootstrapped post-hoc tests, multiple and multinominal logistic regression analyses, and ROC-analyses.
RESULTS
ACM patients showed significantly reduced LV longitudinal strain (-12.6 ± 1.6 vs. -16.8 ± 1.3 %, p = .024) and LV circ. strain (22.3 ± 1.8 vs. -27.8 ± 1.0, p = .014) compared to HV. Conversely, they showed a non-significant trend towards an improved basal
RV circ. SR (-0.63 ± 0.08 vs. -0.47 ± 0.07 s-1, p = .407). In a multiple logistic regression model, LV circ. strain and RV basal circ.
SR proved to be the best independent predictors of ACM with an AUC of 0.82 in ROC-analysis. In ACM patients with preserved LVEF (60%), all three strain parameters showed a trend towards similarly reduced LV and RV strain compared to HV, although this
trend proved not significant at the 5% level. In multinominal logistic regression analysis, again LV circ. strain and RV basal circ. SR
proved to be the best independent predictors of ACM even with preserved LV-EF with an AUC of 0.83 in ROC-analysis.
CONCLUSION
LV circ. strain and RV basal circ. SR are the best predictors for the presence of ACM when other CMR findings of ACM are lacking,
even in patients with preserved LV-EF. These observations point to the potential of CMR-based strain analysis as a novel
noninvasive diagnostic tool in the setting of ACM.
CLINICAL RELEVANCE/APPLICATION
The diagnostic problems of ACM have led to an increasing importance of CMR, but the traditional CMR-criteria often tend to be
false-negative. Strain analysis potentially could overcome these problems.
CA113-EDTUA8
Coronary Artery Fistulas: Review of Abnormalities of Termination and Treatment
Station #8
Participants
Kim L. Sandler, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
Vaughn G. Braxton, MD, Nashville, TN (Presenter) Nothing to Disclose
Murray J. Mazer, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
Jennifer Robinson Williams, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:1. To review the pathophysiology of coronary artery fistulas.2. To provide multiple examples of
coronary artery fistulas, all demonstrating different abnormalities of termination.3. To illustrate the superior ability of coronary CT
angiography over echocardiography and coronary catheterization in the evaluation of coronary artery fistulas and in treatment
planning.4. To describe treatment options and provide examples of post-treatment imaging.
TABLE OF CONTENTS/OUTLINE
Pathophysiology of coronary artery fistula - Epidemiology and common variants - Clinical featuresDiagnostic Methods Echocardiography - Coronary catheterization - Coronary CT AngiographyTreatment optionsSample casesFuture Direction and
Summary
CAS-TUB
Cardiac Tuesday Poster Discussions
Tuesday, Dec. 1 12:45PM - 1:15PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Scott R. Akers, MD, PhD, Philadelphia, PA (Moderator) Nothing to Disclose
Sub-Events
CA231-SDTUB1
Single Breath-Hold Real-time Cardiac Cine MR for Evaluation of Left Ventricular Function, Volumes,
and Mass
Station #1
Participants
Tomoyuki Kido, Toon, Japan (Presenter) Nothing to Disclose
Teruhito Kido, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Kouki Watanabe, Matsuyama, Japan (Abstract Co-Author) Nothing to Disclose
Ryo Ogawa, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Michaela Schmidt, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Teruhito Mochizuki, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Masashi Nakamura, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Michael Zenge, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Yuta Urushibata, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiaki Komori, Tokyo, Japan (Abstract Co-Author) Employee, Siemens AG
Takahiro Yokoi, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Yuki Tanabe, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Naoki Fukuyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Rami Yokoyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiko Nishiyama, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Masao Miyagawa, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac cine Magnetic Resonance (MR) is generally accepted as the gold standard for left ventricular (LV) volume assessment.
Recently, Real-Time (RT) cine with sparse sampling technique and iterative reconstruction has been applied to accelerate cine MR.
However, in prospective RT cine MR, it may be difficult to capture the true end diastole phase because of the finite time needed to
detect the next ECG trigger, which may lead to underestimation of end diastolic volume (EDV), stroke volume (SV), and ejection
fraction (EF) when compared with retrospective standard cine MR. We propose an alternative approach to overcome this limitation,
by acquiring RT cine data over two heart beats, to capture the complete end diastole between the first and second heart beats.
The purpose of this study was to evaluate the diagnostic quality and accuracy of RT-based single-breath-hold cine MR for the
quantification of LV function compared with standard multi-breath-hold cine MR.
METHOD AND MATERIALS
Fifty participants (15 healthy volunteers and 35 patients with different LV pathologies) underwent both RT and standard cine MR
for the assessment of LV function on 3 Tesla MRI scanner. The cine images (temporal/spatial resolution: 41 ms/1.7×1.7×6 mm3)
were obtained in 8 contiguous short axis slices spanning the entire LV. The image quality, EF, EDV, end systolic volume (ESV), SV,
and LV mass for RT cine and standard cine were compared.
RESULTS
All RT cine showed acceptable diagnostic image quality. Standard and RT cine showed good agreement: EF (60.3±10.2% vs.
60.2±9.8%; R2=0.89; p=0.78); EDV (132.0±36.6 ml vs. 131.1±35.9 ml; R2=0.94; p=0.44); ESV (54.6±27.2 ml vs. 54.1±25.6 ml;
R2=0.95; p=0.53); SV (77.4±16.0 ml vs. 77.0±16.3 ml; R2=0.84; p=0.67); LV mass (87.1±33.7 ml vs. 85.8±33.9 ml; R2=0.97;
p=0.15), respectively. The intra- and inter-observer agreement for all parameters was good.
CONCLUSION
The sparse RT cine MR evaluates LV function and volumes with excellent accuracy. The single-breath-hold sparse RT cine MR has
the potential to replace the multi-breath-hold standard cine MR.
CLINICAL RELEVANCE/APPLICATION
RT cine MR is expected to reduce motion artifacts in severely ill patients who cannot hold their breath for an extended amount of
time, to increase spatial and/or temporal resolution, or simply to shorten the CMR examination.
CA232-SDTUB2
Differentiation of Lipid-rich Plaques from Fibrous Plaques using Effective Atomic Number Obtained by
Electrocardiography-gated Single-source Dual-energy Coronary Computed Tomography with Fast
kVp Switching
Station #2
Participants
Haruhiko Machida, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Rika Fukui, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Isao Tanaka, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Yun Shen, PhD, Beijing, China (Abstract Co-Author) Employee, General Electric Company Researcher, General Electric Company
Takuya Ishikawa, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Eiko Ueno, MD, Chiyoda-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Etsuko Tate, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Xiao Zhu Lin, MD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Heqing Wang, Dalian, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
Electrocardiography (ECG)-gated single-source dual-energy coronary computed tomography (CCT) with fast kVp switching (DECCT)
can provide the effective atomic number (EAN) of noncalcified coronary plaques, which allows more accurate differentiation
between lipid-rich and fibrous plaques than use of the CT attenuation value (CT#) obtained by standard CCT. The purpose of this
study was to compare EAN and CT# obtained by DECCT for accurate differentiation between lipid-rich and fibrous plaques defined
by intravascular ultrasound (IVUS) as a reference.
METHOD AND MATERIALS
From October 2013 through November 2014, 5 patients underwent both IVUS and DECCT. Based on IVUS, 2 experienced
cardiologists classified noncalcified coronary plaques as lipid-rich or fibrous. On DECCT reconstructed with the minimal field of view
(5 x 5 cm2), regions of interest were placed to measure the EAN and CT# within each plaque at 70 keV. We used unpaired t-test
to compare the median and mode EAN and CT# between lipid-rich and fibrous plaques and receiver operating characteristics
analysis to compare the area under the curve (AUC) between the median and mode EAN and corresponding CT# to differentiate the
plaque types.
RESULTS
By IVUS, we identified 19 noncalcified coronary plaques (10 lipid-rich, 9 fibrous). The median (8.27 ± 0.79) and mode (8.12 ± 0.86)
EANs of lipid-rich plaques were significantly lower than those of fibrous plaques (median, 10.03 ± 0.74; mode, 9.95 ± 0.79) (P =
0.0001 and 0.0002). The median (40.9 ± 31.2) and mode (29.0 ± 33.1) CT#s of lipid-rich plaques were significantly lower than
those of fibrous plaques (median, 144.7 ± 77.6; mode, 133.2 ± 93.4) (P = 0.0011 and 0.0041). The overlap between the 2 plaque
types was smaller with the EANs than with the corresponding CT#s. The AUC (Az) was higher with the median (0.97) and mode
(0.96) EANs than with the corresponding CT#s (median, 0.92; mode, 0.87).
CONCLUSION
The EAN obtained by DECCT was significantly lower for lipid-rich than fibrous plaques, and its use can improve accuracy for
differentiating lipid-rich from fibrous plaques.
CLINICAL RELEVANCE/APPLICATION
EAN by DECCT allows more accurate differentiation between lipid-rich and fibrous plaques and detection of high risk plaques for
acute coronary syndrome than CT attenuation value by conventional CCT.
CA233-SDTUB3
Myocardial Extracellular Volume Fraction Quantified using Dual-energy Cardiac CT Correlates with the
Defect Score Obtained using Nuclear Myocardial Perfusion Imaging
Station #3
Participants
Tatsuro Ito, MD, PhD, Kobe, Japan (Presenter) Nothing to Disclose
Atsushi K. Kono, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tatsuya Nishii, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Akira Kasamatsu, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kazuhiro Kashio, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Shumpei Mori, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tomofumi Takaya, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Sei Fujiwara, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Satoru Takahashi, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Ken-Ichi Hirata, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The myocardial extracellular volume fraction (ECV) quantified using cardiac magnetic resonance imaging (MRI) is useful for the
assessment of myocardial fibrosis. Recently, the ECV quantified using computed tomography (CT) has been reported to be
comparable to that quantified using MRI. However, no report has described the ECV quantified using dual-energy CT (DECT). This
study aimed to evaluate the feasibility of using DECT to quantify the ECV, and to compare the results with the extent and severity
of infarctions determined using single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI).
METHOD AND MATERIALS
We performed delayed iodine enhancement (DIE) scan with DECT and SPECT-MPI in 20 participants (13 patients with old MI and 7
normal participants without MI and with preserved left ventricular ejection fraction). The DIE scan was performed in dual-energy
mode with tube voltages of 100 and Sn140 kV. Using iodine maps generated with the DIE scan, the ECV was determined. The ECV
was calculated as follows: ECV = (CM_myocardium/CM_blood) × (1 - hematocrit), where CM is the mean value on the iodine maps
generated via 3-material decomposition. SPECT images were evaluated using the visual defect scores (DS) of rest imaging with a 5point scoring system (0 [normal] to 4 [severe defect]), and a score of 1, 2, 3, or 4 was considered "abnormal." The ECV and DS
were estimated according to a 16-segment model based on the 17-segment model proposed by the American Heart Association,
with the exclusion of the apical segment.
RESULTS
The mean ECV was significantly higher in the abnormal segments of patients with MI (72 segments, 38.9±10.3%) than in the normal
segments of patients with MI (136 segments, 31.9±8.5%; P<0.001) and in all segments of participants without MI (112 segments,
29.8±3.4%; P<0.001). In all 20 patients, there were significant correlations between the mean ECV quantified using DECT and the
summed DS obtained using SPECT-MPI (r=0.49, P<0.05).
CONCLUSION
The ECV quantified using DECT significantly correlated with the DS obtained using SPECT-MPI, suggesting that DECT may clarify
myocardial tissue characterization.
CLINICAL RELEVANCE/APPLICATION
The ECV quantified using iodine maps generated with DECT has the potential to be used for myocardial tissue characterization in
patients with and without old MI.
CA234-SDTUB4
Discrepancy between Invasive Fractional Flow Reserve and Stress Perfusion CMR: Functionally
Significant Coronary Stenosis versus Myocardial Ischemia
Station #4
Participants
Moon Young Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Sung Mok Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hae Jin Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
So Hyeon Bak, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Jung Yoon, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Hyeon Choe, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the results between invasive fractional flow reserve (FFR) and stress perfusion cardiovascular magnetic resonance
(CMR) imaging and to evaluate characteristics of stenotic lesion which cause discrepancy between two imaging modalities.
METHOD AND MATERIALS
We reviewed our prospective data registry of patients who underwent stress perfusion CT and CMR. They also underwent
subsequent invasive coronary angiography with optional FFR depending on physician's decision. Among them, 53 patients who
underwent FFR were included in this study. We compared the values of invasive FFR with territorial perfusion state of stress
perfusion CMR (presence or absence of perfusion defects). Quantitative CT measurements of stenotic lesions were performed by
using dedicated software. The CT indexes evaluated included the following: plaque morphology, plaque burden, calcification
severity, lesion length, minimal luminal area, minimal luminal diameter, diameter stenosis, area of stenosis. We evaluate
characteristics of stenotic lesion which cause discrepancy between two imaging modalities. The stenotic lesion with an FFR of 0.8
or less was considered as functionally significant stenosis.
RESULTS
Seventy-five coronary lesions of 53 patients were evaluated. Forty-two coronary lesions (56%) of all 75 lesions had functionally
significant stenosis with an FFR of 0.8 or less. Of 42 significant stenoses, 22 lesions (FFR, 0.58 ± 0.13) had matching perfusion
defects on stress CMR and 20 lesions (FFR, 0.66 ± 0.14) had no perfusion defects. In the comparison of quantitative CT parameters
between perfusion matching and mismatching groups, diameter stenosis, area stenosis, and plaque burden showed significant
differences (p = 0.03, p = 0.01, p < 0.01, respectively).
CONCLUSION
Twenty lesions (48%) of 42 functionally significant stenoses did not induce myocardial ischemia. Beside FFR values, diameter
stenosis, area stenosis, and plaque burden may affect developing myocardial ischemia.
CLINICAL RELEVANCE/APPLICATION
Functionally significant stenoses with an FFR of 0.8 or less do not always induce myocardial ischemia. Quantitative CT parameters
may be also considered in selecting functionally significant coronary stenosis.
CA235-SDTUB5
Prognostic Significance of MR-tomographic Parameters in Patients with Reperfused ST-elevation
Myocardial Infarction and Involvement of Papillary Muscle
Station #5
Participants
Iris Burck, MD, Frankfurt, Germany (Presenter) Nothing to Disclose
Julia Steiner, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Kim K. Lorenz, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Josef Matthias Kerl, MD, Frankfurt, Germany (Abstract Co-Author) Research Consultant, Siemens AG Speakers Bureau, Siemens AG
Moritz H. Albrecht, MD, Frankfurt am Main, Germany (Abstract Co-Author) Nothing to Disclose
Jan-Erik Scholtz, MD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Birgit Assmus, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Andreas Michael Zeiher, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Thomas J. Vogl, MD, PhD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the prevalence and size of papillary muscle infarction and its possible effects on global heart function and survival of
patients with acute myocardial infarction (AMI) by magnetic resonance imaging (MRI) data and clinical outcome in the course of 5
years.
METHOD AND MATERIALS
Haemodynamic stable patients (n=89) with ST-segment elevation myocardial infarction and successful reperfusion by primary
angioplasty (within 3,09h±5,77 after symptoms onset) were enrolled in this study. Cardiac MRI was performed at baseline (9±4 days
after infarction) and at 4-month follow-up (mfu). For all patients clinical 5-year follow-up was completed and adjudicated on major
adverse cardiac event (MACE) endpoint.
RESULTS
Prevalence of PapMI was 16.9% (n=15); 20% anterior, 60% posterior, 20% both. PapMI appeared more frequently in occlusion of
LCx and RCA (p<0.05). Ejection fraction (EF) at baseline was lower in patients with PapMI than without (44.31% vs 48.39%).
Recovery at 4-mfu was better in patients with PapMI (ΔEF 2.09% vs 3.74%; Δventricular scaring -0.53% vs -2.47%;p>0.05).
Ventricular scaring was largest in infarction of both muscles (39.66%;p>0.1). EF recovery at 4-mfu was best with infarction of both
muscles (13.33%;p>0.1). For cumulative population (n=89) there was strong negative correlation between EF and ventricular
scaring at baseline (r=-0.65;p<0.001).At 5-year follow-up 12.4% of patients experienced MACE. At 4-mfu EF in patients with MACE
was reduced compared to baseline (-1.23% versus +2.87 without MACE;p=0.091) while ventricular scaring increased significantly
(+1.45% versus -1.18% without MACE;p=0.017).
CONCLUSION
The extent of ventricular scaring influences the global heart function rather than the presence of PapMI. At 5-year follow-up PapMI
is not a predictor, but rather a side effect of ischemic cardiac disease without affecting directly longterm-survival and heart
function of patients with AMI.
CLINICAL RELEVANCE/APPLICATION
The PapMI is not a predictor of a negative cardiac event after a 5-year follow-up. A PapMI should be understood as a side effect
of ischemic heart disease being present on the vascular anatomy and the closing level of the coronary vessel without direct
influence on survival alone.
CA236-SDTUB6
Congenital Biscuspid Aortic Valve in Pediatric and Early Adulthood: Does Valvular Leaflet Fusion
Pattern Affect Other Parameters?
Station #6
Participants
Noha Behairy, MD, Cairo, Egypt (Presenter) Nothing to Disclose
Ahmed Ramadan, Cairo, Egypt (Abstract Co-Author) Nothing to Disclose
PURPOSE
Our aim was to detect if there is a relationship between the leaflet fusion pattern and other functional parameters including valvular
regurge, stenosis and pressure gradient as well as associated findings.
METHOD AND MATERIALS
One hundered patients between 3 months to 26years were included in the study. They were 78 males and 22 females. BSA for the
patients ranged from 0.45-2.27. All patients were subjected to clinical examination, transthoracic echocardiography and CMR on a
1.5T machine. Written consents were taken from the patients or their guardians. CMR protocol included 2 chamber, 4 chamber,
short axis, LVOT, Q flow on the aortic valve, MRA on the aorta and delayed enhancement was done in cases suspicious of
associated myocardlial pathology. We recorded the leaflet fusion pattern, presence of AS, AR, pressure gradient, EF, LVEDV, aortic
diameter at the annulus, sinus, arch and ascending aorta levels. Associated findings were all recorded.
RESULTS
Sixty patients had right and left coronary cusps (R-L) fusion showing mean pressure gradient of 23.5±14.8 of those 48% patients
showed AS while 52% had AR. Forty patients had right and noncoronary cusps (R-N) fusion with 44.5±31 pressure gradient with P =
0.02, of those 75% had AS while 45% had AR with 20% showing combined lesions. Ejection fraction was within normal range except
in patients with associated myocardial lesions. LVEDV ranged from 49-185ml. Aorta was dilated in 38 cases with no predilection for
any leafleted fusion type. Associated co-aorctation of the aorta was detected in 22 patients of which18 had R-L fusion. Other
associations were PDA (8 cases), VSD (8cases), hypoplastic aortic arch (6 cases), DCM and DORV (2 cases each).
CONCLUSION
Our study showed that patients with R-L leaftet fusion had lower pressure gradient and a higher association with co-aorctation of
the aorta, while patients with R-N leaflet fusion had higher pressure gradient with higher incidence of aortic stenosis.
CLINICAL RELEVANCE/APPLICATION
Knowing if the pattern of valve leaflet fusion in BAV is important for patient management plan and treatment specially in pediatric
age group.
CA114-EDTUB8
Embryological Approach for Understanding Pulmonary Venous Developmental Anomalies
Station #8
Participants
Toru Sakuma, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Kunihiko Fukuda, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Kotaro Ouchi, Kashiwa, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: 1. To learn embryology of pulmonary veins and normal pulmonary venous anatomy 2. To review
cardiac CT imaging of pulmonary venous developmental anomalies 3. To learn important findings that should not be missed
TABLE OF CONTENTS/OUTLINE
Contents: 1. Illustrated description of embryonic development of pulmonary veins 2. Cardiac CT imaging of numerous pulmonary
venous developmental anomalies, including total anomalous pulmonary venous connection (TAPVC) type Ia, Ib, IIa, IIb, III, IV,
partial anomalous pulmonary venous connection (PAPVC), scimitar syndrome, veno-venous bridge, cor triatriatum, in comparison
with embryonic development of pulmonary veins 3. Clinical important findings have to be depicted Summary: Cardiac CT is
frequently performed for patients who present with suspected congenital heart disease because it is mandatory to describe precise
anatomical information and to identify the underlying abnormalities for cardiovascular surgeons. Abnormal embryonic pulmonary vein
development may comprise a wide spectrum of anatomical variations and show various clinical presentations. We will let you
understand various types of pulmonary venous developmental anomalies using embryological approach.
MSAS33
Radiation Safety and Dose Optimization (Sponsored by the Associated Sciences Consortium) (An Interactive
Session)
Tuesday, Dec. 1 1:30PM - 3:00PM Location: S105AB
CA
PD
SQ
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Richard Evans, London, United Kingdom (Moderator) Nothing to Disclose
Louise Coleman, London, United Kingdom (Moderator) Nothing to Disclose
Sub-Events
MSAS33A
Dose Optimization in Pediatric Cardiology
Participants
Sonyia L. McFadden, MD, Antrim, United Kingdom, (s.mcfadden@ulster.ac.uk) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Comprehend current levels and risks of radiation exposure in Paediatric Interventional Cardiology (PIC). 2) Be able to calculate
Local Diagnostic Reference Levels (LDRL). 3) Identify the different Interventional cardiology (IC) protocols currently used across
the UK/Ireland and their impact on radiation dose/image quality. 4) Apply best practice in PIC.
ABSTRACT
PURPOSEThe number of pediatric interventional cardiology (PIC) procedures being performed has increased rapidly in recent years
due to their reliability and cost effectiveness. However, interventional cardiology procedures have been reported to contribute to
the highest doses of radiation to patients from medical examinations. Previous authors have estimated DRL for PIC and identified a
wide variation of radiation exposure to the patient.METHOD AND MATERIALSA questionnaire study was used to investigate the PIC
protocols currently used in clinical departments. Experimental studies were performed on anthropomorphic phantoms investigating
these different variations in practice and the subsequent effect on image quality and radiation dose. A subsequent randomised
controlled trial investigating these different protocols and their effect on image quality and dose is currently ongoing in the clinical
environment. The effect of different scatter removal techniques on radiation dose and associated DNA damage was also
investigated by quantifying γH2AX-foci as a biomarker of radiation-induced effect.RESULTSWide variations in imaging protocols are
currently being used across different hospitals. These variations in practice are having a significant impact on the resultant
radiation dose to the patient. Results of experimental studies on anthropomorphic phantoms showed that radiation dose reductions
of 30% to 50% could be achieved by removing the anti-scatter grid, introducing an air gap and decreasing the frame rate with
minimal impact on image quality. Radiation induced DNA damage is evident in patients undergoing PIC procedures and mean γH2AXfoci can be significantly greater in different hospitals depending on the protocol used.CONCLUSIONGreat variation in radiation
exposure exists across hospitals performing similar examinations on similar sized patients. There is a clear need for standardised
protocols and guidelines.The anti-scatter grid should be removed routinely for newborn and infant patients undergoing PIC. The air
gap should be introduced when possible.CLINICAL RELEVANCE/APPLICATIONSimple modifications to clinical protocols will ensure the
radiation dose to pediatric patients is kept ALARA without affecting image quality or diagnostic efficacy.
MSAS33B
Learning from Errors and Near-Misses
Participants
Sarah Peters, Didcot, United Kingdom, (sarah.peters@phe.gov.uk) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify common causes of errors and near-misses in the UK. 2) Describe the way errors and near-misses are investigated and
reported in the UK. 3) Compare several approaches to disseminating learning from errors and near-misses.
ABSTRACT
Healthcare professionals have a duty to inform their employer when things go wrong, regardless of whether it leads to actual harm.
In turn employers should create an environment where staff members are supported and encouraged to report errors and nearmisses.The World Health Organization (WHO) defines an error as "the failure of a planned action to be completed as intended or the
use of a wrong plan to achieve an aim. Errors may be errors of commission or omission, and usually reflect deficiencies in the
systems of care".The first stage in learning from an error is to investigate not just the 'who was involved, what happened and
when?' but more importantly the 'why did it happen?' These investigations should seek to establish the facts surrounding the error
rather than apportion blame, unless there was obvious malicious intent. Error investigations should also include recommendations
and changes to systems of work and procedures that will lead to improvements in patient safety and prevent recurrence.For every
error or incident, many more near misses will occur. The reporting and subsequent investigation of near misses can reduce the
chances of an actual error occurring.No system is perfect, especially when human beings play an integral part in the process. The
key point is that when errors and near-misses occur, organisations and individuals must learn from them and also ensure that this
learning is shared. This could be on a local, regional or even national level to avoid the same mistake happening over and over
again, at multiple locations and impacting the lives of numerous patients.This presentation will look at common errors and nearmisses from a UK perspective as well as a number of approaches that are used both locally and nationally to ensure that learning is
shared amongst the Radiology community.
SSJ03
Cardiac (Pericardial and Cardiac Valve Imaging)
Tuesday, Dec. 1 3:00PM - 4:00PM Location: S502AB
CA
CT
MR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Leena Mammen, MD, Grand Rapids, MI (Moderator) Nothing to Disclose
Scott R. Akers, MD, PhD, Philadelphia, PA (Moderator) Nothing to Disclose
Diana Litmanovich, MD, Haifa, Israel (Moderator) Nothing to Disclose
Sub-Events
SSJ03-01
Remote 4D MR Flow Assessment of Aortic Valve Regurgitation
Tuesday, Dec. 1 3:00PM - 3:10PM Location: S502AB
Participants
Raluca G. Saru, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Albert Hsiao, MD, PhD, San Diego, CA (Abstract Co-Author) Founder, Arterys, Inc; Consultant, Arterys, Inc; Research Grant,
General Electric Company
Laurens E. Swart, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Piotr A. Wielopolski, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Shreyas S. Vasanawala, MD, PhD, Palo Alto, CA (Abstract Co-Author) Research collaboration, General Electric Company;
Consultant, Arterys; Research Grant, Bayer AG;
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
PURPOSE
4D MR Flow has shown to have advantages over standard cardiac magnetic resonance (CMR), offering both anatomical and
functional information in just a single acquisition.Processing of the large amount of data requires dedicated software.We evaluated
the feasibility and performance of a cloud-based application that combines pre-processing and visualization of 4D Flow data, and
assessed its accuracy for the detection and grading of aortic valve regurgitation (AR) using trans-thoracic echocardiography (TTE)
as reference.
METHOD AND MATERIALS
Between June 2014 and January 2015 patients planned for clinical CMR were consecutively approached to undergo the 4D Flow
examination. The 4D Flow data was uploaded to a dedicated web-based software application for eddy-currents correction,
interactive visualization of the anatomical and flow components, and detection and grading of the aortic regurgitation. The
diagnostic characteristics of 4D MR Flow were evaluated against TTE.
RESULTS
Fifty-four patients were included. The agreement between 4D Flow and TTE for the grading of AR was good (κ=0.726). For
detection of any degree of AR, 4D MR Flow had a sensitivity of 94.4% (81.3-99.2), a specificity of 72.2% (46.5-90), and a positive
(PPV) and negative predictive value(NPV) of 86.7% (59.5-97.9) and 87.1% (72.6-95.7) respectively. To identify clinically relevant
moderate or severe AR, 4D Flow MR had a sensitivity of 100% (40.2-100), specificity of 98% (89.3-99.7), PPV of 80% (28.8-96.7)
and NPV of 100% (92.7-100).
CONCLUSION
Aortic regurgitation can be detected and graded accurately using 4D Flow in comparison to TTE. The use of a remote application
with advanced data correction, integrated with interactive imaging tools allowed for interpretation of the 4D Flow data.
CLINICAL RELEVANCE/APPLICATION
The potential advantages of a 4D Flow protocol are that during a free-breathing acquisition of 7-10 minutes, flow sensitive
information in all three dimensions is acquired for the entire thorax. Without a need to specify beforehand, or assistance during the
examination, flow can be retrospectively measured anywhere and in any direction within the thorax. While 2D sequences measure
flow in a static plane, 4D Flow allows for continuous alignment of the measurement plane to the position of moving structures (e.g.
valve annulus). In case of regurgitation jets that change direction throughout the heart cycle, 4D Flow imaging can provide more
complete visualization.
SSJ03-02
Mitral Annular Dimensions and Geometry in Normals and Patients with Mitral Regurgitation:
Implications for CT-based Sizing in Transcatheter Mitral Valve Implantation
Tuesday, Dec. 1 3:10PM - 3:20PM Location: S502AB
Participants
Nicolas J. Bilbey, MD, Vancouver, BC (Presenter) Nothing to Disclose
Christopher Naoum, MBBS, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Jonathon A. Leipsic, MD, Vancouver, BC (Abstract Co-Author) Speakers Bureau, General Electric Company Speakers Bureau,
Edwards Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc
Anson Cheung, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Jian Ye, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
George Mak, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Adam Berger, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Danny Dvir, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Chesnal Dey Arepalli, MD, Burnaby, BC (Abstract Co-Author) Nothing to Disclose
Jasmine Grewal, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
David Muller, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Darra T. Murphy, MD, FRCPC, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Cameron J. Hague, MD, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Nicolo Piazza, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
John Webb, MD, FRCPC, Vancouver, BC (Abstract Co-Author) Consultant, Edwards Lifesciences Corporation
Philipp Blanke, MD, Vancouver, BC (Abstract Co-Author) Consultant, Edwards Lifesciences Corporation ; Consultant, Neovasc Inc
PURPOSE
The D-shaped mitral annulus was recently proposed as a potentially more appropriate method[DM1] for annular sizing prior to
transcatheter mitral valve implantation (TMVI). We sought to firstly establish normative CT values for the D-shaped mitral annulus;
and secondly, to evaluate these parameters in patients with mitral regurgitation (MR) and determine drivers of annular size.
METHOD AND MATERIALS
Patients with retrospectively-gated cardiac CT performed at our institution (2012-2014) and free of cardiovascular disease were
included ('normals', n=105, 57±11yrs, 51 female). Patients with mitral regurgitation (MR) being considered for transcatheter mitral
therapy were also evaluated (mitral valve prolapse, MVP, n=24, 78±12yrs, 10 female; functional MR, FMR, n=20, 69±14yrs, 6
female). Mitral annular dimensions (projected area, perimeter, trigone-trigone (TT), intercommissural (IC) and septal-lateral (SL)
distance) were measured during mid-late diastole and compared between groups. Maximal left atrial (LA) and phasic left ventricular
(LV) volumes were also measured.
RESULTS
Absolute (indexed) mean ± SD mitral annulus area, perimeter, TT, IC and SL values in normals were 8.95±1.53cm2
(4.68±0.62cm2/m2), 110±9mm (58±6mm/m2), 28.5±3.3mm (15.0±1.9mm/m2), 37.5±3.7mm (19.7±2.1mm/m2) and 27.8±2.8mm
(14.6±1.7mm/m2), respectively. Indexed Annular area was larger in MR patients compared to controls (6.49±1.53m2/m2 vs.
4.68±0.62cm2/m2, P<0.001) and importantly, was larger in MVP patients compared to FMR patients (7.20±1.43cm2/m2 vs.
5.59±1.14cm2, P<0.001). Annular distortion was also observed in MR patients with reduced IC/SL ratio compared to normals
(1.26±0.11 vs. 1.36±0.14, P<0.001). While LA and LV volumes independently predicted annular size in normals and were both
associated with annular size in MVP patients, only LA volume was associated with annular size in FMR patients.
CONCLUSION
We describe normative CT values for the D-shaped mitral annulus. Moreover, we demonstrate differences in and varied drivers of
annular dimensions in patients with MVP and FMR who are being considered for transcatheter mitral therapy.
CLINICAL RELEVANCE/APPLICATION
The data presented provides useful information regarding annular sizing using cardiac CT for the purposes of TMVI.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Jonathon A. Leipsic, MD - 2015 Honored Educator
SSJ03-03
Aortic Valve Planimetry by High-Resolution 3-Dimensional MR Image Acquisition with a Breath-hold:
Comparison with Conventional Cine MR Imaging and Echocardiography to Assess the Severity of
Aortic Valve Stenosis
Tuesday, Dec. 1 3:20PM - 3:30PM Location: S502AB
Participants
Hae Jin Kim, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Sung Mok Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Moon Young Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
So Hyeon Bak, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sung-Ji Park, Seoul, Moldova, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Hyeon Choe, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
We intended to evaluate the novel application of high-resolution 3-dimensional MR image acquisition with single-breath-hold SSFP
sequence to calculate the aortic valve area (AVA).
METHOD AND MATERIALS
In 88 consecutive patients (66.9 ± 9.59 years, 63% men) with varying degrees of aortic valve stenosis, high-resolution 3D SSFP
images (3D planimetry; 2.0 mm slice thickness, 20 contiguous slices; image matrix, 256 ´ 209) were acquired with single breathhold during mid systole and mid diastole. SSFP cine MR imaging (2D planimetry) and velocity-encoded cine MRI (slice thickness, 4.5
mm) in three levels of aortic valve were also performed. AVA area was measured by two experienced observers using commercial
software (iNtuition, TeraRecon). MR imaging measurements and image quality were compared with transthoracic echocardiographic
measurements of effective aortic orifices (EAO) using the continuity equation (1 = severe blurring of images, 2 = moderate blurring
of valve contours; 3 = mild blurring of valve contours, 4 = excellent and no artifact). Sensitivity for accurate measurement and
receiver operating characteristic (ROC) curve were calculated. Intra- and interobserver agreements were determined by using
intraclass correlation coefficient (ICC).
RESULTS
Mean AVA derived by 3D planimetry, 2D planimetry, and echocardiography were 0.77 ± 1.04 cm2, 0.72 ± 1.16 cm2, and 0.75 ± 0.32
Mean AVA derived by 3D planimetry, 2D planimetry, and echocardiography were 0.77 ± 1.04 cm2, 0.72 ± 1.16 cm2, and 0.75 ± 0.32
cm2, respectively. The ICC value of 3D planimetry was higher than 2D planimetry [0.799 (CI, 0.691-0.869) vs. 0.743 (CI, 0.6050.832)] with echocardiographic EAO as the standard of reference. The grade of image quality of 3D planimetry was superior to 2D
planimetry (3.65 ± 0.65 vs. 3.17 ± 0.65). The correlation coefficients of maximum peak velocity on velocity-encoded cine MR
imaging with 3D planimetry and that with 2D planimetry were 0.42 (p < 0.05) and 0.35 (p < 0.05). Intra- and interobserver
agreements for 3D planimetry were excellent [ICC = 0.949 (CI, 881-979) and 0.846 (CI, 0.636-0.935), respectively; both, p =
0.000).
CONCLUSION
Novel application of high-resolution 3D SSFP breath-hold MR imaging enables planimetry of AVA in patients with valvular aortic
stenosis with better image quality than 2D planimetry with conventional cine MR imaging.
CLINICAL RELEVANCE/APPLICATION
Our findings support the validity of 3D planimetry at accurate assessment of the severity of aortic valve stenosis.
SSJ03-04
Association between Geometric Distribution of Wall Shear Stress and Aortic Dilatation in Patients with
Aortic Stenosis: Comparison between TAV and BAV
Tuesday, Dec. 1 3:30PM - 3:40PM Location: S502AB
Participants
Hojin Ha, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Dong Hyun Yang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Guk Bae, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jihoon Kweon, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young-Hak Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Namkug Kim, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Stockholder, Coreline Soft, Inc
Joon-Won Kang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Tae-Hwan Lim, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Although abnormal wall shear stress (WSS) distribution is suspected to have a significant role on the development of the aortic
dilatation, the relationship between hemodynamics characteristics and aortic dilatations is not fully understood yet. The present
study investigates the association between the WSS distributions and aortic dilatations in aortic-stenosis (AS) patients with
tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV).
METHOD AND MATERIALS
A total of 54 moderate and severe AS-patients (TAV=32, BAV=22) who underwent cardiac computed tomography (CT) and phase
contrast magnetic resonance imaging (PC-MRI) at the ascending aorta were retrospectively collected. For calculation of WSS, 2D
velocity profiles were extracted from PC-MRI at the level of ascending aorta. Then, a total of 360 velocity line-profiles were
extracted from the center of the vessel to the wall with 1 degree angular increments. Aortic diameter was measured at 10 levels
from aortic annulus to distal descending aorta using CT. Differences of the aortic diameters and WSS distributions between TAV
and BAV were statistically analyzed using student t-test. Association between aortic diameter and regional WSS at the level right
pulmonary artery were evaluated using linear regression.
RESULTS
Patients with BAV showed more asymmetric systole blood flow compared to those with TAV (center of flow r/R; 0.59±0.11 vs.
0.67±0.10, p=0.018). As a result, AS patients with BAV has significantly higher systolic WSS (0.55±3.14 Pa vs. 2.91±3.20 Pa,
p=0.009) at the right-posterior region and lower systolic WSS (1.12±3.58 vs. 3.12±3.36, p=0.044) at the left and left-posterior
regions of the ascending aorta. In accordance with the increased WSS distribution, AS patients with BAV are found to have larger
diameters of the ascending aorta compared to those with TAV (BAV vs. TAV: 43.7±7.2 mm vs. 34.1±4.8 mm, p <0.001). Linear
regression between the aortic diameter and systolic WSS shows that the increment of the WSS represents about 14% of the aortic
dilatation.
CONCLUSION
Among patients with aortic stenosis, patients with BAV showed more eccentric WSS and larger aortic diameter as compared to
those with TAV at the level of ascending aorta. Eccentric distribution of WSS showed significant correlation with aortic diameter.
CLINICAL RELEVANCE/APPLICATION
WSS may be used to predict future risk of aortic dilatation in patients with aortic stenosis.
SSJ03-05
Multidetector-row Computed Tomography in Patients with Suspected Prosthetic Valve Dysfunction: A
Prospective Study
Tuesday, Dec. 1 3:40PM - 3:50PM Location: S502AB
Participants
Dominika Sucha, MD, Utrecht, Netherlands (Presenter) Nothing to Disclose
Steven Chamuleau, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Petr Symersky, MD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Renee B. Van Den Brink, MD, PhD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Wilco Tanis, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Eduard M. Laufer, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Bas De Mol, MD, PhD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Willem P. Mali, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Jesse Habets, MD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Lex Van Herwerden, Utrecht, Netherlands (Abstract Co-Author) Research Consultant, St. Jude Medical, Inc
Ricardo P. Budde, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
PURPOSE
To systematically assess the role of retrospectively ECG-gated multidetector-row computed tomography (MDCT) for the evaluation
of patients with suspected prosthetic heart valve (PHV) dysfunction.
METHOD AND MATERIALS
We performed a prospective cross-sectional study and enrolled patients consecutively during their clinical presentation in two
university hospitals. Inclusion criteria were: 1. Aortic PHVs with an increase (>20mmHg) of the max. transprosthetic pressure
gradient (TPG), 2. Mitral PHVs with a high mean TPG (>10mmHg), 3. Abnormal (peri)valvular leakage, 4. Leaflet restriction on
fluoroscopy (>5 degrees) or 5. Clinical abnormalities likely due to PHV-dysfunction (e.g. stroke). All patients underwent
transthoracic (TTE) and transesophageal (TEE) echocardiography ± fluoroscopy (routine diagnostic work-up). Additional cardiac
retrospectively ECG-gated MDCT imaging was performed on a 256-slice or 64-slice MDCT scanner in all patients.
RESULTS
Forty-two patients were included (mean age 62±13 years) with 40 mechanical and 9 biological PHVs (34 aortic, 15 mitral). Main
reasons for suspected dysfunction were: aortic TPG increase (n=20, 48%), clinical abnormalities (n=14, 33%) and/or abnormal
(peri)valvular leakage (n=12, 29%). Median radiation exposure was 11.6 mSv [interquartile range 10.8-14.4], 40 patients (95%)
were imaged on the 256-slice scanner. MDCT detected one or more PHV-related pathologies in 32/42 (76%) patients: pannus
(n=11), thrombus (n=5), pannus/thrombus (n=2), PHV angulation (n=2), left ventricular outflow tract obstruction (n=4),
paravalvular leakage (n=7), pseudoaneurysms (n=2), bioprosthesis degeneration (n=1), native annulus remnant (n=1), patient
prosthesis mismatch suspicion (n=2) and restricted leaflet motion of unknown cause (n=3).
CONCLUSION
In this prospective study, MDCT imaging revealed a morphological substrate in 32/42 (76%) patients with suspected PHV
dysfunction and showed a valuable imaging tool for PHV evaluation.
CLINICAL RELEVANCE/APPLICATION
Additional MDCT imaging allows identification of the underlying pathology in the diagnostic work-up of suspected PHV dysfunction.
SSJ03-06
CT-Angiography Prior to Transcatheter Aortic Valve Replacement (TAVR) - Identification of Different
Parameters Leading to a Post-interventional Valvular or Para-valvular Leak
Tuesday, Dec. 1 3:50PM - 4:00PM Location: S502AB
Participants
Florian Wolf, MD, Vienna, Austria (Presenter) Nothing to Disclose
Carmen Fischer, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Dietrich Beitzke, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Philip Kresl, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Sabine Scherzer, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Christian Loewe, MD, Vienna, Austria (Abstract Co-Author) Speaker, Bracco Group Speaker, Guerbet SA Speaker, General Electric
Company Speaker, Medtronic, Inc Speaker, Bayer AG Speaker, Siemens AG
PURPOSE
The purpose of this study was to identify pre-interventional factors by means of CT-Angiography, which could predetermine the
incidence of a significant post-interventional paravalvular or valvular leakage (PVL) in TAVR patients.
METHOD AND MATERIALS
In this retrospective study 160 datasets of patients that underwent TAVR from 2007 until 2013 were analyzed. In 87 patients (36
male, 51 female, mean age 82,6 years, range 63-95 years), all necessary post-interventional echocardiographic datasets were
available to evaluate the degree of aortic insufficiency up to 30 days after TAVR (mild, moderate, severe - moderate to severe
aortic insufficiency was rated as clinically significant). Using the CT-Datasets following parameters were evaluated: diameter (D)
and area of the annulus, distance between the annulus and the right and left coronary artery, respectively, valve calcification
degree (no, mild, moderate, severe calcification), cover index (100 × [prosthesis D - D_mean Annulus]/prosthesis D) and
eccentricity indices (D_meanAnnulus - D_areaAnnulus and D_maxAnnulus - D_minAnnulus). Data was statistically analyzed by
means of linear and multivariate regression analysis and correlated with degree of post-interventional aortic insufficiency.
RESULTS
CoreValve- and Edwards Sapien prostheses were implanted in 20 and 67 patients, respectively. In 94,3% of the patients a postinterventional PVL of any degree within 30 days was detected by echocardiography. Degree and rate of PVL was not different
between the CoreValve or Edwards Sapient System. Univariate regression analysis reported a sole significant (p=0.01) reverse
relationship between the cover index and severity of post-interventional PVL. All other parameters showed no significant correlation
with degree of PVL. In patients with a prosthesis oversizing of at least 15% no clinical relevant PVLs were detected.
CONCLUSION
In this study the cover index is the strongest and sole predictor of post-interventional PVL in TAVR patients. A certain degree of
prosthesis oversizing may be required to reduce the incidence of PVL.
CLINICAL RELEVANCE/APPLICATION
Pre-interventional identification of factors leading to a post-interventional PVL could help to develop strategies to reduce rate of
post-interventional PVL.
SSJ04
Cardiac (Quantitative Imaging)
Tuesday, Dec. 1 3:00PM - 4:00PM Location: S504AB
CA
BQ
CT
MR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
FDA
Discussions may include off-label uses.
Participants
Lisa Diethelm, MD, New Orleans, LA (Moderator) Nothing to Disclose
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Moderator) Research Grant, Toshiba Corporation;
Dianna M. Bardo, MD, Seattle, WA (Moderator) Speaker, Koninklijke Philips NV; Consultant, Koninklijke Philips NV; Author, Thieme
Medical Publishers, Inc
Sub-Events
SSJ04-01
Diagnostic Value of Quantitative Edema Detection Using T2-mapping in Acute Myocarditis
Tuesday, Dec. 1 3:00PM - 3:10PM Location: S504AB
Awards
Trainee Research Prize - Resident
Participants
Bettina Baessler, MD, Cologne, Germany (Presenter) Nothing to Disclose
Frank Schaarschmidt, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Anastasia Dick, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
Christian Stehning, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Bernhard Schnackenburg, PhD, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Guido Michels, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
David C. Maintz, MD, Koln, Germany (Abstract Co-Author) Nothing to Disclose
Alexander C. Bunck, Koln, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the diagnostic value of T2-mapping in patients with acute myocarditis (ACM) and to define an appropriate cut-off
value for edema detection.
METHOD AND MATERIALS
CMR data of 35 patients with clinically suspected ACM and confirmation of diagnosis by CMR according to the Lake Louise criteria
were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. All patients and HV were examined on a clinical 1.5T
scanner, where - in addition to the routine CMR protocol - a breathhold Gradient Spin Echo (GraSE) T2-mapping sequence had been
acquired at a basal, midventricular and apical slice in short axis view. T2-maps were segmented according to the 16-segments
AHA-model and segmental T2 values as well as the segmental pixel-SD were analyzed. Statistical analysis was conducted using
independent t-test, multiple logistic regression analyses, random forests, and decision trees.
RESULTS
Means of global myocardial T2 or pixel-SD showed only small differences between HV and ACM patients (T2: 58.7 ± 0.3 ms vs. 63.1
± 0.4, p < .001; pixel-SD: 7.7 ± 0.1 vs. 8.6 ± 0.2, p < .001), lying in the observed normal range of HV. In contrast, variation of T2
values as well as of pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression
analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD)
of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and
ACM patients with an AUC of 0.85 in ROC-analysis. In decision trees, a cut-off of 0.22 for madSD and of 67.7 ms for maxT2
resulted in 83% specificity and 97% sensitivity for classification between HV and ACM, even when not taking into account Lake
Louise criteria.
CONCLUSION
The proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity
and in a quantitative manner. The two parameters have the potential to overcome the hurdles of T2-mapping for its integration into
clinical routine and should be validated in a greater patient cohort.
CLINICAL RELEVANCE/APPLICATION
Myocardial edema is an important factor not only in ACM. T2-mapping promises to be a quantitative approach in edema imaging,
overcoming some limitations of qualitative edema assessment.
SSJ04-02
Myocardial T1 Mapping in Asymptomatic Subjects: Variations According to Left Ventricular Segments
and Correlation with Cardiovascular Risk Factors
Tuesday, Dec. 1 3:10PM - 3:20PM Location: S504AB
Participants
Moon Young Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Soo Jin Cho, Seoul, Moldova, Republic Of (Abstract Co-Author) Nothing to Disclose
Hae Jin Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sung Mok Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang-Chol Lee, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yeon Hyeon Choe, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate whether there is variation in precontrast and postcontrast myocardial T1 time (prT1 and poT1, respectively) and
extracelluar volume fraction (ECVF) according to left ventricular (LV) segments and to search for any correlation between them and
known cardiovascular risk factors.
METHOD AND MATERIALS
This study included 198 asymptomatic subjects (180 men and 18 women, age 54.4 ± 6.12 years) who underwent cardiac MR
imaging. Precontrast T1 mapping and postcontrast T1 mapping 15 minutes after 0.2 mmol gadobutrol injection were performed using
shortened modified look-locker inversion recovery [ShMOLLI] sequence at 1.5T (Magnetom Avanto, Siemens). Short-axial cine MR
imaging was performed with SSFP technique. T1 values and ECVFs were calculated in 16 AHA myocardial segments. Those values
were compared among LV segments and correlated with presence of hypertension (n = 52), diabetes mellitus (DM, n = 15), or both
(n = 17). ECVF was also correlated with LV mass.
RESULTS
The overall prT1 and poT1 values and ECVF were 1006 ± 291.5 ms, 454.2 ± 38.5 ms, and 0.24 ± 0.04, respectively. There was
significant difference between apical segments and mid-basal segments in poT1 value and ECVF (p<0.03) and between mid-septal
segments and mid-lateral segments in T1 values and ECVF (p <0.04). ECVF showed reverse correlation with LV mass (p=0.002).
There was significantly lower poT1 value (449 ± 35.6 ms) and higher ECVF (0.24 ± 0.04) in subjects with hypertension compared
with those (459 ± 43.3 ms and 0.23 ± 0.02) of subjects without hypertension (p<0.05). Subjects with DM showed no difference in
all T1 values from subjects without DM or hypertension, except poT1 values in mid-septal segments (447 ± 23.6 ms vs 459 ± 45.6
ms, p=0.02). Subjects with both risk factors showed no difference in all T1 values from subjects without DM or hypertension,
except prT1 value between apical septal and lateral segments (1007 ± 126 ms vs 999 ± 156 ms, p=0.03).
CONCLUSION
The septal wall showed higher prT1 value and ECVF but lower poT1 value than the lateral wall of mid- and basal levels. PoT1 value
and ECVF are significantly affected by hypertension and LV mass.
CLINICAL RELEVANCE/APPLICATION
Normal range of T1 values and ECVF and their segmental variation should be differentiated from myocardial pathologic conditions.
Moreover the cardiovascular risk factors may affect T1 values, ECVF, and LV function in asymptomatic subjects before
cardiovascular symptoms develop.
SSJ04-03
3D-Dixon MRI Based Volumetry of Peri- and Epicardial Fat
Tuesday, Dec. 1 3:20PM - 3:30PM Location: S504AB
Participants
Rami Homsi, Bonn, Germany (Presenter) Nothing to Disclose
Michael Meier-Schroers, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Gieseke, DSc, Bonn, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Julian A. Luetkens, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Darius Dabir, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Claas P. Naehle, MD, Bonn, Germany (Abstract Co-Author) Consultant, Medtronic, Inc
Daniel Kuetting, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Daniel K. Thomas, MD, PhD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Alois Martin Sprinkart, MSc, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
There is growing evidence that pericardial and epicardial fat volume (PFV, EFV) are associated with cardiovascular risk. The aim of
this study was to develop a novel approach to accurately measure PFV and EFV using a 3D-Dixon based MRI approach.
METHOD AND MATERIALS
A cardiac triggered and respiratory navigator gated 3D-gradient echo pulse sequence (TR=5.4ms, TE1/TE2 = 1.8/4.0ms, α=20°,
voxel size 1.5x1.5x3.0mm3) was developed for cardiac Dixon imaging. Based on this sequence fat fraction maps were computed.
After correction for relaxation effects and setting of an appropriate noise threshold, voxels with more than 50% signal from fat were
added for volumetry. Validation of the measurement accuracy was performed in a phantom consisting of muscle tissue and five
different known volumes of fat (50-200ml). The proposed sequence was acquired in 34 healthy volunteers (22 male, BMI range 1442 kg/m2, age range 21-79y) at 1.5T (Ingenia, Philips). Analysis was performed independently by two readers by drawing two 3Dregion of interests, one for EFV and one for PFV. Additionally, EFV and PFV were compared between overweighted and nonoverweighted subjects.
RESULTS
The phantom study showed an excellent agreement of measured and true fat volumes (maximum difference = 5 ml, linear correlation
R>0.99). PFV over all volunteers was 158.0±126.4ml and EFV was 77.0±55.3ml. PFV and EFV were highly correlated (R=0.96).
Inter-reader agreement was good with a mean difference of 0.2±5.6ml and 4.5±4.2ml for PFV/EFV, (R>0.99, each). EFV and PFV
differed significantly between overweighted and non-overweighted subjects (BMI >25kg/m2 and BMI <25kg/m2, n=17 each) with
PFV 219.0±151.8ml vs. 96.9±44.7ml and EFV 102.3±66.3ml vs. 51.7±23.6ml (p<0.001, each). There was no significant difference in
age between the two groups (41.4±14.3y vs. 42.9±16.0y, p= 0.76).
CONCLUSION
The implemented Dixon method allows accurate measurement of PFV and EFV with all benefits of a 3D-approach similar to CT.
CLINICAL RELEVANCE/APPLICATION
The proposed 3D-Dixon based method allows accurate measurement of cardiac fat volumes, free of ionizing radiation and provides a
valuable tool for cardiovascular risk stratification.
SSJ04-04
Reproducibility of Cine Displacement Encoding with Stimulated Echoes (DENSE) in Human Subjects
Tuesday, Dec. 1 3:30PM - 3:40PM Location: S504AB
Participants
Kai Lin, MD, MSc, Chicago, IL (Presenter) Nothing to Disclose
Michael Markl, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Jeremy D. Collins, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Varun Chowdhary, MD, BS, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Julie A. Blaisdell, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Gong Feng, MD,PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Bruce Spottiswoode, Chicago, IL (Abstract Co-Author) Employee, Siemens AG
James C. Carr, MD, Chicago, IL (Abstract Co-Author) Research Grant, Astellas Group Research support, Siemens AG Speaker,
Siemens AG Advisory Board, Guerbet SA
PURPOSE
To test the hypothesis that two-dimensional (2D) displacement encoding via stimulated echoes (DENSE) is a reproducible technique
for the depiction of segmental myocardial motion in human subjects.
METHOD AND MATERIALS
Following the approval of the institutional review board (IRB), 10 healthy volunteers without documented history of cardiovascular
disease were recruited. For each participant, 2D DENSE were performed twice (at different days) and the data were obtained at
basal, midventricular and apical levels of the LV with a short-axis view. The first and second principal strains (E1 and E2), radial
thickening strain (Err), circumferential rotating strain (Ecc), twist and torsion were calculated. The intra-, inter-observer and interstudy variances were evaluated using coefficient of variation (CoV) and intra-class correlation coefficient (ICC).
RESULTS
In total, there are 160 pairs of myocardial segments (from 2 scans on 10 subjects) for quantitative analysis and comparison. Figure
1 shows an example set of DENSE images demonstrating myocardial displacement maps from a single subject for scan #1 and #2.
The images demonstrated similar image quality and systolic displacement patterns for both acquisitions. These observations were
confirmed by segment-by-segment comparisons which showed no significant differences in peak Ecc, E1, E2, twist and torsion
between two sequential scans. A difference in radial strain was noted, Err (0.43 ± 0.22 vs.0.38 ± 0.19, p = 0.008). There was good
scan-rescan reproducibility of peak Ecc (CoV = 20.59%, ICC = 0.815, p < 0.001), E2 (CoV = 14.85%, ICC = 0.757, p < 0.001),
twist (CoV= 34.12%, ICC = 0.911, p < 0.001) and torsion (CoV = 11.07%, ICC = 0.818, p < 0.001). There was moderate scanrescan reproducibility of Err (CoV = 36.36%, ICC = 0.664, p < 0.001) and E1 (CoV = 32.74%, ICC = 0.646, p < 0.001). The figure
shows similar segmental patterns for all indices, significant differences only for 2 apical segments between two scans.
CONCLUSION
DENSE is a reproducible MRI technique for characterizing regional myocardial motion on a per-segment basis in human subjects.
CLINICAL RELEVANCE/APPLICATION
In the present study, we demonstrated the overall reproducibility of DENSE for the description of LV motion on a per-segment basis
for human subjects.
SSJ04-05
The Relationship between the Transluminal Attenuation Gradient (TAG) Measured from Coronary CT
Angiography (CTA) and Coronary Blood Flow: Validation in Left- versus Right-Dominant Circulation
Tuesday, Dec. 1 3:40PM - 3:50PM Location: S504AB
Participants
Dimitris Mitsouras, PhD, Boston, MA (Presenter) Research Grant, Toshiba Corporation; Speakers Bureau, Toshiba Corporation
Rani S. Sewatkar, MBBS, Edison, NJ (Abstract Co-Author) Nothing to Disclose
Mukta Agarwal, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Andreas Giannopoulos, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Marcus Y. Chen, MD, Bethesda, MD (Abstract Co-Author) Institutional research agreement, Toshiba Corporation
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Abstract Co-Author) Research Grant, Toshiba Corporation;
Elizabeth George, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael Cheezum, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
TAG characterizes the dropoff in contrast enhancement across a coronary artery in a CT angiogram. We sought to validate a
theoretical relationship to coronary flow using the known relationships of physiologic flow amongst the three main coronary arteries.
METHOD AND MATERIALS
We hypothesized that during changing inflow contrast concentration (eg, during bolus up-/down-slope), TAG relates to volumetric
flow as Q~Lumen Area [mm^2]×Inflowing Contrast Enhancement Change [HU/sec]/TAG [HU/mm]. TAG and relative flow metrics
using this equation were calculated in 25 patients with <25% diameter stenoses imaged with 320-row CTA (AquilionOne, Toshiba),
and compared between those with right- (RD) vs left-/co-dominant (LD) circulation. Lumen area was determined for the arterial
length used for TAG measurement. For 22 patients with bolus tracking images additionally available, inflow contrast enhancement
change during the CTA was estimated in the ascending aorta. TAG-derived flow was averaged for each major coronary artery of LD
and RD patients separately, and compared to invasively-measured flows reported in the PREDICTION trial (n=496 patients;
Sakamoto et al, Am J Cardiol 2013;111:1420-).
RESULTS
20 patients were RD and 5 LD. In those with bolus tracking images, TAG-derived flow in the LAD and LCX was within 4-16% of
physiologic values; RCA flow was over/underestimated by 21-40%. In terms of physiologic LD/RD ratios, TAG-derived flow in the
LAD for LD vs RD patients was 1.09 (104 vs 92.5 ml/min), which compares well to the known physiologic ratio of 1.07 (2%
difference). Similarly, the ratio for the LCX was 1.47 (113 vs 76 ml/min) compared to the physiologic ratio of 1.57 (6% difference),
and in the RCA it was 0.37 (56 vs 158 ml/min) compared to 0.50 (26% difference).
CONCLUSION
The TAG in coronary arteries appears inversely proportional to resting coronary flow. Knowledge of the temporal change of inflow
contrast concentration further enables derivation of coronary flow from TAG.
CLINICAL RELEVANCE/APPLICATION
Knowledge of the relationship of TAG to coronary flow can enhance detection of functionally significant CAD. We have used this
relationship to increase TAG accuracy for predicting a significant invasive fractional flow reserve (FFR<0.8), and to obtain more
accurate hyperemic blood flow boundary conditions for FFR-CT estimation via computational fluid dynamics.
SSJ04-06
Feasibility of the Combined CT Assessment of Coronary CT Angiography and Quantitative Myocardial
CT Perfusion Imaging for the Detection of Obstructive Coronary Artery Disease Assessed by Invasive
Coronary Angiography and Cardiac Magnetic Resonance
Tuesday, Dec. 1 3:50PM - 4:00PM Location: S504AB
Participants
Yuki Tanabe, Toon, Japan (Presenter) Nothing to Disclose
Teruhito Kido, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Takahiro Yokoi, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Naoki Fukuyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Ryo Ogawa, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Rami Yokoyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiko Nishiyama, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Tomoyuki Kido, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Masao Miyagawa, MD, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Teruhito Mochizuki, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of this study was to evaluate the diagnostic performance of the combined assessment of coronary computed tomography
angiography (CTA) and quantitative myocardial CT perfusion (CTP) to identify obstructive coronary artery disease (CAD).
METHOD AND MATERIALS
The study group comprised consecutive 34 patients (mean age 68.7 years) who underwent combined CT protocol and cardiac
magnetic resonance (CMR) prior to invasive coronary angiography (ICA). CT scan protocol consisted of pharmacological stress
dynamic myocardial CTP and coronary CTA using 256-slice CT. Obstructive CAD was defined as stenosis>=50% on ICA with a
corresponding myocardial ischemia on CMR. Quantitative CTP assessment was performed with myocardial blood flow (MBF), which
was calculated by model-based deconvolution method using semi-automated prototype software (FUJIFILM RI Pharma Co., Ltd.,
Tokyo, Japan) built on MATLAB (The MathWorks Inc, Natick, MA). A cut-off value of CT-MBF was determined for detecting
myocardial ischemia assessed by CMR using receiver operating characteristic (ROC) analysis at a vessel level. The presence of
coronary stenosis was assessed with lesions defined as follows: 0-no luminal stenosis; 1-minimal (<25% stenosis); 2-mild (25-49%
stenosis); 3-moderate (50-69% stenosis); 4-severe (70-99% stenosis); and 5-occlusion. Coronary stenosis >= 50% or unavailable
vessels were defined as significant, and CT-MBF was referred consequently. A vascular territory with a significant stenosis on CTA
along with CT-MBF less than the cut-off value was considered to be positive. Diagnostic performance (sensitivity, specificity,
positive and negative predictive value [PPV and NPV]) of CTA, CTP and combined assessment (CTA+CTP) for detecting obstructive
CAD.
RESULTS
A cut-off value of CT-MBF was 1.28 ml/g/min. In comparison with ICA and CMR, sensitivity, specificity, PPV and NPV were 97%,
47%, 52% and 97% for CTA, 84%, 76%, 67% and 89% for CTP and 84%, 89%, 82% and 90% for combined assessment. Area under
the ROC curve of CTA, CTP and combined assessment were 0.79, 0.83 and 0.88.
CONCLUSION
Combined CT assessment of CTA and quantitative CTP imaging allows for evaluating obstructive CAD with high diagnostic accuracy
using single modality.
CLINICAL RELEVANCE/APPLICATION
Combined CT protocol of CTA and CTP allows for anatomical and physiological assessment of coronary artery disease with high
diagnostic accuracy by using a single modality.
MSES34
Essentials of Cardiac Imaging
Tuesday, Dec. 1 3:30PM - 5:00PM Location: S100AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Sub-Events
MSES34A
CMR Basics - Patterns of Enhancement
Participants
Nikhil Goyal, MD, Staten Island, NY (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Understand the basic components of a post contrast Cardiac MRI (CMRI) examination. 2) Understand the concept of myocardial
nulling and its role in delayed enhancement CMRI. 3) Learn the patterns of delayed enhancement associated with ischemic and
nonischemic cardiac disease.
MSES34B
Congenital Anomalies of the Coronary Arteries with Pathologic Correlation
Participants
Seth J. Kligerman, MD, Denver, CO (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Recognize various congenital anomalies of the coronary arteries on cross-sectional imaging. 2) Learn which anomalies are benign
and which can lead to adverse cardiac events. 3) Understand how anomalies in the origin, course, and termination of the coronary
arteries can lead to a abnormal perfusion of the myocardium.
MSES34C
Cardiac CT and MRI: Seeing the Unseen
Participants
Musturay Karcaaltincaba, MD, Ankara, Turkey, (musturayk@gmail.com) (Presenter) Speaker, General Electric Company; Speaker,
Koninklijke Philips NV
LEARNING OBJECTIVES
1) To describe the cardiac CT and MRI findings that can not be seen or characterized by echocardiography and catheter
angiography. 2) To depict imaging features of mild atherosclerosis, napkin ring sign, bypass grafts, interatrial septal and myocardial
pathologies. 3) To elucidate our understanding of cardiac pathologies ( such as fibrosis, iron overload and amyloidosis) than can be
diagnosed without biopsy.
RC403
Predicting Outcome with Cardiac CT - Which Is Best?
Tuesday, Dec. 1 4:30PM - 6:00PM Location: N226
CA
CT
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Sub-Events
RC403A
Calcium Scoring
Participants
John J. Carr, MD, MS, Nashville, TN (Presenter) Nothing to Disclose
ABSTRACT
Coronary artery calcifications document the presence of advance atheroma in the coronary arteries. Calcified plaque is the
"sclerosis" of atherosclerosis and thus is an established imaging biomarker of coronary artery disease. In this presentation we will
review the evidence of CAC supporting application of CT measured CAC as a risk marker of coronary artery disease and evidencebased application for clinical practice and prevention in 2015 and beyond.
RC403B
Coronary CT Angiography (CCTA)
Participants
John R. Lesser, MD, Minneapolis, MN, (jrlesser1@gmail.com) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) -Review the data predicting cardiac events from information obtained on cardiac CT angiography. 2) -Understand the predictive
value of coronary CT angiography in the setting of acute chest pain in the emergency room. 3) -Understand the predictive value of
CTangiographic findings in the setting of chronic chest pain. 4.) Review the additional predictive value of coronary CT angiography
relative to calcium scoring in symptomatic vs asymptomatic populations.
ABSTRACT
Active Handout:John Raymond Lesser
http://abstract.rsna.org/uploads/2015/15003315/RC403B.pdf
Active Handout:John Raymond Lesser
http://abstract.rsna.org/uploads/2015/15003315/Active RC403B.pdf
RC403C
Myocardial Perfusion
Participants
Ricardo C. Cury, MD, Miami, FL (Presenter) Research Grant, General Electric Company; Research Consultant, General Electric
Company; Research Consultant, Novartis AG; Research Consultant, Heartflow, Inc
LEARNING OBJECTIVES
1) To review the available literature supporting the growing evidence of myocardial perfusion to predict outcomes. 2) To discuss
new imaging modalities, such as myocardial CT perfusion, and their current role. 3) To describe the current limitations and
challenges of combined CTA/CTP evaluation and its future role.
ABSTRACT
Myocardial perfusion imaging (MPI) is an integral component for the diagnosis and management of patients with coronary artery
disease. Single photon emission computed tomography (SPECT) is the most frequently requested and widely available non-invasive
MPI modality. Importantly, it provides an accurate assessment of the presence or absence of a myocardial perfusion abnormality,
yields incremental prognostic information, and contributes to therapeutic decision making. Coronary CT angiography (CTA) is a noninvasive procedure with high diagnostic performance for the detection and exclusion of obstructive coronary stenosis. While CTA
offers high sensitivity and negative predictive value, its specificity and positive predictive value are less robust and indicate a
systematic over-estimation of stenosis severity . Further, even for high-grade stenoses correctly identified by CTA, comparison
with a fractional flow reserve or SPECT reference standard indicates that more than half do not cause ischemia. These findings
have evoked concerns that CTA without adjunctive physiologic data may promote excess referral to invasive angiography and/or
revascularization. Stress myocardial CT perfusion (CTP) has been shown to provide a combined assessment of both cardiac
anatomy and physiology. Multiple single-center studies have established its feasibility using stress agents such as adenosine,
dipyridamole and regadenoson, with similar diagnostic accuracy compared with other techniques, including SPECT, fractional flow
reserve, cardiac magnetic resonance imaging, and invasive coronary angiography (ICA). Recent multi-center trials also
demonstrated promising results of using combined CTA and Stress myocardial CT perfusion (CTP) for a comprehensive cardiac
evaluation.
ED002-W E
Cardiac Wednesday Case of the Day
W ednesday, Dec. 2 7:00AM - 11:59PM Location: Case of Day, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Timothy S. Tatum, MD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Sushilkumar K. Sonavane, MD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Identify pertinent findings and generate differential diagnosis for cardiac imaging studies. 2) Develop differential diagnoses based
on the clinical information and imaging findings. 3) Recommend appropriate management for patients based on imaging findings.
RC503
Adult Structural and Congenital Heart Disease (An Interactive Session)
W ednesday, Dec. 2 8:30AM - 10:00AM Location: S103AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
ABSTRACT
Sub-Events
RC503A
Systematic Approach to CT Interpretation in Congenital Heart Disease
Participants
Suhny Abbara, MD, Dallas, TX (Presenter) Author, Reed Elsevier; Editor, Reed Elsevier; Institutional research agreement, Koninklijke
Philips NV; Institutional research agreement, Siemens AG
LEARNING OBJECTIVES
1) To understand the systematic segmental approach to congenital heart disease. 2) To recognize the CT specific imaging findings
that relate to each step in the segmental approach to congenital heart disease.
ABSTRACT
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Suhny Abbara, MD - 2014 Honored Educator
RC503B
Tailoring CT Scan Acquisitions to Specific Indications
Participants
Brian B. Ghoshhajra, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To understand the different indications for cardiac CT, including calcium scoring, coronary CT angiography, electrophysiology
procedural planning, structural heart disease interventions (including TAVR), congenital heart disease, myocardial evaluation, and
mass workup. 2) To review the differences between various available equipment, and how available equipment might affect a given
protocol. 3) To review basic protocols for each of the above exam types, and review specific features of each exam type. 4) To
review the advantages and disadvantages of individualized settings within each of the above protocols.
Active Handout:Brian Burns Ghoshhajra
http://abstract.rsna.org/uploads/2015/14000914/RC503B Tailoring CT Scan Acquisitions to Specific Indications - Ghoshhajra
Handout.pdf
RC503C
Imaging of Cardiac Shunts
Participants
Harold I. Litt, MD, PhD, Philadelphia, PA (Presenter) Research Grant, Siemens AG ; Research Grant, Heartflow, Inc;
LEARNING OBJECTIVES
1) Describe MR imaging methods for detection and quantification of intra and extracardiac shunts. 2) Describe CT imaging methods
for detection and quantification of intra and extracardiac shunts. 3) Plan an optimized protocol for CT or MR imaging of shunts.
RC503D
Role of MRI in Adult CHD Management
Participants
Mini V. Pakkal, MBBS, FRCR, Toronto, ON, (mini.pakkal@uhn.ca) (Presenter) Nothing to Disclose
Active Handout:Mini Vithal Pakkal
http://abstract.rsna.org/uploads/2015/14000924/RC503D RSNA final2015.pdf
SSK03
Cardiac (Contrast Media)
W ednesday, Dec. 2 10:30AM - 12:00PM Location: S502AB
CA
CT
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Ethan J. Halpern, MD, Philadelphia, PA (Moderator) Nothing to Disclose
Hans-Christoph R. Becker, MD, PhD, Stanford, CA (Moderator) Nothing to Disclose
Jean Jeudy JR, MD, Baltimore, MD (Moderator) Nothing to Disclose
Sub-Events
SSK03-01
Long-term Adverse Effects of Low-osmolar Compared with Iso-osmolar Contrast Media after
Coronary Angiography: A Propensity Score Analysis
W ednesday, Dec. 2 10:30AM - 10:40AM Location: S502AB
Participants
Yuan-Cheng Wang, Nanjing, China (Presenter) Nothing to Disclose
Adrian Tang, MRCP, FRCR, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Shenghong Ju, MD, PhD, Nanjing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
The long-term adverse effects of low-osmolar contrast media (LOCM) versus iso-osmolar contrast media (IOCM) remain unclear.
This study aims to compare the long-term mortality, renal injury and cardiovascular events between LOCM and IOCM after coronary
angiography using propensity scoring in a large retrospective cohort.
METHOD AND MATERIALS
12611 Cardiology patients underwent coronary angiography between January 2006 to July 2013 using either LOCM (iohexol,
iopromide) or IOCM (iodixanol). For each contrast medium Primary (all-cause mortality) and Secondary outcomes (renal injury and
cardiovascular events beyond 90 days) was recorded. Propensity scoring with subsequent 1:1 matching (PSM) or re-weighting with
inverse probability of treatment (IPW) was applied to minimize the selection bias between groups.
RESULTS
Unadjusted all-cause mortality was significantly lower with LOCM versus IOCM (hazard ratio [HR] = 0.28; 95% CI, 0.23-0.34). After
propensity adjustment, all-cause mortality became comparable and lost statistical significance. LOCM subgroup analysis showed a
trend to lower odds of kidney injury with iopromide vs iohexol after propensity adjustment. Chronic kidney disease (CKD) subgroups
had higher mortality risk when receiving LOCM compared with IOCM (PSM: HR = 3.48, 95% CI: 1.24-9.78; IPW: HR = 4.34, 95% CI:
1.36-13.91).
CONCLUSION
After coronary angiography, patients receiving LOCM had comparable overall long-term mortality compared with IOCM after
propensity adjustment. IOCM may have significantly lower long-term mortality in CKD cohort.
CLINICAL RELEVANCE/APPLICATION
LOCM had comparable long-term adverse effects to IOCM in overall population receiving coronary angiography. However, IOCM
might be more advisable than LOCM for patients with CKD.
SSK03-02
Evaluation of Individually Body Weight Adapted Contrast Media Injection in Coronary CTangiography
W ednesday, Dec. 2 10:40AM - 10:50AM Location: S502AB
Participants
Casper Mihl, MD, Maastricht, Netherlands (Presenter) Nothing to Disclose
Madeleine Kok, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Sibel Altintas, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Bastiaan Kietselaer, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Joachim E. Wildberger, MD, PhD, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Marco Das, MD, Maastricht, Netherlands (Abstract Co-Author) Research Consultant, Bayer AG; Research Grant, Siemens AG;
Speakers Bureau, Siemens AG; Research Grant, Koninklijke Philips NV
PURPOSE
Ideally, contrast media (CM) injection protocols should be customized to the individual patient. The aim of this study was to
determine if software tailored CM injections result in diagnostic vascular enhancement of the coronary arteries and if attenuation
values were comparable between different weight categories.
METHOD AND MATERIALS
265 consecutive patients referred for routine coronary computed tomography angiography (CTA) were scanned on a 2nd generation
dual-source CT at 100kV. Group 1 (n=141) received an individual CM bolus based on weight categories (39-59kg; 60-74kg; 75-
94kg; 95-109kg) and scan duration ('high-pitch: 1s; 'dual-step prospective triggering': 7s), as determined by contrast injection
software (CertegraTM P3T, Bayer). Group 2 (n=124) received a standard fixed CM bolus; Iopromide 300mgI/ml; volume: 75ml; flow
rate: 7.2ml/s. Contrast enhancement was measured in all proximal and distal coronary segments. Statistical analysis was performed
using SPSS (IBM, version 20.0).
RESULTS
For group 1, mean attenuation values of all segments were diagnostic (>325HU) and without statistical significant differences
between different weight categories (p>0.17), proximal-distal: 449±65-373±58HU (39-59kg); 443±69-367±81HU (60-74kg);
427±59-370±61HU (75-94kg); 427±73-347±61HU (95-109kg). Mean CM volumes were: 55±6ml (39-59kg); 61±7ml (60-74kg);
71±8ml (75-94kg); 84±9ml (95-109kg). For group 2, mean attenuation values were not all diagnostic with differences between
weight categories (p<0.01), proximal-distal: 611±142-408±69HU (39-59kg); 562±135-389±98HU (60-74kg); 481±83-329±81HU (7594kg); 420±73-305±35HU (95-109kg).
CONCLUSION
Individually tailored CM injection protocols yield diagnostic attenuation in all scans and a more homogeneous enhancement pattern
between different weight groups compared to a fixed injection protocol. In addition, overall CM volumes could be reduced for the
majority of patients utilizing P3T software.
CLINICAL RELEVANCE/APPLICATION
Individually tailored CM injection protocols in coronary CTA allow substantial reduction of CM volume for the majority of patients
while keeping images diagnostically sufficient.
SSK03-03
Comparison of Three Iodine Concentrations in the Visualization of Coronary Arteries by CT
Angiography: A Randomized European Multicenter Trial
W ednesday, Dec. 2 10:50AM - 11:00AM Location: S502AB
Participants
Hans-Christoph R. Becker, MD, PhD, Stanford, CA (Presenter) Nothing to Disclose
PURPOSE
To assess the diagnostic efficacy of iobitridol 350 compared to iopromide 370 and iomeprol 400in the visualization of coronary
arteries by CT.
METHOD AND MATERIALS
Prospective, randomized, multi-center, double blind, non-inferiority phase IV trial including 468 patients with suspected coronary
artery disease (CAD) and scheduled for clinically indicated coronary CT angiography. The primary endpoint was the CT scan
evaluability for CAD diagnosis in terms of quality and interpretability of images. It was based on the full evaluation of 18 coronary
segments for each patient assessed by 2 off-site independent readers. Secondary endpoints were related to the safety and
efficacy of the 3 contrast media (mainly image quality, stenosis assessment, and signal quantification).
RESULTS
Out of the 452 patients completed for the primary analysis, 92.1% had their 18 segments fully evaluable in the iobitridol group, vs.
94.6 and 95.4% in the iomeprol and iopromide groups respectively. Non-inferiority for the primary outcome was statistically
demonstrated (p<0.05). Mean image quality was good to excellent for all contrast media, and no relevant differences were
observed for the other secondary endpoints between the 3 groups. The mass of iodine (in g) injected was significantly different
between the 3 groups: 27.8±3.4 (iobitridol), 29.3±3.8 (iopromide) and 31.7±3.8 (iomeprol), p<0.001. The good general safety
profile of products was confirmed.
CONCLUSION
Coronary CT angiography using iobitridol 350 is non-inferior to higher concentration contrast agents regarding image quality and
evaluability while the amount of iodine required can be significantly reduced.
CLINICAL RELEVANCE/APPLICATION
The present study addresses the patient safety perspective based on the reduction of iodine loading while keeping adequate
diagnostic capacity in coronary CTA.
SSK03-04
Impact of Contrast Media Iodine Dose on Radiation Induced DNA Damage after Cardiac CTA
W ednesday, Dec. 2 11:00AM - 11:10AM Location: S502AB
Participants
Toon Van Cauteren, MSc, Brussels, Belgium (Presenter) Nothing to Disclose
Nico Buls, DSc, PhD, Jette, Belgium (Abstract Co-Author) Nothing to Disclose
Gert Van Gompel, PhD, Brussel, Belgium (Abstract Co-Author) Speaker, General Electric Company
Johan De Mey, Jette, Belgium (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the impact of the administered contrast media iodine dose on the radiation induced DNA double-strand breaks in
peripheral blood lymphocytes after a diagnostic cardiac CTA in a porcine model.
METHOD AND MATERIALS
A Göttingen minipig (Ellegaard, Denmark) was scanned with a constant cardiac CTA protocol (100 kV, Auto mA, ECG gated, 0-300%
phase, CTDIvol = 45 mGy) on a Revolution CT (GE Healthcare) with an inter-scan delay of one week. We asses a range of contrast
media with different iodine concentrations (0-160-200-320 mg I/mL) while keeping the injection parameters constant (3 mL/s and
60 mL followed by a 12 mL saline flush). Before and 15 min after each CT scan, blood samples were collected and put on ice. The
lymphocytes were isolated from these blood samples and immunofluoresce microscopy was performed to quantify the γH2AX foci
representing the radiation induced DNA double strand breaks. At least 750 lymphocytes were analyzed for each condition.
Statistical analysis was performed using an independent sample t-test.
RESULTS
We report preliminary results of the first experiments without contrast media (0 mg I/mL) and with 320 mg I/mL contrast media
iodine concentration. The amount of DNA double strand breaks was significantly higher when contrast media was present (0.45 ±
0.19 foci/cell) compared to the identical scan protocol without contrast media (0.17 ± 0.15 foci/cell) (p-value < 0.001).
CONCLUSION
The presence of iodine contrast has an impact on the amount of radiation induced DNA double strand breaks. The iodine blood
concentration results in a higher photoelectric effect which lead to an increase in the formation of secondary electrons responsible
for the induction of DNA double strand breaks.
CLINICAL RELEVANCE/APPLICATION
Due to the iodine dose dependent side effect of contrast media, the administration should be continuously reassessed in function of
the evolving CT technology.
SSK03-05
Comparison of Different Concentration Iodinated Contrast Medium in Coronary CT Angiography
W ednesday, Dec. 2 11:10AM - 11:20AM Location: S502AB
Participants
Yanhua Duan, MD, Jinan, China (Presenter) Nothing to Disclose
Ximing Wang, PhD, Jinan, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the image quality of DSCT coronary angiography by different concentration iodinated contrast medium with same iodine
volume.
METHOD AND MATERIALS
In this study, 180 consecutive patients underwent DSCT coronary angiography were enrolled between Jan. 2013 to Jan. 2015 in our
institute. Prospective ECG-triggered high-pitch spiral scanning mode was performed in all patients. A tube-voltage of 100 kV was
adopted in all patients.All patients were assigned to 4 groups randomly according to the different concentration of contrast
medium: 270 mgI/ml iodinated contrast medium (n=45, group A), 320 mgI/ml iodinated CM (n=45, group B), 350 mgI/ml iodinated CM
(n=45, group C), 370 mgI/ml iodinated CM (n=45, group D). All patients were administrated with same iodine volume (296 mgI/kg
body weight). A volume of 1.1ml/kg, 0.93ml/kg, 0.85 ml/kg and 0.8 ml/kg body weight iodinated CM (296 mgI/kg body weight) was
adopted in group A, B, C and D, respectively. The injection time of CM was fixed at 12 seconds. Injection rate was calculated at
total injection volume of CM divided by 12 seconds.Subjective image quality was independently assessed by two radiologists by 4grade scoring system. Objective image quality (enhancement value, image noise, signal-to-noise ratio and contrast-to-noise ratio
of RCA and LAD) was compared among groups.
RESULTS
All prospective ECG-triggering high-pitch spiral DSCT coronary angiographic scans were successful. BMI, age and heart rate were
not statistically different among groups. The image quality scores of groups A, B, C and D were 2.00±0.93, 2.13±1.01, 2.85±1.23,
2.93±0.95, respectively. The subjective image quality was significantly higher in group C and D than in the other groups. Mean
attenuation in RCA and LAD of group D was significant higher than that in the other groups. The image noise in group A was
significantly higher than the other groups. The SNR and CNR in group A were significantly lower than the other groups.
CONCLUSION
The different concentration of contrast medium has a significant impact on the image quality with a same dose of iodine.
Considered the image quality and dose of iodine together, higher-concentration of contrast medium provides better image quality of
coronary arteries.
CLINICAL RELEVANCE/APPLICATION
Higher-concentration of contrast medium provides better image quality of CT coronary arteries.
SSK03-07
Contrast Media Administration in Coronary Computed Tomography Angiography- A Systematic
Review and Meta-analysis
W ednesday, Dec. 2 11:30AM - 11:40AM Location: S502AB
Participants
Casper Mihl, MD, Maastricht, Netherlands (Presenter) Nothing to Disclose
Jakub Turek, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Madeleine Kok, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Joachim E. Wildberger, MD, PhD, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Marco Das, MD, Maastricht, Netherlands (Abstract Co-Author) Research Consultant, Bayer AG; Research Grant, Siemens AG;
Speakers Bureau, Siemens AG; Research Grant, Koninklijke Philips NV
PURPOSE
Scanner related parameters, patient related factors and contrast media (CM) application parameters all significantly influence
contrast enhancement of the coronary arteries. No consensus exists in the literature on the optimal CM injection protocol. Thus the
aim of this review and meta-analysis is to provide an update on the effect of different CM injection parameters on the attenuation
in coronary computed tomography angiography (CCTA).
METHOD AND MATERIALS
Relevant studies published between January 2001 and May 2014 identified by Pubmed, Embase and MEDLINE were evaluated. Using
predefined inclusion and exclusion criteria and a data extraction form, two reviewers independently assessed the content of each
eligible study after primary selection. A possible relationship between the parameters iodine delivery rate (IDR), injection rate, CM
concentration, total iodine dose (TID), CM volume and attenuation of the coronary arteries was assessed using multivariable
random-effects meta-regression analysis.
RESULTS
In the primary literature search, 2552 potential studies were identified. After examination, a total of 36 studies were found to be
eligible for this systematic review. Extracted data on CM-, patient-, and scan-related parameters proved to be heterogeneous and
often inconsistent. In a multivariable analysis, IDR and CM injection rate proved to be significantly associated with arterial
enhancement of the coronary arteries (p<0.05), while CM concentration, TID and CM volume did not.
CONCLUSION
Multivariable meta-regression analysis showed that both IDR and CM injection rate are decisive for attenuation of the coronary
arteries. No evidence of any association between CM concentration and attenuation levels was found.
CLINICAL RELEVANCE/APPLICATION
A thorough understanding of the factors responsible for optimal attenuation of the coronary arteries is considered an absolute
requirement for optimizing CM injection protocols in the near future. Multivariable meta-regression analysis showed that both IDR
and CM injection rate are decisive for opacification of the coronary arteries.
SSK03-08
Preserving Kidney Function with Ultra-low Contrast Volume CT Angiography
W ednesday, Dec. 2 11:40AM - 11:50AM Location: S502AB
Participants
Alexander S. Misono, MD,MBA, Boston, MA (Presenter) Nothing to Disclose
Elie R. Balesh, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
George R. Oliveira, MD, Newton Center, MA (Abstract Co-Author) Nothing to Disclose
Anand M. Prabhakar, MD, Somerville, MA (Abstract Co-Author) Nothing to Disclose
Brian B. Ghoshhajra, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Ultra-low contrast volume (ULCV) technique for CT angiography (CTA) has been advocated for pre-operative workup for patients
undergoing transcatheter aortic valve implantation (TAVI) as the majority of candidates have chronic kidney disease (CKD), a
suspected risk factor for contrast-induced nephrotoxicity (CIN). While feasibility has been demonstrated, impact on kidney function
in this vulnerable population is a topic of continued inquiry. This study aims to quantify changes in kidney function after ULCV
scans.
METHOD AND MATERIALS
In this IRB-approved, HIPAA compliant study, adult ULCV CTA examinations performed from 2012-2015 at a tertiary care hospital
were identified. Reports were reviewed for indication and total contrast administered. For each patient, laboratory values of
creatinine (Cr) and GFR were identified pre- and post-exam. Patients were excluded if they did not have pre-exam labs within the
preceding 3 months or if post-exam labs exceeded 30 days after examination. Paired t tests were performed to assess for change in
kidney function between time points, with statistical significance set at p<0.05.
RESULTS
75 ULCV scans were identified, of which 56 (75%) had lab results within the prescribed timeframe. Of note, all of the exams were
technically successful. The sample included patients with average age 79 +/- 12.9 (mean +/- SD) with a range of 27-95, including
52% male, 48% female. Indications for studies were primarily for poor renal function (98%) with the majority specifically for TAVI
planning (73%); 2% of patients underwent this technique for prior anaphylactoid reaction. Contrast bolus ranged from 15 to 45 cc
with an average of 22.3 +/- 6.3. Post-exam labs were obtained 10 +/- 6 days after contrast CT. For the study population, postexam Cr of 2.1 +/- 1.5 was not significantly changed from pre-exam Cr of 2.1 +/- 1.7 (p=0.248). Similarly, post-exam GFR of 32.3
+/- 10.7 was not significantly changed from pre-exam GFR of 32.1 +/- 10.8 (p=0.901).
CONCLUSION
ULCV CT angiography is likely a suitable technique in patients with poor baseline kidney function, with no detectable change in preversus post-exam creatinine or GFR in this cohort study.
CLINICAL RELEVANCE/APPLICATION
In patients with CKD, ULCV technique likely allows for diagnostic contrast-enhanced CT without detrimental effect on kidney
function.
SSK03-09
Lower Volume of Lower Concentration Isotonic Contrast Medium for 320-Row Detector Coronary CT
Angiography
W ednesday, Dec. 2 11:50AM - 12:00PM Location: S502AB
Participants
Yi Liang, Wuhan, China (Presenter) Nothing to Disclose
Bolin Du, MD, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Zhen Li, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Hanlin Wang, wuhan, China (Abstract Co-Author) Nothing to Disclose
Jingxiong Tao, wuhan, China (Abstract Co-Author) Nothing to Disclose
Jia Wang, wuhan, China (Abstract Co-Author) Nothing to Disclose
Jie Zhou, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Yang Gao, Wuhan, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the feasibility of 320 row coronary CT angiography by using lower volume of lower concentration isotonic contrast
medium while maintaining image quality.
METHOD AND MATERIALS
64 patients whose heart beat rate are 70 bpm or less,normal cardiac rhythm,and BMI ≤ 24 kg/m2 were scanned by 320 row
detector dynamic volume CT using 100 kVp (lower tube voltage) and a kind of contrast medium (270mgI/mL). Prospective ECG
gating technique and adaptive iterative dose reduction algorithm reconstruction were used. In group A,22 patients in group A were
injected 50ml fixed dose of contrast medium by a rate of 5.0ml/s;In group B, 21 patients were injected with the volume of contrast
medium calculated by body weight(0.7 ml/kg),injection rate was 4.5 ml/s;In group C, 21 patients were injected with the dosage of
contrast medium calculated by body weight (0.6 ml/kg) and the injection rate was 4.0 ml/s. The attenuation value,signal-tonoise(SNR),contrast-to-noise ratio(CNR),image quality and iodine intake between three groups were compared using One-Way
ANOVA.
RESULTS
There was no significant statistic difference of age,sex ratio,BMI,heart rate between the three groups (P>0.05). However, the
dosage of the contrast agent and different injection rate had statistical significance (P<0.05). The attenuation value from group A
to group B and then to group C was on the decline,the CT value of group A was obviously higher than that of group B and group
C,the differences were statistically significant (P < 0.05),and there was no statistically significant difference between the group B
and group C (P >0.05). The image quality,SNR and CNR in three groups did not have significant difference (P >0.05). The total
iodine and iodine injection rates were lowest in group C.
CONCLUSION
Using 320 row detector dynamic volume CT with 100kVp tube voltage and iterative reconstruction algorithm,the patients whose
heart beat rates are 70 bpm or less,BMI≤24 kg/m2 are injected with lower concentration of contrast medium by 0.6 ml/kg dose
injection give a good image quality of coronary CT angiography which can meet the diagnostic requirement. Meanwhile, it can also
reduce the iodine intake and the risk of contrast induced nephrology (CIN).
CLINICAL RELEVANCE/APPLICATION
320 row coronary CT angiography by using lower volume of lower concentration isotonic contrastmedium maintain image
quality,meanwhile,it can also reduce the iodine intake and the risk of contrast induced nephrology (CIN).
SSK04
Cardiac (General Topics)
W ednesday, Dec. 2 10:30AM - 12:00PM Location: S504AB
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Pamela K. Woodard, MD, Saint Louis, MO (Moderator) Research Consultant, Bristol-Myers Squibb Company; Research Grant, Astellas
Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG; Research Grant,
Actelion Ltd; Research Grant, Guerbet SA; ; ;
Robert J. Herfkens, MD, Stanford, CA (Moderator) Nothing to Disclose
Istvan Battyani, MD, PhD, Pecs, Hungary (Moderator) Nothing to Disclose
Sub-Events
SSK04-01
Dynamic First Pass CT Perfusion Imaging of the Myocardium vs. Intracoronary Transluminal
Attenuation Gradient in Coronary CT Angiography for the Assessment of Coronary Artery Stenosis
W ednesday, Dec. 2 10:30AM - 10:40AM Location: S504AB
Participants
Bettina M. Gramer, MD, Munich, Germany (Presenter) Nothing to Disclose
Isabella Baur, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Michael Rasper, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Alexander W. Leber, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Johannes Rieber, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Ellen Hoffmann, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Mani Vembar, MS, Cleveland, OH (Abstract Co-Author) Employee, Koninklijke Philips NV
Ernst J. Rummeny, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Armin M. Huber, MD, Munchen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the diagnostic accuracy of dynamic first pass CT perfusion (CTP) imaging and the transluminal attenuation gradient
derived from coronary CT angiography in the assessment of coronary artery stenosis.
METHOD AND MATERIALS
34 patients with suspicion of coronary artery disease, who underwent invasive coronary angiography (CA) and assessment of
intermediate coronary artery lesions (50-75% diameter reduction) by an invasive pressure wire examination (FFR) were included. All
patients underwent a coronary CTA and a dynamic CTP examination under adenosine stress at a 256 slice CT scanner with an 8 cm
wide detector. Myocardial blood flow was determined using the dynamic first pass CTP data. Transluminal attenuation gradient
(TAG) was calculated as the linear regression coeffcient between luminal attenuation and the distance of the location in the
coronary artery from its origin. MBF and TAG were compared with the results CA and FFR. ROC curves were calculated. Sensitivity
and specificity were calculated using Youden´s index.
RESULTS
The area under the ROC curve was 0.92 (0.80 to 0.95) for MBF and 0.64 (0.46 to 0.793) for TAG (p=0.002). The optimal threshold
using Youden´s index was 1.51 for TAG and 1.21 for MBF. Sensitivity and specificity for detection of hemodynamically relevant
coronary artery lesions were 71.4 (41.9- 91.4) and 73.2 (57.1- 85.8) for TAG. Sensitivity and specificity were 90.9 ( 58.7- 98.5)
and 84.6 (65.1- 95.5) for MBF.
CONCLUSION
MBF derived from dynamic CTP imaging of the myocardium is superior compared to the TAG derived from coronary CTA for the
assessment of coronary artery stenosis.
CLINICAL RELEVANCE/APPLICATION
In spite of being inferior compared to the MBF the TAG can be used as additional functional parameter in the assessment of
coronary artery stenosis derived from coronary CTA without additional contrast agent or radiation exposure and may contribute to
improve diagnostic accuracy of CTA.
SSK04-02
Detection and Differentiation of Ischemic Myocardial Lesions with Quantitative Post-mortem Cardiac
1.5T MRI
W ednesday, Dec. 2 10:40AM - 10:50AM Location: S504AB
Participants
Wolf-Dieter Zech, MD, Bern, Switzerland (Presenter) Nothing to Disclose
Nicole Schwendener, Bern, Switzerland (Abstract Co-Author) Nothing to Disclose
Anders Persson, MD, PhD, Linkoping, Sweden (Abstract Co-Author) Nothing to Disclose
Marcel Warntjes, Linkoping, Sweden (Abstract Co-Author) Employee, SyntheticMR AB
Christian Jackowski, MD, Bern, Switzerland (Abstract Co-Author) Nothing to Disclose
PURPOSE
MR quantification of T1 and T2 relaxation times and proton density (PD) is feasible for characterizing tissue lesions. Since
quantitative T1 and T2 values are dependent on magnetic field strength and temperature there is a need for evaluation of
quantitative values with regard to magnetic field strength and tissue temperatures. The purpose of this study was to assess the
quantitative T1, T2 and PD values of ischemic myocardial lesions for a post-mortem 1.5T application and to relate quantitative
values to tissue temperature.
METHOD AND MATERIALS
Eighty forensic postmortem short axis cardiac 1,5T MR examinations were quantified using a quantification sequence prior to
autopsy. During the MR examination the temperature of corpses was assessed. Quantitative T1, T2 and PD values of myocardial
lesions were assessed in synthetically calculated cardiac MR images. The quantitative values were related to temperature and
correlated with autopsy and histology findings.
RESULTS
A total of 95 ischemic lesions were detected at histology and autopsy (early acute n=61, acute n=14, subacute n=10, chronic
n=10). Of 61 histologically confirmed early acute lesions a total of 22 lesions (36.1 %) were not visible in conventional PMMR
images. These lesions were targeted in MR images at the location of histologic specimens and presented with quantitative T1 and
T2 values that differed significantly from the quantitative values of normal myocardium. ANOVA revealed that the quantitative
values of all assessed ischemic lesions and normal myocardium differed significantly from each other. Temperature correction of
quantitative values led to lower standard deviations and better differentiability of all lesions.
CONCLUSION
Postmortem 1,5T MR quantification is feasible for detection and diagnosis of different age stages of myocardial ischemia and
enables to assess early acute myocardial ischemia not visible in conventional MR images. The quantification approach provides a
base for computer aided detection and diagnosis of ischemic myocardial lesions.
CLINICAL RELEVANCE/APPLICATION
If quantitative values are extrapolated to 37°C diagnostic criteria validated in quantitative cardiac PMMR scans may be applied for
the detection of myocardial ischemia in living patients.
SSK04-03
Imaging for Suspected Coronary Artery Disease: Recent Utilization Trends Point Downward
W ednesday, Dec. 2 10:50AM - 11:00AM Location: S504AB
Participants
David C. Levin, MD, Philadelphia, PA (Presenter) Consultant, HealthHelp, LLC; Board of Directors, Outpatient Imaging Affiliates, LLC
Laurence Parker, PhD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Vijay M. Rao, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
PURPOSE
In recent years, appropriate use criteria have been developed for cardiac imaging by both the ACR and the American College of
Cardiology. Our purpose was to attempt to determine if these criteria affected utilization of the 3 major imaging tests for suspected
coronary artery disease (CAD) - nuclear myocardial perfusion imaging (MPI), stress echocardiography (SE), and coronary CT
angiography (CCTA).
METHOD AND MATERIALS
The nationwide Medicare Part B databases from 2001 through 2013 were studied. The CPT codes for primary MPI, SE, and CCTA
were selected. Procedure volumes were tabulated for all places of service, and utilization rates per 1000 Medicare fee-for-service
beneficiaries were calculated. Medicare specialty codes were used to ascertain the relative roles of radiologists and cardiologists.
RESULTS
The utilization rate per 1000 of MPI increased from 63.4 in 2001 to a peak of 88.0 in 2006, then declined to 61.9 in 2013 (-30% vs
2006 peak). In 2013, cardiologists did 77% of the MPIs; radiologists did 17%; the rest were done by other physicians. The
utilization rate of SE was 12.5 in 2001 and remained relatively stable through 2010, then declined to 10.8 by 2013 (-14% vs 2010).
Radiologists had essentially no role in SE. CCTA utilization could only be tracked since 2006, the first complete year codes were
available for that study. The rate per 1000 that year was 1.0. It went up to 2.1 the following year, but then declined every year
thereafter to 1.1 in 2013 (-48% vs peak). In 2013, radiologists did 49% of CCTAs; cardiologists did 46%; other physicians did the
rest. That year, 56 times as many MPIs as CCTAs were performed.
CONCLUSION
The utilization rate of noninvasive imaging in patients with suspected CAD is declining. The cause is likely multifactorial. The decline
is more pronounced in MPI than in SE. The use of CCTA has also dropped, but its rate is far lower than that of MPI and SE. CCTA is
probably underused in comparison to those 2 techniques. Radiologists have no role in SE, a relatively small role in MPI, but an
important role in CCTA.
CLINICAL RELEVANCE/APPLICATION
n/a
SSK04-04
Automated 3D MRI Volumetry of the Pulmonary Arteries: Evaluation in Patients with Pulmonary
Arterial Hypertension and Potential for Predicting Pulmonary Hypertension
W ednesday, Dec. 2 11:00AM - 11:10AM Location: S504AB
Awards
Trainee Research Prize - Resident
Participants
Fabian Rengier, MD, Heidelberg, Germany (Presenter) Nothing to Disclose
Stefan Woerz, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Claudius Melzig, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Sebastian Ley, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Christian Fink, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Nicola Ehlken, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Sasan Partovi, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Hendrik Von Tengg-Kobligk, MD, Bern, Switzerland (Abstract Co-Author) Research Grant, W. L. Gore & Associates, Inc
Karl Rohr, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Hans-Ulrich Kauczor, MD, Heidelberg, Germany (Abstract Co-Author) Research Grant, Siemens AG; Research Grant, Bayer AG;
Speakers Bureau, Boehringer Ingelheim GmbH; Speakers Bureau, Siemens AG; Speakers Bureau, Novartis AG; Speakers Bureau,
GlaxoSmithKline plc ; Speakers Bureau, Almirall SA
Ekkehard Gruenig, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Increased pulmonary artery diameters have been shown to indicate pulmonary hypertension, but 2D diameter measurements are
only a limited representation of 3D geometry. Purpose of this study was to demonstrate feasibility of 3D volumetry of pulmonary
arteries based on magnetic resonance angiography (MRA), to assess pulmonary artery volumes in patients with pulmonary arterial
hypertension compared to healthy volunteers, and to investigate its potential for predicting pulmonary hypertension (PH).
METHOD AND MATERIALS
MRA of the pulmonary arteries was acquired at 1.5T in 37 subjects (mean age 42+/-14 years) with a slice thickness of 1.6mm and
in-plane resolution of 1.3x1.3mm². 20 patients had pulmonary arterial hypertension (WHO classification Group 1) confirmed by right
heart catheterization, 17 healthy volunteers had no history of cardiovascular disease. Using in-house developed 3D model-based
image analysis software, main, right and left pulmonary arteries (mPA, rPA and lPA) were automatically segmented after placement
of seed points. Volumes for mPA, rPA and lPA were computed and corrected for body surface area (BSA). For comparison purposes,
diameter of mPA was manually measured on axial reconstructions by an experienced radiologist.
RESULTS
Volumes for patients/volunteers were (in mm³/m² BSA): mPA 25570/13927 (p=0.002), rPA 10484/3807 (p<0.001) and lPA
7533/3899 (p<0.001). ROC analysis of volumes showed: mPA AUC 0.874 (95% CI 0.748-0.999, p=0.001), rPA AUC 1.0 (95% CI 1.01.0, p<0.001) and lPA AUC 0.889 (95% CI 0.774-1.0, p=0.001). Sensitivity, specificity, positive predictive value and negative
predictive value for predicting PH were highest for rPA volume with 100%, 100%, 100% and 100% using 6000mm³/m² BSA as sexindependent cut-off, compared to 95%, 78%, 82% and 93% for mPA diameter using 29/27mm as cut-off for males/females as
suggested by the Framingham Heart Study.
CONCLUSION
MRA-based 3D volumetry of pulmonary arteries is feasible and demonstrated significantly increased volumes for main, right and left
pulmonary arteries in patients with pulmonary arterial hypertension compared to healthy volunteers. Volume of right pulmonary
artery might be an accurate predictor for PH but validation in a larger study population is warranted.
CLINICAL RELEVANCE/APPLICATION
3D pulmonary artery volumes might be more accurate than 2D diameter measurements in the prediction and evaluation of pulmonary
hypertension.
SSK04-05
Pulmonary Arterial Hypertension is Associated with Increased T1 Relaxation Times and Decreased
Left Ventricular Performance in Spite of Preserved Left Ventricular Function
W ednesday, Dec. 2 11:10AM - 11:20AM Location: S504AB
Participants
Rami Homsi, Bonn, Germany (Presenter) Nothing to Disclose
Julian A. Luetkens, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Dirk Skowasch, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Julia Meyer zur Heide, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Gieseke, DSc, Bonn, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Claas P. Naehle, MD, Bonn, Germany (Abstract Co-Author) Consultant, Medtronic, Inc
PURPOSE
Pulmonary arterial hypertension (PAH) mainly affects the right (RV), but also the left ventricle (LV). Strain analysis allows for
detection of ventricular dysfunction even in patients with preserved ventricular function. Cardiac magnetic resonance (CMR)
mapping techniques with determination of T1 and T2 relaxation times (T1 resp T2) may allow for discrimination between healthy
myocardium and diffuse fibrosis in PAH patients. This study was performed to evaluate the association between myocardial changes
assessed by strain analysis and by native T1 and T2 map in patients with PAH.
METHOD AND MATERIALS
16 Patients with PAH (8 men, 8 women, mean age 63.75y ± 13.85) and 17 healthy volunteers (8 men,9 women, mean age 57.56y ±
12.45) were examined on a 1.5 Tesla MR system (Ingenia, Philips). Native T1s were assessed using the modified Look-Locker
inversion recovery sequence and T2s were assessed using a GraSE sequence. RV and LV longitudinal strain was assessed during
postprocessing of standard SSFP Cine images by CMR feature tracking using a dedicated software (Diogenes, TomTec,
Unterschleissheim, Germany). LV and RV function were assessed by volumetric analysis.
RESULTS
LV ejection fraction did not differ between PAH patients and healthy volunteers (61.26 ± 7.13 vs. 61.53 ± 6.48; p>0.05). Left
ventricular T1 s however were significantly higher in patients with PAH (1050.17 ± 47.90 vs. 980.72 ± 45.5; p<0.01). LV longitudinal
strain was significantly lower in patients with PAH (-17.01 ± 5.34 vs. -23.05 ± 3.57, p<0.01). RV longitudinal strain and RV-Ejection
fraction were both significantly lower in patients with PAH. There were no significant differences in T2 relaxation times, age, body
mass index, or sex.
CONCLUSION
LV myocardial fibrosis as indicated by increased T1 reduces LV strain despite of normal LV function in patients with PAH.
LV myocardial fibrosis as indicated by increased T1 reduces LV strain despite of normal LV function in patients with PAH.
CLINICAL RELEVANCE/APPLICATION
Increased T1 as an indicator for LV involvement in PAH may be useful to identify patients at risk and to determine the intensity of
treatment even when myocardial function is preserved.
SSK04-06
Cardiac Effects of Prolonged Apnea in Elite Divers Investigated with Comprehensive Cardiac Magnetic
Resonance
W ednesday, Dec. 2 11:20AM - 11:30AM Location: S504AB
Participants
Jonas Doerner, MD, Bonn, Germany (Presenter) Nothing to Disclose
Lars Eichhorn, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Jean-Marc Lunkenheimer, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Julian A. Luetkens, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Gieseke, DSc, Bonn, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Rainer Meyer, 53115, Germany (Abstract Co-Author) Nothing to Disclose
Andreas Hoeft, 53105, Germany (Abstract Co-Author) Nothing to Disclose
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Claas P. Naehle, MD, Bonn, Germany (Abstract Co-Author) Consultant, Medtronic, Inc
PURPOSE
Apnea diving is getting more and more popular as a recreational sport activity and performance of apnea divers has been constantly
rising in the recent years. Prolonged apnea leads to the so-called diving response (i.e. bradycardia, reduced cardiac output,
peripheral vasoconstriction) which burdens the heart and leads to changes in circulation. This study investigated the effects of
prolonged apnea to the heart and hemodynamic alterations using comprehensive cardiac magnetic resonance imaging (CMR).
METHOD AND MATERIALS
We investigated 17 (15 male, 2 women) elite divers using CMR at 1,5T before, during, and after apnea in air. Subjects performed
two sessions: in the first cardiac function (left ventricular end-diastolic volume (LV-EDV), end-systolic volume (LV-ESV), ejection
fraction (LV-EF), fractional shortening (FS)) was repeatedly measured using steady state free precision (SSFP) imaging in SAX and
VLA; in the second blood flow was measured in both common carotid arteries (ACC) using phase contrast imaging. Apnea was
performed in maximal inspiration.
RESULTS
Mean breath hold duration was 297s±52 in the cardiac session and 276s±78 in the flow session. Maximal apnea time reached was
8:03min. Over time, apnea (AP) resulted in a progressive increase of LV-EDV (baseline: 131ml±33; AP: 190ml±35; p<0.0001), slight
decrease of LV-EF (baseline: 63%±10; AP: 58%±8; p=0.0112) and a consecutive increase of LV-ESV (baseline: 49ml±20; AP:
80ml±18;p<0.0001). FS as a parameter of regional function also decreased significantly during apnea (baseline: 35%±5; AP:
25%±5; p<0.0001). Flow measurement revealed an increase of blood-flow to the brain (left ACC; baseline: 5.0ml±2.0; AP:
12.8ml±6.4; p=0.0026; right ACC; baseline: 5.1ml±2.2; AP: 12.4ml±6,3; p=0.0009).
CONCLUSION
This work reveals that prolonged apnea results in massive hemodynamic changes to the heart and an increase of blood-flow to the
brain as expected from the diving reflex. In particular, apnea leads to a transient cardiac dilation, decrease of LV-EF and fractional
shortening, a similar pattern as seen in patients with systolic heart failure.
CLINICAL RELEVANCE/APPLICATION
This study shows that prolonged apnea has tremendous effects to the heart and the vascular system; therefore moderate trained
subjects, especially with known medical conditions, should perform maximal apnea with caution.
SSK04-07
Is it Possible to Investigate Archeological Hearts Using CT and MRI? About Five Archeological Hearts
W ednesday, Dec. 2 11:30AM - 11:40AM Location: S504AB
Participants
Fatima-Zohra Mokrane, MD, Toulouse, France (Presenter) Nothing to Disclose
Rozenn Colleter, Cesson-Sevigne, France (Abstract Co-Author) Nothing to Disclose
Sylvie Duchesne, MSc, Saint Orens de Gameville, France (Abstract Co-Author) Nothing to Disclose
Ramiro Moreno, MS, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Anou Sewonu, PhD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Herve P. Rousseau, MD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Eric Crubezy, MD,PhD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Norbert Telmon, Toulouse, France (Abstract Co-Author) Nothing to Disclose
Fabrice H. Dedouit, MD, PhD, Toulouse, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
Five archeological hearts were found in an archeological site last year. Several graves were found in the basement of a church. In
addition to different archeological bones found, five heart shaped lead polls were discovered.These findings were found in vaults
from elite class families.At the opening of the polls, findings were very interesting: five well conserved hearts dating form the end
on the 16th century, to the beginning of the 17th century.
METHOD AND MATERIALS
Thanks to the embalming process, archeological hearts were well conserved. Each archeological heart has been studied with CT
scanner and with MRI, before and after balm extraction, and after rehydration.CT parameters were standard, using a 16 row CT
scanner. MRI parameters were difficult to optimize. This was due to lack of hydration of these archeological pieces.
RESULTS
First images acquired were very impressive, but with poor information. This was due to important vegetal embalming process.
Hearts were first scanned with their balms. Then, they were carefully "cleaned". Finally, they were rehydrated.CT and MR
examinations where performed for each heart.Because of an intra tissue lead diffusion, especially in infra epicardial fat, there was
an impressive natural contrast on CT images. This element permitted to identify different heart structures like chambers, valves and
coronary arteries.MRI images were hard to obtain because of lake of hydration. Therefore, images after rehydration were relevant
and allowed to better identify myocardial muscles
CONCLUSION
Study of archeological smooth tissues like heart is possible using CT and MRI, but it requires a good knowledge of the embalming
process and MR technical parameters.
CLINICAL RELEVANCE/APPLICATION
Until now, no radiological examination of archeological hearts was described in the literature data.
SSK04-08
Atherosclerotic Plaque Burden Assessment: Coronary CT Angiography versus Invasive Coronary
Angiography
W ednesday, Dec. 2 11:40AM - 11:50AM Location: S504AB
Participants
Pal Maurovich-Horvat, MD,PhD, Budapest, Hungary (Presenter) Nothing to Disclose
Szilard Voros, Richmond, VT (Abstract Co-Author) Shareholder, Global Genomics Group; Employee, Global Genomics Group
Balint Szilveszter, MD, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Marton Kolossvary, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Istvan Edes, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Zsolt Bagyura, Budapest, Hungary (Abstract Co-Author) Nothing to Disclose
Bela Merkely, MD,PhD, Budapest, Hungary (Abstract Co-Author) Speakers Bureau, Medtronic, Inc
PURPOSE
Strong relationship exists between atherosclerotic disease burden and risk for adverse events as assessed by coronary computed
tomography angiography (CTA) and conventional invasive coronary angiography (ICA). Despite widespread use of CTA and ICA for
coronary plaque burden assessment, few studies have compared coronary CTA and ICA regarding semi-quantitative plaque burden
measurements.
METHOD AND MATERIALS
We enrolled 71 consecutive patients (mean age 60.8±11.7 yrs, 36.6% women) who underwent both 256-slice coronary CTA and
conventional ICA within no more than 120 days. A total of 1016 coronary segments were evaluated for the presence of plaque and
stenosis severity. On average, 32 [IQR:15-62.5] days passed between the two examinations. A total of 16 segments were excluded
due to presence of a stent. We calculated the segment stenosis score (SSS), which describes the amount and severity of the
stenosis (0-normal, 1-minimal, 2-mild 3-moderate 4-severe 5-occluded). The presence of plaques has been described by the
segment involvement score (SIS) (0-intact, 1-plaque). The SSS index (SSSi)=SSS/all assessed segments and SIS index
(SISi)=SIS/all assessed segments were also calculated. CTA and ICA scores were compared using Wilcoxon rank sum test (SPSS
22).
RESULTS
CT detected coronary artery plaques in 48.7% of all assessed segments (487/1000), whereas ICA showed coronary plaques in only
23.5% (235/1000) of 1000 segments (p<0.001). Importantly, CTA detected atherosclerotic plaque in 34.8 % (266/765) of coronary
segments where the ICA was negative. Conversely, ICA detected plaques only in 2.7% (14/513) segments where CTA was
negative. We found significant differences between the two methods for segment involvement and luminal stenosis indices, CTA
versus ICA; SISi: 0.49±0.22 vs. 0.24±0.14 (p<0.001); SSSi: 1.17±0.64 vs. 0.67±0.50 (p <0.001).
CONCLUSION
Coronary CTA detected approximately twice as many coronary segments with atherosclerotic plaques as ICA. Our findings are in
line with previous histological studies, according to which a significant number of plaques do not cause luminal stenosis. Using
coronary CTA for atherosclerotic plaque burden assessment may allow for better risk stratification and improved patient outcomes.
CLINICAL RELEVANCE/APPLICATION
Coronary CTA for atherosclerotic plaque burden assessment may allow for improved risk stratification as compared to invasive
coronary angiography.
SSK04-09
Effect of Calcium Blooming in Coronary Arteries at Different Monoenergetic Levels of a Novel Spectral
Detector CT and Comparison with Polyenergetic Conventional Image
W ednesday, Dec. 2 11:50AM - 12:00PM Location: S504AB
Participants
Majid Chalian, MD, Cleveland Heights, OH (Presenter) Nothing to Disclose
Bahar Mansoori, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Hamid Chalian, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Abstract Co-Author) Institutional Research Grant, Koninklijke Philips NV
PURPOSE
To evaluate the extent of calcium blooming in coronary arteries at different virtual monoenergetic levels of a novel spectral
detector CT (SDCT) and compare with the conventional polychromatic image.
METHOD AND MATERIALS
This study included 59 patients who had coronary CTA using an SDCT prototype (Philips Healthcare, Cleveland, OH, USA). 17
patients were found to have coronary artery calcifications and recruited in the study. Two independent readers evaluated calcified
plaques for plaque diameter, plaque area, luminal diameter, and percentage of stenosis. Measurements were performed at
conventional polychromatic image as well as virtual monoenergetic images from 70 to 140 keV at 10 keV intervals. The images were
also evaluated qualitatively for vascular enhancement, noise, and mage quality on a 5-point scale (1 -worst, 5-best). Repeated
measure ANOVA test was used to compare differences at different energy levels. Intra-class correlation coefficient (ICC) was used
to evaluate inter-observer reliability.
RESULTS
Diameter of calcification, area of calcification, and degree of stenosis demonstrated gradual statistically significant (p<0.001)
decrease at different incrementally increasing monochromatic imaging keVs from 70 to 140 keV (3.41mm to 1.55mm, 9.96mm2 to
3.39 mm2, and 70% to 30% stenosis, respectively). Also, diameter and area of lumen demonstrated gradual ncrease at higher
monochromatic energy levels (1.56mm to 2.74mm and 4.47mm2 to 8.61mm2, respectively, p<0.001). Comparison of monochromatic
reconstructed images with conventional polychromatic imaging also demonstrated the same pattern of changes, with progressive
improvement at higher energy levels. The monochromatic images at 80 keV provided the best image quality metrics. There was
excellent inter-observer reliability between two readers (ICC> 0.970). Subjective analysis showed that the image quality
progressively declined above 80 keV due to decreasing vascular enhancement, with the maximum image quality seen at 80 keV (4.8
at 80 keV to 2 at 140 keV).
CONCLUSION
Calcium blooming significantly decreases at higher monoenergy levels compared to polychromatic images with resultant increased
luminal size and decreased stenotic grade. 80 keV is the best level due to declining image quailty at higher levels
CLINICAL RELEVANCE/APPLICATION
Use of monoenergetic images decreases the effect of calcium blooming in coronary arteries compared to polychromatic images.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
CAS-W EA
Cardiac Wednesday Poster Discussions
W ednesday, Dec. 2 12:15PM - 12:45PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Lisa Diethelm, MD, New Orleans, LA (Moderator) Nothing to Disclose
Sub-Events
CA239-SDWEA2
Dual Energy Computed Tomography Coronary Angiography with Reduced Iodine Volume Load
Station #2
Participants
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Presenter) Research Consultant, General Electric Company
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Deviggiano, MD, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Alejandro Goldsmit, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Gaston Rodriguez Granillo, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
Dual-energy CT (DECT) allows the reconstruction of low and high energy projections and generation of monochromatic image
reconstructions. Consequently, higher intravascular attenuation levels can be attained through low energy monochromatic imaging.
The purpose of this paper is to compare image quality, interpretability, and diagnostic performance of dual-energy CT coronary
angiography (DE-CTCA) performed with 50 % iodine volume load reduction versus single energy acquisitions (SE-CTCA) with full
iodine volume load.
METHOD AND MATERIALS
The present prospective study involved patients with suspected CAD clinically referred for CTCA. DE-CTCA with 50 % iodine volume
load (group A) was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load
(group B). The primary endpoint was to compare image quality and interpretability between groups. The secondary endpoint was to
evaluate the diagnostic performance in a subset of patients who underwent invasive coronary angiography.
RESULTS
Thirty-six patients constituted the study population. The mean heart rate before the CT scan (group A 57.3±10.7 bpm vs. group B
58.5±11.2 bpm, p= 0.29) and the mean effective radiation dose (3.5±1.9 mSv vs.3.8±0.9 mSv, p=0.48) did not differ between
groups. The mean contrast volume was 31.7±4.1 ml in group A and 63.4±8.3 ml in group B (p< 0.0001). Image quality was similar
between groups (group A 4.42±0.98 vs. group B 4.43±0.84, p=0.67). The sensitivity and specificity for the detection of stenosis >
50 % was indistinguishable between groups (group A 84.4 % (69.9-93.0 %), 87.1 % (81.6-91.2 %); group B 84.4 % (69.9-93.0 %),
87.1 % (81.6-91.2 %).
CONCLUSION
In this pilot, prospective study, dual energy CTCA imaging with half iodine volume load achieved comparable image quality and
interpretability than full iodine volume load with conventional single energy CTCA.
CLINICAL RELEVANCE/APPLICATION
Dual energy CT potentially provides clinical benefits on coronary CT angiography achieving good image quality and interpretability
using half iodine volume load.
CA240-SDWEA3
Percutaneous Left Atrial Appendage Occlusion: Planning and Sizing using Cardiac Computed
Tomography Angiography
Station #3
Participants
Alberto Clemente, Massa, Italy (Presenter) Nothing to Disclose
Francesco Avogliero, MD, Massa, Italy (Abstract Co-Author) Nothing to Disclose
Daniele Della Latta, PhD, Massa, Italy (Abstract Co-Author) Nothing to Disclose
Carla Susini, Pisa, Italy (Abstract Co-Author) Nothing to Disclose
Dante Chiappino, MD, Massa, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac Computed Tomography Angiography (CCTA) can be used in planning Left Atrial Appendage (LAA) percutaneous occlusion
evaluating appendage diameters and excluding intracavitary thrombosis, but there are only few reports in literature. The purpose of
our study is to establish an easy to learn method to measure LAA ostium and landing zone diameters with low inter-observer
variability using CCTA.
METHOD AND MATERIALS
sixtysix (66) consecutive patients subjected to CCTA investigation for pre-operative planning of LAAO between September 2009
and July 2013 were selected. The mean diameter from the average of the largest diameter and its perpendicular (dM), the diameter
from the area of the lumen (dA) in the visually estimated maximum and minimum expansion phases were measured by two blinded
operators. The variability of the diameters, inter-operator variability, the difference between measures in maximum and minimum
LAA expansion were evaluated.
RESULTS
low inter-operator variability (lower with dA measurements) was observed measuring LAA ostium and landing zone diameters. A
significant difference in the measurement of the diameters exists in the phase of major and minor filling despite atrial fibrillation for
both oparators.
CONCLUSION
the sizing of the left appendage evaluated with CCTA, using the mean diameter taken by the areas in the phase of greater
expansion is a reliable and reproducible method, with an extremely high inter-operator correlation. In addition, it is useful to
measure LAA in the phase of maximum dilation to avoid the risk of an undersizing of the occlusion device.
CLINICAL RELEVANCE/APPLICATION
despite atrial fibrillation , the left atrial appendage studied with CCTA demonstrates dimensional changes during R-R interval at the
level of the ostium and landing zone. This is crucial in the choice of the size of the occlusion device to be used.
CA242-SDWEA5
Epi-and Pericardial Fat Volume in Hypertensive Patients with and without Myocardial Infarction
Station #5
Participants
Rami Homsi, Bonn, Germany (Presenter) Nothing to Disclose
Alois Martin Sprinkart, MSc, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Darius Dabir, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Michael Meier-Schroers, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Daniel Kuetting, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Julian A. Luetkens, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Seyrani Yuecel, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Juergen Gieseke, DSc, Bonn, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Hans H. Schild, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
Daniel K. Thomas, MD, PhD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Pericardial and epicardial fat volume (PFV, EFV) are associated with cardiovascular risk. We investigated for the first time PFV and
EFV in hypertensive patients with and without myocardial infarction using a 3D-Dixon pulse sequence.
METHOD AND MATERIALS
All scans were performed on a 1.5 Tesla MR system (Ingenia, Philips). 57 hypertensive patients (39 men; mean age 62.96 ±
11.22years; mean Body mass index (BMI) [kg/m²] = 28.59 ± 4.96) with (16 patients; mean age 63.44 ± 10.07) and without (41
patients; mean age 62.78 ± 11.75) myocardial infarction (MI) underwent a comprehensive cardiac MR examination (CMR). Patients
with diabetes were excluded from the study. EFV and PFV were assessed by a 3D transversal ECG- and respiratory navigator gated
mDixon-sequence. Fat only images were reconstructed online at the scanner, images were then analyzed offline. Segmentation of
fat volumes was based on the fat fraction map. PFV and EFV were additionally normalized to the body surface area.
RESULTS
Mean PFV was 168.63ml ± 73.95; mean EFV was 72.37 ± 27.49. Hypertensive patients with MI had a higher PFV and EFV than
hypertensive patients without MI (203.09ml ± 80.73 and 85.62ml ± 30.62 vs. 155.18ml ± 67.47 and 67.20ml ± 24.67 [p < 0.01,
each]). There was no significant difference in age, BMI, sex or heart rate between the two groups. Hypertensive patients with
infarction had a lower left ventricular ejection fraction (LVEF) and higher end diastolic volume (LVEDV) [LVEF: 53.49% vs. 63.79%;
LVEDV: 80.52ml/m² vs. 65.80ml/m²) due to myocardial damage after MI.
CONCLUSION
In hypertensive patients with myocardial infarction PFV and EFV is increased compared to hypertensive subjects without myocardial
infarction. This finding underscores the role of fatty tissue as an endocrine and metabolically active organ. Accurate and
noninvasive measurement such as the used 3D-Dixon pulse sequence may play a relevant future role in cardiovascular risk
stratification and disease management.
CLINICAL RELEVANCE/APPLICATION
Patients with hypertension have a greater risk for the development of myocardial infarction. The accurate measurement of epi- and
pericardial fat may be helpful to identify patients at risk.
CA244-SDWEA7
Correlation of Coronary CT Angiography (cCTA) with Fractional Flow Reserve: Can cCTA Predict the
Functional Severity of Coronary Lesions Which Result in Moderate to Severe Anatomic Stenosis ?
Station #7
Participants
Vishal Desai, MD, Philadelphia, PA (Presenter) Nothing to Disclose
Michael Savage, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
David M. Goldberg, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Ethan J. Halpern, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Coronary CT angiography (cCTA) can exclude coronary disease or document high grade disease based upon anatomic severity of
stenosis, but is not effective for predicting the functional severity of moderate stenosis (50-80% narrowing). Fractional flow
reserve (FFR) is the standard of reference for diagnosis of functionally significant coronary disease with catheter angiography.
However, calculation of FFR based upon cCTA imaging is computationally intense and not generally available in real time. The
purpose of this study was to evaluate cCTA findings associated with moderate lesions that might predict functional severity.
METHOD AND MATERIALS
Retrospective review identified 17 moderate coronary lesions in 14 patients with an abnormal cCTA who subsequently underwent
coronary catheterization with measurement of FFR. cCTA studies were reviewed for degree of stenosis, presence / absence of
calcification at the site of stenosis, plaque irregularity, caliber change beyond the stenosis, loss of enhancement in the distal vessel
and associated segmental wall motion abnormalities. These findings were correlated with cath lab FFR using an FFR < 0.8 as the
reference standard for functionally significant coronary disease.
RESULTS
The 17 lesions included 3 in the left main coronary artery (all with FFR > 0.8), 8 in the left anterior descending artery (3 with FFR <
0.8), 2 in the circumflex (1 with FFR < 0.8), and 4 in the right coronary artery (1 with FFR < 0.8). Univariate analysis suggests that
of all the variables evaluated, decreased coronary caliber beyond a stenosis was most significantly associated with an abnormal FFR
(sensitivity = 60%; specificity = 92%; p=0.02). Assessment of plaque calcification, plaque irregularity or associated segmental wall
motion were not helpful to identify functionally significant stenosis. However, a criteria that combined decreased coronary caliber
and/or loss of coronary enhancement beyond a stenosis was the best predictor of an abnormal FFR (sensitivity = 80%; specificity =
83%; p=0.01).
CONCLUSION
In the setting of a moderate coronary stenosis visualized by cCTA, decreased coronary caliber or enhancement beyond the stenosis
is predictive of a functionally significant stenosis on FFR.
CLINICAL RELEVANCE/APPLICATION
When a coronary stenosis appears to be of moderate anatomic severity, evaluation of vessel caliber change and enhancement
beyond the stenosis may assist to define functional severity of the stenosis.
CA124-EDWEA8
Atrioventricular Septum Junction: Comprehensive Imaging Inadults Using Cardiac CT and MR
Station #8
Awards
Magna Cum Laude
Identified for RadioGraphics
Participants
Cameron Hassani, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Damian Sanchez-Quintana, MD, Badajoz, Spain (Abstract Co-Author) Nothing to Disclose
Farhood Saremi, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: 1. Review the relevant anatomy and anatomic variants of the atrioventricular septum (AVS) junction
2. Review characteristic imaging findings of common and uncommon diseases involving the AVS
TABLE OF CONTENTS/OUTLINE
Normal embryology and anatomy of the AVS Development Imaging characteristics of the septal components of the AV junction
Muscular (AV fibrofatty sandwich) and membranous (AV and interventricular) components Cardiac crux Koch triangle, Inferior
pyramidal space, cavotricuspid isthmus Relationship to the cardiac valves Relationship to the normal conduction pathways
Abnormalities of the AVS junction Defects in adults Atrial and interventricular septal defects AV septal defect: Gerbode; congenital,
acquired Coronary sinus defect Vascular, AVM, occlusion, anomalous vessel Aneurysm/prolapse Membranous septum Aortic sinuses
Masses and infiltrative processes Ischemia and trauma Infection Electrophysiology applications
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Farhood Saremi, MD - 2015 Honored Educator
CAS-W EB
Cardiac Wednesday Poster Discussions
W ednesday, Dec. 2 12:45PM - 1:15PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
FDA
Discussions may include off-label uses.
Participants
Lisa Diethelm, MD, New Orleans, LA (Moderator) Nothing to Disclose
Sub-Events
CA245-SDWEB1
Assessment of Diffuse Ventricular Fibrosis in Atrial Fibrillation Using Extracellular Volume Fraction
Mapping: Initial Study
Station #1
Participants
Zhanhong Wang, Beijing, China (Presenter) Nothing to Disclose
Songnan Li, Beijing, China (Abstract Co-Author) Nothing to Disclose
Xiaohai Ma, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Tianjing Zhang, Beijing, China (Abstract Co-Author) Employee, Siemens AG
Jing An, Beijing, China (Abstract Co-Author) Research collaboration, Siemens AG
Andreas Greiser, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Lei Zhao, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Zhanming Fan, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
In atrial fibrillation (AF), diffuse myocardial fibrosis may be induced by arrhythmia or reflect pre-existing cardiomyopathy. The
presence of concurrent AF and diffuse myocardial fibrosis has been associated with an increased risk of heart failure progression.
The extracellular volume fraction (ECV) mapping may provide new insights to the understanding of AF. Unlike focal fibrosis, diffuse
myocardial fibrosis is not visualized on delayed enhancement magnetic resonance imaging (MRI), but can be quantified with
extracellular volume fraction (ECV) mapping. Therefore, the purpose of this study was to evaluate diffuse myocardial fibrosis of the
left ventricle (LV) in patients with AF. EndFragment-->
METHOD AND MATERIALS
Ten subjects underwent MRI using a clinical 3 T scanner (Magnetom Verio, Siemens Healthcare): 8 persistent AF patients and 2
controls. Left-atrial volume was evaluated from MR cine imaging. A validated Look-Locker T1 Mapping Siemens prototype sequence
was used to generate T1 maps as an index of diffuse myocardial fibrosis. The imaging parameters were: TE/TR = 1/295.33ms, FOV
= 360mm, Slice Thickness = 8mm, image matrix = 192. 3 short axes of pre and post T1 maps were acquired as shown in Figure 1.
Global ECV values were calculated from T1 maps acquired pre- and post-contrast calibrated by blood hematocrit. The ECV value
was calculated as: EndFragment-->
RESULTS
AF patients had larger left atrial volume (115.8±36.5 ml) than controls (75.85.1 ml) and published normal values [3]. Mean ECV of
AF patients was 32.7±4.5% in the basal segments, 30.0±4.8% in the mid-cavity segments, 33.3±5.3% in the apical segments,
which were higher than the controls (basal: 26.1±0.0 %, mid-cavity: 26.0±1.5 %, apical: 27.9±1.8 %). EndFragment-->
CONCLUSION
ECV of AF patients were higher than healthy controls in the left ventricle from basal to apical levels. ECV is higher in patients with
heart failure [4]. AF patients demonstrated diffuse fibrosis suggesting that AF itself may play an independent role in adverse
prognosis. The mean leftatrial volume of AF patients was larger than in controls, which is in line with other studies . ECV mapping
could help to identify the diffuse LV fibrosis in patients with AF. The quantification could be a better solution for clinicians in
diagnosing diffuse LV fibrosis. Our findings need to be validated by enrolling more subjects. EndFragment--> EndFragment-->
CLINICAL RELEVANCE/APPLICATION
Unlike focal fibrosis, diffuse myocardial fibrosis is not visualized on delayed enhancement magnetic resonance imaging (MRI), but
can be quantified with extracellular volume fraction (ECV) mapping. In atrial fibrillation (AF), it may be induced by arrhythmia or
reflect pre-existing cardiomyopathy. EndFragment-->
CA246-SDWEB2
Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive
Cardiomyopathy after Percutaneous Transluminal Septal Myocardial Ablation
Station #2
Participants
Fumi Yamada, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Yasuo Amano, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Masaki Tachi, MD, PhD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shogo Imai, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Shinichiro Kumita, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac MRI is useful for evaluating the efficiency of percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic
obstructive cardiomyopathy (HOCM). Cine steady-state free precession (SSFP) imaging quantifies the myocardial wall thickness and
mass, and visualizes jet flow crossing the left ventricular outflow tract (LVOT). Late gadolinium enhancement (LGE) MRI identifies
myocardial infarction (MI) after PTSMA. The aim of this study was to evaluate whether we could detect PTSMA-induced MI and
microvascular obstruction (MO) and LVOT jet flow with a single contrast-enhanced SSFP (ceSSFP) imaging in patients with HOCM.
METHOD AND MATERIALS
The 16 MRI examinations of 12 HOCM patients after PTSMA were assessed. Precontrast SSFP, ceSSFP and LGE MRI were performed
with a 1.5-T imager. The ceSSFP was performed immediately after gadolinium injection. The signal ratios between PTSMA-induced
MI and MO and the remote myocardium were compared between ceSSFP and LGE imaging. The LVOT flow was observed using
ceSSFP in the three-chamber view.
RESULTS
LGE and ceSSFP visualized PTSMA-induced MI in all 16 studies, while precontrast SSFP did only in the 6 studies (37.5%) of the 6
patients. Both LGE and ceSSFP showed PTSMA-induced MO in the 7 patients who underwent MRI within 7weeks after PTSMA.
However, precontrast SSFP did only in one patient. The location of MO identified by ceSSFP or LGE was related to the decrease in
the LVOT pressure gradient (i.e., left-sided MO, good efficiency; right sided MO, limited efficiency). The signal ratio of MI/remote
myocardium was significantly higher in LGE imaging than in ceSSFP imaging (P=0.011). The signal ratio of MI/MO was significantly
higher in LGE imaging than in ceSSFP imaging (P=0.042). The ceSSFP visualized the abnormal jet flow crossing the LVOT, which was
consistent with an LVOT pressure gradient higher than 30 mmHg at echocardiography, in 3 of the 4 studies.
CONCLUSION
The ceSSFP is feasible for detecting PTSMA-induced MI and MO and the LVOT jet flow in a single scan.
CLINICAL RELEVANCE/APPLICATION
Contrast enhanced SSFP is feasible for detecting PTSMA-induced myocardial damages and the left ventricular outflow tract jet flow
in patients with HOCM.
CA247-SDWEB3
Impact of an Automated Planning Software in Daily CMR Protocols
Station #3
Participants
Paula Garcia Barquin, MD, Pamplona, Spain (Presenter) Nothing to Disclose
Maite Millor, MEd, Pamplona, Spain (Abstract Co-Author) Nothing to Disclose
Pablo Bartolome, MD, Pamplona, Spain (Abstract Co-Author) Nothing to Disclose
Meylin Caballeros, MD, Pamplona, Spain (Abstract Co-Author) Nothing to Disclose
Gorka Bastarrika, MD, Pamplona, Spain (Abstract Co-Author) Speaker, Bayer AG; Speaker, Siemens AG
Jesus C. Pueyo, MD, PhD, Pamplona, Spain (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac Magnetic Resonance (CMR) has rapidly developed and is now a very used technique in our clinical practice. Furthermore, in
CMR studies, scan times continue to be extended.Recently, it has been developed the program "Day Optimizing Throughput"
(Cardiac DOT Engine) that perform an automatic planning of the various cardiac planes and allows us to obtain superimposable
slices.The aim of our study was to demonstrate whether this software is able to decrease scan time.
METHOD AND MATERIALS
From October 2012 to September 2014, 300 studies were consecutively analyzed. CMR studies were performed on a 1.5T system
(MAGNETOM Aera XQ).We retrospectively selected cardiomyopathies and Stress perfusion MRI protocols because they are the most
frequently used in our hospital.Cardiomyopathies protocol included (HASTE, four, three, two and short axis chambers cine, perfusion
and delayed enhancement sequences) and stress perfusion protocol included (HASTE, four, three, two and short axis chambers
cine, perfusion, delayed enhancement and resting perfusion sequences).The total examination time comprises the time from the
beginning until the end of each scan.The average scan time in minutes for each group was analyzed and compared with a standard
software (SS) using a T-Test for independent samples with SPSS Statistics software 20.0.
RESULTS
SS was performed in 89 patients and DOT in 211 .We observed a difference in the time spent on exploration between the use of
software DOT and the use of a standard software SS in both protocols (cardiomyopathies and stress-perfusion).The average time
for the cardiomyopathies group were (n= 130): DOT (t =37.99 +/- 11.52 minutes) to SS (t =64.89 +/- 16.9 minutes) (P= .001).
The average time for the stress perfusion group were (n=170): DOT (t =42.91 +/-13.95 minutes) to SS (t =62.25 +/- 12.85
minutes) (P= .001).
CONCLUSION
Using an automatic planning software on cardiomyopathies and stress perfusion MRI protocols always decrease the scan time.
CLINICAL RELEVANCE/APPLICATION
Systematical and reproducible studies with examination time reduction are always obtained with Cardiac Dot Engine .
CA249-SDWEB5
Feasibility, Image Quality and Radiation Dose of Coronary CT Angiography (CCTA) in Patients with
Atrial Fibrillation using a New Generation 256 Multi-Detector CT (MDCT)
Station #5
Participants
Laurent Macron, Saint Denis, France (Presenter) Nothing to Disclose
Jean-Louis Sablayrolles, Saint Denis, France (Abstract Co-Author) Nothing to Disclose
Jacques Feignoux, MD, Saint Denis, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate feasibility, image quality and radiation dose of CCTA in patients with atrial fibrillation (AF) using a new generation 256MDCT
METHOD AND MATERIALS
Thirty consecutive patients (mean HR 103.8±52.2 bpm) with AF underwent CCTA on a 256-MDCT (Revolution CT, General Electric).
Prevalence and impact on diagnosis of motion and step artifacts were independently evaluated by two experienced readers using a
3-point scale (0: no artifact; 1: artifacts without interference on diagnosis; 2: artifacts interfere with diagnosis) and percentage of
assessable coronary segments was calculated. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured for
quantitative assessment. Radiation dose was evaluated by calculating the mean effective dose (ED).
RESULTS
On a per-patient analysis, all the coronary segments were assessable in 28 (93%) patients. Only 3 coronary segments were not
assessable in 2 patients due to motion artefacts resulted in a coronary segments assessability of 99.3% (453/456 segments) in the
overall population. No step artifact was observed whereas motion artefacts (3-point scale score of 0.53±0.6) were infrequent and
do not interfere with diagnosis. The mean CNR and mean SNR were respectively 13.3±4.6 and 13.0±3.3. ED remains low with an
average of 3.3±2.5 mSv.
CONCLUSION
CCTA is feasible in AF patients using a new generation 256-MDCTproviding good image quality and low radiation dose in this
challenging population.
CLINICAL RELEVANCE/APPLICATION
Improvement of CCTA in atrial fibrilation patients
CA251-SDWEB7
High-pitch Single Heart Beat Coronary CT Angiography, The Effect of Heart Rate on Image Quality ? a
2nd and 3rd Generation Dual Source CT Study
Station #7
Participants
Adriaan Coenen, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Philip V. Linsen, BSc, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Raluca G. Saru, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Marcel L. Dijkshoorn, RT, Rotterdam, Netherlands (Abstract Co-Author) Consultant, Siemens AG
Mohamed Ouhlous, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
PURPOSE
Coronary CT angiography (CCTA) is a reliable examination with a strong ability to rule out coronary artery disease. However the
radiation exposure from a CCTA examination was relatively high, in the last decade multiple technical improvements resulted in a
decrease in radiation exposure. The high-pitch spiral scan mode allows for further reduction in radiation dose. However as the scan
is made in a single heart beat a low heart rate has always been a necessity. With the introduction of the 3rd generation dual
source CT (DSCT) the time needed for the acquisition has been reduced, allowing for acquisition in patients with higher heart rates.
In this study we investigate the effect of heart rate on image quality when using the high-pitch spiral mode comparing the 2nd and
3rd generation DSCT.
METHOD AND MATERIALS
We retrospectively investigated the first 50 patients scanned with the 2nd and 3rd generation DSCT at our institution. The heart
rate during acquisition was recorded. Tube voltage and current were selected semi-automatic. The table movement speed
increased from 458mm/sec to 737mm/sec with the 3rd generation DSCT. Subjective image quality was measured by two
independent observers using a five-point Likert score.
RESULTS
The mean heart rate was 56.4 ±6.0 for the 2nd and 59.0 ±7.4 for the 3rd generation DSCT (p= 0.045). Subjective image quality
was better for the 3rd generation DSCT with a mean Likert score of 4.2 ±0.8 vs 3.0 ±0.7 (p=<0.0001). The decrease in image
quality due to higher heart rates started at a later point for the 3rd generation compared to the 2nd generation DSCT (figure 1).
The radiation dose for high-pitch spiral mode is already low, with a lower radiation dose of 0.6 ±0.3 mSv for the 3rd generation
DSCT compared with 1.2 ±0.5 mSv for the 2nd generation DSCT (p<0.0001).
CONCLUSION
Higher heart rates increase the change of a lower quality CCTA. When comparing the 3rd and 2nd generation DSCT the 3rd
generation allows for a utilization of the high-pitch spiral mode at higher heart rates, increasing the population suitable for highpitch spiral scan mode.
CLINICAL RELEVANCE/APPLICATION
With the applicability of the high-pitch spiral mode with higher heart rates the clinical usage can be further increased. Decreasing
radiation exposure without concerns for image quality.
CA148-EDWEB8
Cardiac MR in Left Ventricular Hypertrophy: State of the Art
Station #8
Participants
Jerome Caudron, MD, Rouen, France (Presenter) Nothing to Disclose
Benjamin Dubourg, MBBS, MD, Rouen, France (Abstract Co-Author) Nothing to Disclose
Jean-Nicolas Dacher, MD, Rouen, France (Abstract Co-Author) Consultant, General Electric Company
TEACHING POINTS
1. To define and quantify left ventricular hypertrophy (LVH) by cardiac MR (CMR).2. To describe the diagnostic approach when
exploring a patient with LVH.3. To discuss and illustrate the usefulness of CMR in identifying the cause of LVH and the associated
prognosis.4. To know the basics of T1 mapping and extracellular volume fraction of the myocardium and their interest when
exploring a patient with LVH.
TABLE OF CONTENTS/OUTLINE
In this exhibit will be described: 1.Definition and main causes of LVH; 2. Applicable methods to explore LVH; 3. Pictorial review of
LVH with CMR; 4. Differential diagnosis and pitfalls.
SSM03
ISP: Cardiac (Congenital Heart Disease/Cardiac Stents)
W ednesday, Dec. 2 3:00PM - 4:00PM Location: S502AB
CA
CT
MR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Cynthia K. Rigsby, MD, Chicago, IL (Moderator) Nothing to Disclose
U. Joseph Schoepf, MD, Charleston, SC (Moderator) Research Grant, Bracco Group; Research Grant, Bayer AG; Research Grant,
General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Sub-Events
SSM03-01
Iterative Reconstructions for Imaging of Coronary-Artery Stents with Computed Tomography: First
In-vitro Experience
W ednesday, Dec. 2 3:00PM - 3:10PM Location: S502AB
Participants
Tilman Hickethier, MD, Cologne, Germany (Presenter) Nothing to Disclose
Jan Robert Kroger, MD, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
Jochen von Spiczak, Muenster, Germany (Abstract Co-Author) Nothing to Disclose
Bettina Baessler, MD, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
Dirk K. Mueller, PhD, Hamburg, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
Walter Giepmans, Best, Netherlands (Abstract Co-Author) Employee, Koninklijke Philips NV
Guido Michels, Cologne, Germany (Abstract Co-Author) Nothing to Disclose
David C. Maintz, MD, Koln, Germany (Abstract Co-Author) Nothing to Disclose
Alexander C. Bunck, Koln, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
In-stent restenosis is one of the most important limitations of coronary angioplasty (PCI). Accurate assessment of coronary stents
after PCI using non-invasive CT imaging remains challenging despite new stent materials and improvements in CT technology. New
model-based iterative reconstruction (IR) filters have been shown to significantly improve the assessment of native coronary
vessels. In our study we systemically evaluated the influence of IR on visualization of coronary stent lumen.
METHOD AND MATERIALS
Ten coronary stents of various materials placed in plastic tubes filled with contrast agent (345 HU) were scanned with a 256-slice
CT (iCT, Philips). Images were reconstructed (0.67mm slice thickness, 0.35mm increment) with standard filtered back projection,
hybrid IR (iDose L4) and two different model-based IR settings (Cardiac Routine (CR) & Cardiac Sharp (CS)) at 3 strength levels
(IMR, Philips). Each stent and reconstruction was assessed using established parameters: image noise (standard deviation (SD) in a
standardized ROI), in-stent attenuation (mean attenuation difference between stented and non-stented lumen of the contrast
agent-filled tube) and image sharpness (calculated maximum slope of signal intensity profiles across the stents).
RESULTS
Image noise was significantly lower in IMR data, being lowest at higher iteration levels (FBP 25.4/iDose 18.8/IMRCR1 9.6/IMRCR2
6.1/IMRCR3 3.4/IMRCS1 12.9/IMRCS2 8.6/IMRCS3 4.7 HU; p < .01).Differences in attenuation across the stents were significantly
smaller in IMR data when applying the CR setting which showed the best depiction of the in-stent attenuation (FBP 372.8/iDose
353.9/IMRCR1 90.1/IMRCR2 110.8/IMRCR3 112.6 HU; p < .01). IMR CS however suppressed stent-blooming artifacts excessively
with in parts severely reduced densities in stented tube lumina which might be explained by limitations of spatial resolution.Maximum
image sharpness was significantly higher in IMR data (FBP 387.2/iDose 386.8/IMRCR1 656.2/IMRCR2 661.8/IMRCR3 647.0/IMRCS1
845.3/IMRCS2 862.8/IMRCS3 879.7 HU/pixel; p < .01).
CONCLUSION
Well-established objective CT image-quality assessment parameters of coronary stents are significantly improved by using modelbased IR when the adequate setting is applied.
CLINICAL RELEVANCE/APPLICATION
Non-invasive evaluation of coronary stents is an important and challenging task. Model-based IR has the potential of significantly
improving coronary-stent assessment.
SSM03-02
Assessment of Iterative Metal Artifact Reduction (iMAR) in Cardiac CT for Patients with Pacemakers
and Implantable Defibrillators
W ednesday, Dec. 2 3:10PM - 3:20PM Location: S502AB
Participants
Juan Montoya, Rochester, MN (Presenter) Nothing to Disclose
Shuai Leng, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Ahmed Halaweish, PhD, Rochester, MN (Abstract Co-Author) Employee, Siemens AG
Cynthia H. McCollough, PhD, Rochester, MN (Abstract Co-Author) Research Grant, Siemens AG
Eric E. Williamson, MD, Rochester, MN (Abstract Co-Author) Research Grant, General Electric Company
PURPOSE
Metal artifacts from pacemaker leads and implantable cardioverter defibrillators (ICD) can significantly obscure relevant anatomy in
cardiac CT. This study aimed to apply iterative metal artifact reduction (iMAR) to Cardiac CT for improved visualization of lead tips
and surrounding anatomy in patients with pacemakers and ICDs.
METHOD AND MATERIALS
CT raw data were retrospectively collected for patients that underwent clinically indicated gated CT of the heart using a dualsource CT scanner (Somatom Definition and Definition Flash, Siemens Healthcare) and had a pacemaker or ICD. Images were
reconstructed using routine weighted-filtered back projection (WFBP) and a research prototype of cardiac iMAR using an offline
reconstruction workstation. A cardiac radiologist evaluated WFBP and iMAR images side-by-side, blinded to the reconstruction
method. Another investigator determined post hoc which image was WFBP and iMAR so that the following grading scale was applied
to the iMAR images: 1= obviously worse, degrades diagnosis confidence, 2=slightly worse, does not affect diagnosis confidence,
3=equivalent, 4=slightly better, does not affect diagnosis confidence, 5=obviously better, improves diagnosis confidence. For
objective metal artifact evaluation, the length of severe artifacts from each lead were measured in multiple axial images. Wilcoxon
signed rank test was used to compare the radiologist evaluation as well as the difference in the length of metal artifacts.
RESULTS
16 patients (13 pacemakers, 3 ICDs) had a total of 31 leads. Mean reader grade was 4.5 for iMAR (P-value<0.001) indicating
significant improvement of image quality and diagnostic confidence. The average reduction in the length of severe metal artifacts
caused by the leads was 4.5 mm using iMAR compared to WFBP (p-value < 0.0001). Better metal artifact reduction was achieved in
right ventricle leads, which we suspect is due to increased motion in the right atrium. Two iMAR cases created artifacts in
anatomical regions different than lead tips.
CONCLUSION
The use of iMAR for cardiac CT in patients with pacemakers or ICDs can improve the visualization of anatomical structures close to
the leads, resulting in improved diagnostic confidence.
CLINICAL RELEVANCE/APPLICATION
The use of iMAR in cardiac CT could improve the visualization of critical anatomy by significantly reducing artifacts from metal
devices, leading to improved diagnostic confidence.
SSM03-03
Cardiac Keynote Speaker: Congenital Heart Disease
W ednesday, Dec. 2 3:20PM - 3:40PM Location: S502AB
Participants
Albert De Roos, MD, Leiden, Netherlands (Presenter) Nothing to Disclose
SSM03-05
Pulmonary Insufficiency Assessment by Cardiac Magnetic Resonance: Regurgitation Fraction or
Absolute Value of Reverse Volume?
W ednesday, Dec. 2 3:40PM - 3:50PM Location: S502AB
Participants
Francesco Secchi, MD, Milano, Italy (Presenter) Nothing to Disclose
Marcello Petrini, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Paola Maria Cannao, MD, San Donato Milanese, Italy (Abstract Co-Author) Nothing to Disclose
Elda Chiara Resta, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Massimo Chessa, San Donato Milanese, Italy (Abstract Co-Author) Nothing to Disclose
Francesco Sardanelli, MD, San Donato Milanese, Italy (Abstract Co-Author) Speakers Bureau, Bracco Group Research Grant, Bracco
Group Speakers Bureau, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific
Mario Carminati, MD, San Donato Milanese, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the use pulmonary regurgitation fraction (PRF) or absolute value of pulmonary reverse volume (PRV) in the evaluation
of pulmonary insufficiency with cardiac magnetic resonance (CMR).
METHOD AND MATERIALS
We retrospectively studied 44 patients (mean age 23±11 mean value±standard deviation, 17 females and 27 males) with
pulmonary/conduit insufficiency due to various congenital heart diseases who underwent CMR (1.5 T) before and after surgical
valve implantation (14 patients) or percutaneous Melody valve implantation (30 patients). We performed short axis ECG triggered
cine true-FISP (fast imaging with steady state precession) and phase contrast sequences. A reader with four-year of experience in
CMR segmented endocardial contours of right ventricle (RV) to obtain end diastolic volume index (EDVi), stroke volume index (SVi)
and analyzed the flow. We obtained both PRF (%, retrograde flow divided by anterograde) and PRV (ml/m2) and we correlated them
with RVEDVI, SVi and differences (Δ) of RVEDVI before and after procedures. Spearman test was used.
RESULTS
Overall PRF (%), PRV (ml/m2), RVEDVi (ml/m2) and SVi (ml) were 23±25, 0.29±0.22, 99±43 and 45±16 respectively. RVEDVI was
significantly correlated with PRF (r=0.480; P=.001) and PRV (r=0.549; P<.001). RVSVi was significantly correlated with PRF
(r=0.605; P<.001) and PRV (r=0.701; P<.001). ΔRVEDVi was significantly correlated with PRF (r=0.427; P=.004) and PRV (r=0.489;
P=.001).
CONCLUSION
PRV is stronger correlated with RVEDVi, RVSVi and ΔRVEDVi than PRF.
CLINICAL RELEVANCE/APPLICATION
Pulmonary reverse volume is a stronger indicator of RV dysfunction than regurgitant fraction.
SSM03-06
Assessment and Intervention Planning in Aortic Coarctation Based on Anatomic and 4D PC MRI
W ednesday, Dec. 2 3:50PM - 4:00PM Location: S502AB
Participants
Anja Hennemuth, PhD, Bremen, Germany (Presenter) Nothing to Disclose
Hanieh Mirzaee, Bremen, Germany (Abstract Co-Author) Nothing to Disclose
Mathias Neugebauer, Bremen, Germany (Abstract Co-Author) Nothing to Disclose
Johann Drexl, Bremen, Germany (Abstract Co-Author) Nothing to Disclose
Christian Schumann, Bremen, Germany (Abstract Co-Author) Nothing to Disclose
Marcus Kelm, MD, Berlin, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Aortic coarctation is a narrowing of the aorta in the region of the transition between the aortic arch and the descending aorta
where the fetal ductus arteriosus had joined. The AHA Guidelines recommended therapy for patients with a systolic coarctation
pressure gradient of more than 20 mmHg.We have implemented a solution for the non-invasive assessment of aortic diameters and
pressure gradients based on an MRI protocol combining a whole heart or angiographic MRI with a 4D PC MRI.
METHOD AND MATERIALS
The EXTENTO software prototype works with a 3D whole heart covering the aortic arch or MR angiography of the aorta for the
extraction of the anatomical information and geometrical measurements. This is fused with a 4D PCMRI sequence for the
assessment of the corresponding hemodynamics. The workflow consists of an interactive segmentation followed by the exploration
of diameters as well as the centerline pressure difference curve for an interactively selected vessel region. Furthermore, pressure
maps are visualized in 3D.The provided application has been applied to 5 datasets of patients scheduled for stenting therapy of
aortic coarctation (age 11-44). All data were acquired with a Philips Achieva 1.5T scanner. Whole heart volumes were acquired
with a resolution of 1.42x1.42x2mm³, 4D PC MRI had a velocity encocing between 3 and 4 m/s, a spatial resolution of
1.41x1.41x2.3mm³, and a temporal resolution of 40ms.
RESULTS
Data processing was possible in all cases and took 10 to 15 minutes. Systolic pressure gradients along the selected centerline
sections were between 15 and 22mmHg and clearly visible in the calculated parameter maps.
CONCLUSION
The presented results suggest that the proposed MR imaging protocol and image processing solution could be suitable for the noninvasive assessment of stenoses in clinical practice.
CLINICAL RELEVANCE/APPLICATION
Aortic coarctation occurs in about 7% of all congenital heart defects. The high afterload induced by the stenosis can lead to
ventricular dysfunction and thus a major therapy goal is to remove the pressure gradient. Pressure catheters are the standard
diagnostic tool for the assessment of intravascular pressures. The suggested imaging and analysis aims at enabling the noninvasive measurement of relevant anatomic and hemodynamic information.
SSM04
Cardiac (Angiography)
W ednesday, Dec. 2 3:00PM - 4:00PM Location: S504AB
CA
CT
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Phillip M. Young, MD, Rochester, MN (Moderator) Nothing to Disclose
Shawn D. Teague, MD, Indianapolis, IN (Moderator) Stockholder, Apple Inc
Antoinette S. Gomes, MD, Culver City, CA (Moderator) Stockholder, St. Jude Medical, Inc; Research Consultant, Boston Scientific
Corporation
Sub-Events
SSM04-01
Four-dimensional Noise Reduction Using the Time Series of CT Datasets in Short Interval Times;
Initial Comparison in Clinical Cases
W ednesday, Dec. 2 3:00PM - 3:10PM Location: S504AB
Participants
Tatsuya Nishii, MD, PhD, Kobe, Japan (Presenter) Nothing to Disclose
Atsushi K. Kono, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Wakiko Tani, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Erina Suehiro, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Noriyuki Negi, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Yoshiaki Watanabe, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Satoru Takahashi, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kazuro Sugimura, MD, PhD, Kobe, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation Research Grant, Koninklijke
Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group
Shumpei Mori, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tatsuro Ito, MD, PhD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Tomofumi Takaya, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
A four-dimensional noise reduction (4DNR) method applied to datasets having short interval times (≤ 50 ms), referred to as legato,
has been reported using phantom analysis to significantly reduce noise without changing the CT numbers or spatial resolution.
Coronary CT angiography (CCTA) usually acquires datasets that include "padding" phases centered on the end-diastole. However,
the additional information provided by additional phases has largely been ignored. Legato can be applied to such datasets to reduce
image noise in CCTA. The present study conducts quantitative image quality analysis using retrospective clinical cases to examine
the hypothesis that post-processing with legato reduces noise in CCTA images.
METHOD AND MATERIALS
The records of 25 consecutive patients (mean 63 [range 15-80] years old, 7 female) who had undergone routine CCTA using a
retrospective ECG-gated helical scan (120 kVp, reference tube current-time product as 390 mAs) with a 128-detector row dualsource CT, were retrospectively reviewed. The three datasets for the end-diastolic phase were reconstructed with iterative
reconstruction, and were post-processed including the implementation of legato. Image datasets for the center phase obtained
from the collected and computed datasets are referred to as non-legato and legato images. Objective image quality was measured
for various regions of interest, and subjective image quality was evaluated with a five-point Likert scale. The difference in image
quality between non-legato and legato images was assessed by the Welch test and the Cochran-Armitage test.
RESULTS
Using legato, contrast-to-noise ratio and signal-to-noise ratio were significantly improved from 13.6 ± 2.8 to 22.9 ± 4.6, and 19.6 ±
4.1 to 29.7 ± 7.1 for the aortic root, and 17.7 ± 3.6 to 29.6 ± 5.5, and 14.2 ± 3.5 to 23.0 ± 6.6 for the mean of the proximal
coronary arteries (P < 0.001 for each). Further, the subjective image score was also significantly improved using legato (median 4
to 5, P = 0.028).
CONCLUSION
Our proposed post-processing 4DNR method with short internal time reduced 40% of the image noise in clinical CCTA, and
significantly improved image quality.
CLINICAL RELEVANCE/APPLICATION
Using the "padding" data, image quality of coronary CT angiography could be significantly improved using the post-processing 4DNR
method.
SSM04-03
Intelligent Boundary Registration Technique (IBR) in Correcting Banding Artifact of Coronary
CTA(CCTA) in 64-slice CT
W ednesday, Dec. 2 3:20PM - 3:30PM Location: S504AB
Participants
Yan Feng, Shanghai, China (Presenter) Nothing to Disclose
Qingguo Wang, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Zhiguo Zhou, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Na Gao, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Gui-Xiang Zhang, MD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the effect of IBR technique in correcting banding artifact of CCTA in 64-slice CT.
METHOD AND MATERIALS
Coronary CTA was performed on 70 patients with diagnosed or suspected coronary artery disease,using a 64-row CT scanner (GE
Discovery CT750 HD).Image quality between standard reconstruction(group standard) and IBR reconstruction(group IBR) was
compared by 2 experienced readers on GE AW4.6 workstation., using a 5-point scale, according to a standard 15-segment model by
American Heart Association.
RESULTS
Mean heart rate range 43-132bpm, 71±13.29 bpm,There were 163 segments with 220 motion artifacts, IBR construction corrected
73.6%(162/220) of the artifacts. Stepladder as the most artifact, 97.27% of which were recovered after IBR reconstruction, and
the majority artifacts of split-level, disconnection, density gradient were recovered well. Significant higher image quality was
observed in IBR group than standard group (3.97±0.93VS4.11±0.92,P<0.001).The interpretability was increased after IBR
reconstruction at level of segment and artery with no statistical difference between two groups.
CONCLUSION
IBR technique is helpful in correcting banding artifact in CCTA of 64-slice CT.
CLINICAL RELEVANCE/APPLICATION
IBR technique provides a convenient and effective method to correct banding artifact ,especially for ladder artifact,which is helpful
in improving image quality and diagnostic accuracy of coronary CTA.
SSM04-04
High-pitch Single Heart Beat Coronary CT Angiography, The Effect of Heart Rate on Image Quality ?
A 2nd and 3rd Generation Dual Source CT Study
W ednesday, Dec. 2 3:30PM - 3:40PM Location: S504AB
Participants
Adriaan Coenen, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Philip V. Linsen, BSc, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Raluca G. Saru, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Marcel L. Dijkshoorn, RT, Rotterdam, Netherlands (Abstract Co-Author) Consultant, Siemens AG
Mohamed Ouhlous, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
PURPOSE
Coronary CT angiography (CCTA) is a reliable examination with a strong ability to rule out coronary artery disease. However the
radiation exposure from a CCTA examination was relatively high, in the last decade multiple technical improvements resulted in a
decrease in radiation exposure. The high-pitch spiral scan mode allows for further reduction in radiation dose. However as the scan
is made in a single heart beat a low heart rate has always been a necessity. With the introduction of the 3rd generation dual
source CT (DSCT) the time needed for the acquisition has been reduced, allowing for acquisition in patients with higher heart rates.
In this study we investigate the effect of heart rate on image quality when using the high-pitch spiral mode comparing the 2nd and
3rd generation DSCT.
METHOD AND MATERIALS
We retrospectively investigated the first 50 patients scanned with the 2nd and 3rd generation DSCT at our institution. The heart
rate during acquisition was recorded. Tube voltage and current were selected semi-automatic. The table movement speed
increased from 458mm/sec to 737mm/sec with the 3rd generation DSCT. Subjective image quality was measured by two
independent observers using a five-point Likert score.
RESULTS
The mean heart rate was 56.4 ±6.0 for the 2nd and 59.0 ±7.4 for the 3rd generation DSCT (p= 0.045). Subjective image quality
was better for the 3rd generation DSCT with a mean Likert score of 4.2 ±0.8 vs 3.0 ±0.7 (p=<0.0001). The decrease in image
quality due to higher heart rates started at a later point for the 3rd generation compared to the 2nd generation DSCT (figure 1).
The radiation dose for high-pitch spiral mode is already low, with a lower radiation dose of 0.6 ±0.3 mSv for the 3rd generation
DSCT compared with 1.2 ±0.5 mSv for the 2nd generation DSCT (p<0.0001).
CONCLUSION
Higher heart rates increase the change of a lower quality CCTA. When comparing the 3rd and 2nd generation DSCT the 3rd
generation allows for a utilization of the high-pitch spiral mode at higher heart rates, increasing the population suitable for highpitch spiral scan mode.
CLINICAL RELEVANCE/APPLICATION
With the applicability of the high-pitch spiral mode with higher heart rates the clinical usage can be further increased. Decreasing
radiation exposure without concerns for image quality.
SSM04-06
Radiation Dose Levels of Retrospectively ECG-Gated Coronary CT Angiography Using 70 kVp Tube
Voltage in Patients with High or Irregular Heart Rates
W ednesday, Dec. 2 3:50PM - 4:00PM Location: S504AB
Participants
Mathias Meyer, Mannheim, Germany (Presenter) Speaker, Siemens AG; Speaker, Bracco Group
Holger Haubenreisser, Mannheim, Germany (Abstract Co-Author) Speaker, Siemens AG; Speaker, Bayer AG
U. Joseph Schoepf, MD, Charleston, SC (Abstract Co-Author) Research Grant, Bracco Group; Research Grant, Bayer AG; Research
Grant, General Electric Company; Research Grant, Siemens AG; Research support, Bayer AG; ; ;
Rozemarijn Vliegenthart, MD, PhD, Groningen, Netherlands (Abstract Co-Author) Nothing to Disclose
Melissa Ong, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Christina Doesch, Tubingen, Germany (Abstract Co-Author) Nothing to Disclose
Sonja Sudarski, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Martin Borggrefe, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Stefan O. Schoenberg, MD, PhD, Mannheim , Germany (Abstract Co-Author) Institutional research agreement, Siemens AG
Thomas Henzler, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate radiation dose and number of inconclusive coronary segments at coronary CT angiography (cCTA) using retrospective
electrocardiographic (ECG) gating at 100/70kV.
METHOD AND MATERIALS
With IRB approval, 154 patients (median age 54 years; 98 men) with high or irregular heart rate prospectively underwent
retrospectively ECG-gated cCTA on a third generation dual-source CT (DSCT) system at 70kV (n=103) or on a second generation
DSCT system at 100kV (n=51). Images were reconstructed in best diastolic phase (BDP), best systolic phase (BSP), and in all
phases (AP) at 10% intervals across the R-R cycle. Objective and subjective image quality were evaluated as well as the presence
of motion artifacts with the three different reconstruction approaches. Comparisons between the groups were analyzed with twoway ANOVA or Wilcoxon-Rank-Sum Test depending on the distribution of the data.
RESULTS
Mean heart rate was 93 ± 16 beats per minute. The mean effective radiation dose was 4.5 mSv for 70kV compared to 8.4 for 100kV
(p<0.05). At BDP reconstruction, 110 patients showed motion artifacts in one or more coronary segments (in total, 246 segments).
At BSP reconstruction, the number of patients with motion artifacts decreased to 57 (147 segments). In contrast, if images were
reconstructed with the AP approach, all vessels and coronary segments were evaluable with both cCTA protocols.
CONCLUSION
Retrospectively ECG-gated cCTA at 70kV results in 52% decreased radiation dose. This is especially important as the AP algorithm
allows evaluating all coronary segments for stenosis, in contrast to best BDP or BSP phase alone. Furthermore, retrospectively ECGgated cCTA allows for the evaluation of left ventricular function as a potentially useful diagnostic and prognostic adjunct.
CLINICAL RELEVANCE/APPLICATION
Retrospectively-ECG-gated coronary CTA at 70 kV without ECG-controlled tube current modulation strengthens the robustness of
cCTA by significantly reducing the number of non-diagnostic coronary segments while radiation dose can be reduced.
SSM16
Nuclear Medicine (Cardiovascular Imaging)
W ednesday, Dec. 2 3:00PM - 4:00PM Location: S505AB
CA
CT
NM
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
FDA
Discussions may include off-label uses.
Participants
Charles M. Intenzo, MD, Philadelphia, PA (Moderator) Nothing to Disclose
Andrew C. Homb, MD, Louisville, KY (Moderator) Nothing to Disclose
Sub-Events
SSM16-01
Anthropometric-based Radiopharmaceutical Dosing to Reduce Radiation in SPECT MPI: Initial
Experience
W ednesday, Dec. 2 3:00PM - 3:10PM Location: S505AB
Participants
Jie Zhang, PhD, Lexington, KY (Presenter) Nothing to Disclose
Vince Sorrell, MD, Lexington, KY (Abstract Co-Author) Nothing to Disclose
Paul Anaya, Lexington, KY (Abstract Co-Author) Nothing to Disclose
M. Elizabeth Oates, MD, Lexington, KY (Abstract Co-Author) Nothing to Disclose
PURPOSE
Myocardial perfusion imaging (MPI) using gated single photon emission computed tomography (SPECT) is a well-established
approach to detect coronary artery disease and risk-stratify patients. For a typical 1-day rest/stress SPECT protocol, standard
administered activities of Tc-99m sestamibi are 10 mCi (rest)/30 mCi (stress), resulting in a patient radiation dose of ~12 mSv..
The American Society of Nuclear Cardiology recommended decreasing radiation exposure to < 9 mSv in 50% of patients by 2014. To
comply with this recommendation, we employed a new anthropometric-based dosage regimen.
METHOD AND MATERIALS
We investigated the relationship between administered Tc-99msestamibi activity, patient size, and image quality. Patients
undergoing SPECT MPI were recruited over two consecutive weeks; measures of weight (kg), height (m), and chest circumference
(cm) [ITS1] were recorded. Body Mass Index (BMI) was calculated (kg/m2). Image quality was evaluated by a board-certified
nuclear radiologist and a nuclear cardiologist.
RESULTS
Thirty-one patients underwent 1-day rest/stress SPECT MPI. A convenient BMI-based 1-day rest/stress dosing regimen was
developed through analyses of administered activity, patient size, and image quality. Administered activities were 6 mCi/18 mCi for
BMI < 25 kg/m2, 7 mCi/21 mCi for BMI 25-30 kg/m2, 8 mCi/24 mCi for BMI30-35 kg/m2, and 10 mCi/30 mCi for BMI > 35 kg/m2. The
patient radiation doses were 7.26 mSv, 8.47 mSv, 9.68 mSv and 12.10 mSv, respectively. Image quality met clinical diagnostic
requirements. Scan time remained the same. With the proposed dosing regimen, radiation exposures in ~ 60% of 31 patients were <
9 mSv.
CONCLUSION
Using "older" gamma camera technology anthropometric-based dosing of Tc-99m sestamibi significantly reduces radiation exposure
while maintaining diagnostic image quality.
CLINICAL RELEVANCE/APPLICATION
BMI-adjusted dosing of Tc-99m sestamibi for rest/stress SPECT MPI can significantly reduce patient radiation dose while
maintaining image quality.
SSM16-02
Effect of Inflammatory Cardiac Sarcoidosis on Myocardial Blood Flow Assessed by PET/CT
W ednesday, Dec. 2 3:10PM - 3:20PM Location: S505AB
Participants
Matthew J. Kruse, MD, Baltimore, MD (Presenter) Nothing to Disclose
Thomas H. Schindler, MD, Geneva, Switzerland (Abstract Co-Author) Nothing to Disclose
PURPOSE
Inflammatory cardiac sarcoidosis, as evidenced by FDG PET/CT imaging, confers an increased risk for sudden cardiac death and
onset of heart failure. Dysfunction of the coronary circulation may represent a mechanistic link between inflammatory sarcoidosis
activity and adverse outcomes. In this respect, we aimed to investigate effects of inflammatory cardiac sarcoidosis on coronary
circulatory function.
METHOD AND MATERIALS
Individuals were 13 patients with biopsy-proven or clinical/imaging evidence of cardiac sarcoidosis undergoing baseline and followup cardiac PET/CT studies (31 total studies). Quantitative myocardial blood flow (MBF) was determined at rest and during
pharmacologic vasodilation with N-13 ammonia or Rb-82 PET/CT, with calculation of myocardial flow reserve (MFR). Following a
sarcoid diet protocol, FDG PET/CT was additionally performed to determine the presence of abnormal FDG uptake in the heart.
Myocardial segmentation was performed using the 17-segment model. Maximum SUV and metabolic volume above previously
published SUV thresholds was calculated.
RESULTS
Myocardial segments with abnormal FDG activity (n=122) demonstrated decreased MBF during vasodilation (1.96 +/- 0.86 ml/g/min
vs. 2.13 +/- 0.84 ml/g/min; p=0.045, Mann-Whitney Test) and decreased MFR (2.40 +/- 0.81 vs. 2.75 +/- 1.05; p=0.002). Resting
MBF was not significantly different (0.82 ml/g/min vs. 0.79 ml/g/min; p=0.305). Myocardial segments that developed abnormal FDG
activity on follow-up study (n=47) demonstrated a greater decrease in MFR compared with segments that remained FDG-negative
(n=200) (p=0.003). Segments that normalized on follow-up study (n=31) demonstrated decreased resting MBF compared with
segments that remained FDG-positive (n=28) (p=0.013). Global MFR was not significantly correlated with maximum SUV, metabolic
volumes, or clinical factors. BMI was weakly inversely correlated with both resting (Pearson r=-0.364, p=0.044) and vasodilation
(r=-0.485, p=0.007) global MBF.
CONCLUSION
Myocardial segments involved with active sarcoidosis as evidenced by abnormal FDG activity demonstrate decreased vasodilation
MBF and MFR, indicative of regional microvascular dysfunction that may reflect a basis for increased cardiovascular risk.
CLINICAL RELEVANCE/APPLICATION
Further studies are needed to determine if microvascular dysfunction detected by PET/CT perfusion quantitation may predict the
risk of poor outcomes in cardiac sarcoidosis.
SSM16-03
The Influence of Myocardial Scar as Assessed by Myocardial Perfusion SPECT on the Development of
Electrical Reverse Remodeling after Cardiac Resynchronization Therapy
W ednesday, Dec. 2 3:20PM - 3:30PM Location: S505AB
Participants
Guang-Uei Hung, MD, Lugang, Taiwan (Presenter) Nothing to Disclose
Ji Chen, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac resynchronization therapy (CRT) can provide cardiac reverse remodeling (RR), which may include electrical (ERR: QRS
duration shortened ≥ 10 ms) and/or mechanical (MRR: ESV reduced ≥15%) reverse remodeling. However, the pathophysiological
mechanism is not clear. Myocardial perfusion SPECT (MPS) provided a comprehensive evaluation of LV perfusion, function and
mechanical activation. The purpose of this was to explore the mechanism of RR with MPS.
METHOD AND MATERIALS
Forty-one patients (26 men, mean age 66±10 yrs) with heart failure received CRT for at least 12 months underwent resting MPS
under transient CRT-off. The patients were divided into three groups according to their RR levels: group I: MRR+ERR, group II: MRR
only and group III: non-responder. Emory cardiac toolbox was used for analysis of MPS to assess myocardial scar, LV volume, EF,
dyssynchrony, activation sequence and contraction delay.
RESULTS
Between the three groups of patients, there were significant differences for scar burden (15.9±9.5%, 26.8±16.1% and 45.6±15.1%,
for group I, II and III, respectively, p < 0.001), EDV (136.6±64.9ml, 221.6±123.9ml and 351.8±216.3ml, p = 0.002), ESV
(82.6±59.8ml, 172.3±117.2ml and 293.3±209.6ml, p = 0.001), LVEF (44.9±15.0%, 25.6±10.9% and 21.5±11.7%, p < 0.001),
systolic phase SD (23.4±10.3°, 36.0±16.2° and 57.0±22.2°, p < 0.001) and diastolic phase SD (32.1±12.4°, 48.4±18.3° and
64.7±22.5°, p < 0.001). As shown on the polar map of phase analysis (see attached figures), myocardial scar interfered with the
normal propagation of mechanical activation and resulted in heterogeneous activation sequences. Compared to group II, group I
had significantly less initiation points (1.9 ± 1.0 vs. 2.6 ± 0.7, p< 0.05) and smaller maximal contraction delay (46.9 ± 12.9°vs. 58.8
± 18.5°, p <0.05).
CONCLUSION
The perfusion, function and mechanical activation parameters as assessed by MPS were significantly associated with different
levels of RR. The volume of myocardial scar may play a critical role in the development of electrical RR.
CLINICAL RELEVANCE/APPLICATION
The comprehensive evaluation of myocardial substrates by myocardial perfusion SPECT disclosed the pathophysiological mechanisms
of different reverse remodeling patterns post CRT.
SSM16-04
Development of a Novel Software for Calculating Myocardial Flow Reserve from Dynamic Kinetic
Analysis Using a Cadmium-zinc-telluride (CZT) SPECT
W ednesday, Dec. 2 3:30PM - 3:40PM Location: S505AB
Participants
Masao Miyagawa, MD, PhD, Toon, Japan (Presenter) Nothing to Disclose
Yoshiko Nishiyama, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Rami Yokoyama, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Kana S. Ide, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Ryo Ogawa, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Tomoyuki Kido, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Akira Kurata, PhD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
Teruhito Mochizuki, MD, Toon, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
CZT camera enables fast acquisition of serial dynamic images during the first pass of flow agents. The aims are to develop a novel
software for calculating myocardial flow reserve (MFR) and validate the utility for screening patients (pts) with multi-vessel
coronary artery disease (CAD).
METHOD AND MATERIALS
Dynamic myocardial perfusion imaging (MPI) starting with 30-s bolus of Tc-99m perfusion agents was performed during adenosine
stress and at-rest using a CZT camera (DNM 530c). The interval between two imaging was 3 hours and a 30-s pre-scan count was
subtracted from the dynamic data at-rest. We generated 200 3-D volumes integrating 3-s time frames in the course of 600-s.
Routine summed MPI were also acquired thereafter. The software allows the automatic edge detection of volume of interest for the
blood pool in the left ventricle and the myocardium. Global time activity curves were fitted to a 2-compartment kinetic model (2com), a Patlak plot analysis (PPA), and a dose uptake ratio of MPI (DUR) with input function. K1 and K2 were calculated for the
stress and rest images. MFR index was calculated as follows: MFR index=K1 stress/K1 at-rest. The validation study included 45
consecutive pts who underwent CZT SPECT and coronary angiography within 2 weeks. (25 males, 68±11 y).
RESULTS
There were 17 pts with multi-vessel CAD while 28 had 0 or 1-vessel CAD. In the multi-vessel group, global MFR estimated by 2-com
was 1.12±0.16 (Figure), which was significantly lower than 1.35±0.15 for pts with 0 or 1-vessel CAD (p<0.0001). The area under
the curve (AUC) by receiver operating characteristic (ROC) analysis was 0.85, 0.73, and 0.65 for 2-com, PPA, and DUR,
respectively. Using a cut-off value of 1.3, the sensitivity was 94% and specificity was 64% for diagnosing multi-vessel CAD.
Moreover, multivariate analysis reveals that the global MFR by 2-com was an independent predictor of multi-vessel CAD among 11
clinical and MPI variables (chi-square: 5.46, p=0.02).
CONCLUSION
We developed and validated a novel software for calculating MFR from dynamic kinetic analysis using a CZT SPECT. It improves the
detectability of multi-vessel CAD which causes globally decreased MFR and adds incremental diagnostic value to the standard MPI.
CLINICAL RELEVANCE/APPLICATION
Dynamic myocardial perfusion imaging with the 2-compartment analysis using the CZT SPECT enables us to estimate myocardial
flow reserve and may improve the detectability of multi-vessel CAD.
SSM16-05
Physiologic Correlates of Rb-82 PET/CT Left Ventricular Mass: Volume Ratios
W ednesday, Dec. 2 3:40PM - 3:50PM Location: S505AB
Participants
Kenneth Nichols, PhD, New Hyde Park, NY (Presenter) Royalties, Syntermed, Inc;
Andrew Van Tosh, MD, Roslyn, NY (Abstract Co-Author) Consultant, Pfizer Inc; Consultant, Bracco Group; Consultant, Cardinal
Health, Inc; Consultant, Ion Beam Applications, SA
Nathaniel Reichek, MD, Roslyn, NY (Abstract Co-Author) Nothing to Disclose
Christopher J. Palestro, MD, New Hyde Park, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
MRI and echocardiography investigators have found that computing the ratio of left ventricular (LV) mass:volume, indexed to a pt's
body size, is a useful means of characterizing ventricular remodeling, including aiding in predicting the likelihood of adverse cardiac
events. We sought to identify the pathophysiologic mechanisms leading to abnormal M/Vi by examining whether LV myocardial blood
flow (MBF) measured by Rb-82 PET/CT is also abnormal for pts with low Mi/Vi.
METHOD AND MATERIALS
We performed a retrospective investigation of data acquired for 194 pts who underwent rest/stress Rb-82 PET/CT imaging for
suspected cardiac disease. LV mass indexed to body size (Mi) = 100 • resting mass/(a • height^0.54 • weight^0.61), where a =
6.82 for women, 8.25 for men. LV end-diastolic volume indexed to body (Vi) = 100 • resting end-diastolic volume/(b • height^1.25 •
weight^0.43), where b = 10.0 for women, 10.5 for men. The normal range for Mi/Vi = 1.0-1.5. We compared ejection fraction (EF),
myocardial blood flow (MBF), and coronary vascular resistance (CVR) against Mi/Vi. LV MBF and CVR were computed from the first
pass transit of injected Rb-82 using a 2-compartment model, and volumes and EF values were computed from subsequent
myocardial gated equilibrium data.
RESULTS
55 pts had Mi/Vi < 1.0 (mean 0.86±0.08) and 139 pts had Mi/Vi ≥ 1.0 (mean 1.32±0.22). Compared to pts with Mi/Vi ≥ 1.0, those
with Mi/Vi < 1.0 had abnormally low rest values of EF (45±16% versus 60±15%, p<0.0001) and low MBF (0.58±0.25 versus
0.96±0.59 ml/g/min, p < 0.0001) and abnormally high CVR (182±71 versus 131±80 mm Hg/ml/g/min, p = 0.0001). Differences were
even more pronounced at stress, with abnormally low values of EF (45±17% versus 65±14%, p<0.0001) and low MBF (1.06±0.61
versus 1.89 ± 0.96ml/g/min, p < 0.0001) and abnormally high CVR (107±49 versus 64±42 mm Hg/ml/g/min, p = 0.0001). For pts with
Mi/Vi < 1.0, rest and stress MBF and EF were significantly lower, and CVR significantly higher, than published normal limits for these
parameters.
CONCLUSION
Our results suggest that a finding of an abnormally low indexed mass-to-volume ratio in an individual is consistent with impaired
myocardial blood flow, which hampers EF response to stress.
CLINICAL RELEVANCE/APPLICATION
A finding of low indexed mass-to-volume ratio should be followed up by more specific procedures such as coronary arteriography to
assess more completely arterial status.
SSM16-06
F-18 FLT PET/CT Imaging for Diagnosis of Cardiac Sarcoidosis
W ednesday, Dec. 2 3:50PM - 4:00PM Location: S505AB
Participants
Takashi Norikane, Kita-gun, Japan (Presenter) Nothing to Disclose
Yuka Yamamoto, MD, PhD, Kagawa, Japan (Abstract Co-Author) Nothing to Disclose
Yukito Maeda, Kita-Gun, Japan (Abstract Co-Author) Nothing to Disclose
Takahisa Noma, Kita-Gun, Japan (Abstract Co-Author) Nothing to Disclose
Yoshihiro Nishiyama, MD, Kagawa, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
2-deoxy-2-F-18 fluoro-D-glucose (FDG) positron emission tomography (PET) has been proposed to play a role in the diagnosis of
cardiac sarcoidosis. However, assessing inflammatory lesions in cardiac sarcoidosis using FDG can be challenging because the FDG
accumulates in normal myocardium. In contrast to FDG, 3'-deoxy-3'-F-18 fluorothymidine (FLT) uptake in normal myocardium is low.
The purpose of this study was to investigate the feasibility of FLT PET/CT for the detection of cardiac sarcoidosis.
METHOD AND MATERIALS
Sixteen FLT PET/CT studies in 12 patients suspected of having cardiac sarcoidosis were performed. Six studies were performed
before therapy and 10 studies were performed after immunosuppressive therapy. Fifty min after an intravenous injection of FLT, a
10-min emission scan of the heart was obtained. CT data for attenuation correction was obtained. Myocardial FLT uptake in cardiac
sarcoidosis was defined as a "focal" or "focal on diffuse" pattern. In case of abnormal uptake, the maximal standardized uptake
value (SUV) of lesions was measured. In case of no abnormal uptake, the mean SUV of myocardium was measured.
RESULTS
Five of 6 FLT studies before therapy showed a focal pattern of FLT uptake. Four of 10 FLT studies after therapy showed a focal
pattern of FLT uptake. The mean (±SD) SUV after therapy (1.68±0.59) was significantly lower than that before therapy
(3.02±0.90) (p<0.02).
CONCLUSION
These preliminary results indicate that FLT PET/CT might be a potentially useful tracer in the detection and therapy monitoring of
cardiac sarcoidosis.
CLINICAL RELEVANCE/APPLICATION
FLT PET/CT might be a potentially useful tracer in the detection and therapy monitoring of cardiac sarcoidosis.
ED002-TH
Cardiac Thursday Case of the Day
Thursday, Dec. 3 7:00AM - 11:59PM Location: Case of Day, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Zachary R. Laste, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Identify pertinent findings and generate differential diagnosis for cardiac imaging studies. 2) Develop differential diagnoses based
on the clinical information and imaging findings. 3) Recommend appropriate management for patients based on imaging findings.
RC603
Interpreting Coronary Artery CTA
Thursday, Dec. 3 8:30AM - 10:00AM Location: N228
CA
CT
IR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
LEARNING OBJECTIVES
ABSTRACT
Sub-Events
RC603A
Imaging and Interpreting Re-vascularized Coronary Arteries (I: Bypass Grafts)
Participants
Smita Patel, MBBS, Ann Arbor, MI (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To review the basic approach of evaluating coronary artery bypass grafts on CT. 2) To review normal surgical anatomy and
pathology of coronary artery bypass graft conduits on CT.
ABSTRACT
RC603B
Imaging and Interpreting Re-vascularized Coronary Arteries (II: Stents)
Participants
Marc Dewey, MD, Berlin, Germany (Presenter) Research Grant, General Electric Company; Research Grant, Bracco Group; Research
Grant, Guerbet SA; Research Grant, Toshiba Corporation; Research Grant, European Commission; Research Grant, German Research
Foundation; Speakers Bureau, Toshiba Corporation; Speakers Bureau, Guerbet SA; Speakers Bureau, Bayer AG; Consultant, Guerbet
SA; Author, Springer Science+Business Media Deutschland GmbH; Editor, Springer Science+Business Media Deutschland GmbH;
Institutional research agreement, Siemens AG; Institutional research agreement, Koninklijke Philips NV; Institutional research
agreement, Toshiba Corporation; ; ; ; ; ; ; ; ;
LEARNING OBJECTIVES
1) Review the issues involved in detecting coronary in-stent restenosis by CT angiography. 2) Get an overview of the diagnostic
accuracy of CT angiography for coronary stents. 3) Understand the potential advantages of iterative reconstruction and perfusion
assessment by CT for stents.
URL
www.herz-kurs.de
RC603C
Deciphering Coronary Anomalies and Fistulas
Participants
Jonathan D. Dodd, MD, Dublin 4, Ireland (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Review the basic classification of coronary anomalies and fistulas. 2) Understand the most clinically important anomalies and
fistulas.
RC611
Advances in Cardiac Nuclear Imaging: SPECT/CT and PET/CT
Thursday, Dec. 3 8:30AM - 10:00AM Location: S504CD
CA
CT
NM
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
LEARNING OBJECTIVES
1) Understand the technical advancements associated with new scintillation cameras and SPECT-CT and PET-CT cameras. 2)
Appreciate the benefits of CT attenuation correction. 3) Appreciate the adjunctive benefits of anatomic definition provided with CT
and physiologic/function information provided by SPECT and PET. 4) Improve interpretive skills related to SPECT and PET-CT.
ABSTRACT
Camera and software technology recently has rapidly advanced, providing improved SPECT image resolution and increased counting
statistics. These advancements in turn have provided the possibility of reduced-time and reduced radiopharmaceutical dose image
acquisitions. Moreover, increased flexibility in imaging protocols has been realized. Future development of these methods hold
promise in increasing diagnostic accuracy and expanding diagnostic applications. The addition of CT to SPECT and PET has afforded
the ability to perform attenuation correction, thereby minizing attenuation artifacts and increasing diagnostic specificity. With CT
acquisitions of sufficient resolution, complementary anatomic diagnostic information is provided. In addition, more precise anatomic
localization of SPECT and PET abnormalities significantly increases clinical applicability.
Sub-Events
RC611A
Advances in Cardiac SPECT
Participants
E. Gordon Depuey, MD, New York, NY (Presenter) Steering Committee, Adenosine Therapeutics, LLC;
LEARNING OBJECTIVES
1) Understand software methods to cope with lower SPECT counting statistics in order to reduce scan acquisition time and/or
radiopharmaceutical injected activity and their clinical impact. 2) Understand instrumentation advances that allow new cameras to
perform SPECT with markedly reduced acquisition times and/or less radiopharmaceutical activity and their clinical impact. 3)
Implement protocols that facilitate patient-centered imaging and that reduce patient radiation exposure.
ABSTRACT
New software methods and new innovative hardware now allow for significantly shortened SPECT acquisition times without a
decrease in image quality. Advancements include iterative reconstruction, resolution recovery, and noise reduction software, and
focused collimation and solid state detectors incorporated into new camera designs. Attenuation correction increases diagnostic
specificity and facilitates stress-only protocols. Software advancements such such as high resolution imaging, scatter correction,
and respiratory gating increase diagnostic sensitivity. There has been an intersocietal effort to promote patient-centered imaging
with a focus on appropriateness guidelines, cost-containment, radiation dose reduction, and the selection of the most appropriate
imaging test and protocol to suit particular patient needs. The technical advancements described above facilitate implementation of
patient-centered imaging. Even with such technical advancements, however, attention to technical detail is essential to assure
optimal image quality. Camera and radiopharmaceutical quality control deserve the highest priority. A systematic review of
myocardial perfusion SPECT images is essential to recognize artifacts and optimize diagnostic accuracy. Case examples will be
presented to reinforce this approach.
RC611B
Advances in Cardiac PET
Participants
Sharmila Dorbala, MBBS, Boston, MA (Presenter) Research Grant, Astellas Group; Stockholder, General Electric Company; ; ; ;
LEARNING OBJECTIVES
1) Review the advantages and disadvantages of myocardial perfusion PET compared to SPECT for evaluation of coronary artery
disease. 2) Learn the added value of absolute quantitative parameters derived from PET for assessment of cardiovascular disease.
3) Update of current and future clinical applications of cardiac PET imaging in cardiovascular medicine.
ABSTRACT
Novel advances in PET detectors, radiotracer availability, clinical software, as well as hybrid PET/CT and PET/MR scanners have
revolutionized the clinical and investigative applications of cardiac PET. Cardiac PET myocardial perfusion imaging, in the 1970's,
was a predominantly investigative tool, with home-grown software, available at select major academic centers with access to a
cyclotron. Over the last decade, with easy access to PET scanners, and to positron emitting perfusion tracers, the use of cardiac
PET has exploded -well beyond major academic centers to several hospitals and to large office-based practices. Commercially
available software has made quantitative myocardial blood flow assessment, a main-stream clinical application. Hybrid PET/CT
scanner applications- calcium score and CT based coronary angiography-have further advanced the applications of cardiac PET.
PET/MR is an emerging technology with promising cardiovascular applications. Each of these exciting developments has transformed
cardiac PET from a predominantly investigative tool of the 1970's to the advanced clinical tool of the 2015. The primary goal of this
session is to discuss the present-day clinical and emerging applications of cardiac PET/CT and PET/MR using a practical case-based
approach.
SSQ02
Cardiac (PET CT, PET MRI and SPECT)
Thursday, Dec. 3 10:30AM - 12:00PM Location: S502AB
CA
CT
MR
NM
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Rainer K. Rienmueller, MD, Graz, Austria (Moderator) Nothing to Disclose
Seth J. Kligerman, MD, Denver, CO (Moderator) Nothing to Disclose
W. Brian Hyslop, MD, PhD, Chapel Hill, NC (Moderator) Nothing to Disclose
Sub-Events
SSQ02-01
Optimal Scan Timing for Transluminal Attenuation-gradient Coronary CT Angiography Using a
Contrast-material Flow Phantom
Thursday, Dec. 3 10:30AM - 10:40AM Location: S502AB
Participants
Yoshinori Funama, PhD, Kumamoto, Japan (Presenter) Nothing to Disclose
Toshiaki Shimonobo, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Takashi Shirasaka, BS, Fukuoka, Japan (Abstract Co-Author) Nothing to Disclose
Daisuke Utsunomiya, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Seitaro Oda, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yasuyuki Yamashita, MD, Kumamoto, Japan (Abstract Co-Author) Consultant, DAIICHI SANKYO Group
PURPOSE
The transluminal attenuation gradient (TAG), the gradient of intraluminal radiological attenuation, is a novel index that improves the
classification of coronary artery stenosis in coronary CT angiography (CCTA). However, the quantitative TAG value affected by the
scan timing after the injection of contrast material because it is calculated from the difference between the pre- and post-stenosis
CT numbers. Using a flow phantom and a 320-MDCT volume scanner we investigated the quantitative TAG value at different scan
timing points after contrast material injection for coronary CT angiography.
METHOD AND MATERIALS
Using a contrast-material flow phantom we performed one-volume scans on a 320-MDCT volume scanner (Aquilion ONE ViSION,
Toshiba). We employed two types of connecting tubes mimicking 0% and 70% stenosis. The heart rate (HR) was set at 60 bpm,
cardiac output at 2.0 and 4.0 l/min; the injection volume of contrast material was 40 ml delivered in the course of 10 sec. Flushing
was with 20 ml of physiological saline. The tube voltage and rotation time were 120 kVp and 275 msec. Acquisition of the 80-mm
coverage area (160 x 0.5 mm) along the z-axis was started 5.0 sec post-injection and repeated at 0.5 sec intervals for 40 sec with
no table movement. We measured the CT numbers on the same slice level and calculated the time density curve (TDC) for 40 sec
at 0.5-sec intervals. The TAG value was also calculated from the difference in the CT number obtained at 0% and 70% stenosis at
each time point.
RESULTS
At 70% stenosis and a cardiac output of 2.0 l/min, the time to peak enhancement (PE) from the arrival time was 15.5 sec. In
contrast, the time from the arrival time for the lowest TAG value was 6.5 sec at -6.6 Hounsfield units (HU)/cm, i.e. 9.0 sec earlier
from the time to PE. At the same time point of 6.5 sec from the arrival time, The TAG value at 0% stenosis was -1.4 HU/cm. At
70% stenosis and a cardiac output of 4.0 l/min, the time for the lowest TAG was 6.0 sec earlier and the TAG value was -4.0
HU/cm; it was -1.7 HU/cm at 0% stenosis.
CONCLUSION
The TAG value depends on the scan timing after contrast material injection and optimal scan timing dose not correspond to the
time to peak enhancement.
CLINICAL RELEVANCE/APPLICATION
The time to PE differs by 6.0-9.0 sec when the TAG value is obtained with optimal scan timing on a 320-MDCT volume scanner.
SSQ02-02
Feasibility Study of Low Tube Voltage (80kVp) Coronary CT Angiography with Knowledge Based
Iterative Reconstruction on Patients with BMI 20-25
Thursday, Dec. 3 10:40AM - 10:50AM Location: S502AB
Participants
Fan Zhang, PhD, Sanya, China (Presenter) Nothing to Disclose
Li Yang, MD, PhD, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the feasibility of low tube voltage (80kVp) coronary CT angiography with knowledge based iterative reconstruction
(IMR, Philips Healthcare) on BMI20-25 patients by comparing to images acquired with clinical routine protocols.
METHOD AND MATERIALS
Coronary CT angiography scans were acquired using a 256-slice MSCT (Brilliance iCT, Philips Healthcare) on 94 patients with body
Coronary CT angiography scans were acquired using a 256-slice MSCT (Brilliance iCT, Philips Healthcare) on 94 patients with body
mass index (BMI, 20-25 kg/m2) who were randomly assigned into 2 groups. The scan protocol for group 1 was 100kVp, 600mAs with
70ml contrast medium at an injection rate of 4.5 to 5.5ml/s, and images were reconstructed by a hybrid iterative reconstruction
technique (iDose4, Philips Healthcare), while the protocol for group 2 was 80kVp, 600mAs with 35ml contrast medium at an injection
rate of 3.5 to 4.5ml/s, and images were reconstructed with IMR. The mean image noise and CNR of different groups were measured
on CT images and compared using the paired-t test. In addition, image quality evaluation was performed by two radiologists who
were blinded to scan protocol, using a five-point scale (1 [poor] to 5 [excellent]).The results of the two groups were compared
between two groups with the Mann-Whitney U-test.
RESULTS
Compared to group 1, group 2 reduced the iodine delivery rate by 52.4% from 2.1±0.5 gI/s to 1.0±0.5 gI/s and the effective
radiation dose by 56.4% from 5.5±1.4 mSv to 2.4±1.2mSv. The mean CT attenuation, CNRs and image quality of all segments on
group2 were significantly improved compared to those on group2 (all, p<0.01).
CONCLUSION
By using of knowledge based iterative reconstruction technique, an ultra-low tube voltage combining with low contrast medium
protocol for cCTA can reduce both radiation dose and contrast medium dose with even better image quality.
CLINICAL RELEVANCE/APPLICATION
The use of 80kV-IMR with low injection dose protocols offers even lower image noise and better image quality especially of distal
segments despite a 56.4% radiation dose reduction and a 52.4% contrast medium dose reduction when compared to 100kV-HIR
with standard injection dose protocols on non-obese patients.
SSQ02-03
Myocardial Triglyceride and Left Ventricular Systolic Function: A Cross-Sectional CMR Study in PostAcute Hospitalization Heart Failure Patients
Thursday, Dec. 3 10:50AM - 11:00AM Location: S502AB
Participants
Pen-An Liao, MD, Taipei City, Taiwan (Presenter) Nothing to Disclose
Gigin Lin, MD, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Shang-Yueh Tsai, Taipei, Taiwan (Abstract Co-Author) Nothing to Disclose
Chao-Hung Wang, Keelung City, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Hsiang Juan, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Ching Lin, MD, Tao Yuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Ming-Ting Wu, MD, Kaohsiung, Taiwan (Abstract Co-Author) Nothing to Disclose
Lan-Yan Yang, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Min-Hui Liu, Keelung City, Taiwan (Abstract Co-Author) Nothing to Disclose
Tsun-Ching Chang, Keelung City, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Chun Lin, MSC, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Chieh Huang, Keelung City, Taiwan (Abstract Co-Author) Nothing to Disclose
Pei-Ching Huang, Taoyuan City, Taiwan (Abstract Co-Author) Nothing to Disclose
Jiun-Jie Wang, Taoyuan City, Taiwan (Abstract Co-Author) Nothing to Disclose
Koon-Kwan Ng, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Shu-Hang Ng, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Myocardial triglyceride (TG) is related to increased risk of heart disease. However, its relation with cardiac function in recovery
status of acute heart failure (HF) has not been investigated. We aim to study the association between myocardial TG content
measured on magnetic resonance spectroscopy (1H-MRS) and left ventricular (LV) function revealed on cardiac MR (CMR) in postacute hospitalization HF patients.
METHOD AND MATERIALS
We enrolled 50 HF patients discharged from acute hospitalization 6-12 month ago and recruited 21 age- and gender-matched
normal controls. Myocardial TG content as well as the left ventricular (LV) function and LV mass was measured by using a 3.0 T MR
system. Myocardial TG resonances, comprising fatty acid (FA) and unsaturated fatty acid (UFA), were analyzed and normalized
with water (W) signal by using the LC-Model algorithm. According to their LV ejection fraction (LVEF) at the time of CMR
examination, our patients was dichotomized into the low LVEF group (LVEF < 50%) and the normal LVEF group (LVEF >= 50%).
RESULTS
There were 48 patients and 21 controls with successful 1H-MRS available for analysis. Among our 48 patients, 25 had their low
LVEF (mean, 31.2%) while the other 23 had normal LVEF (mean, 60.2%). Myocardial UFA/W, but no TG/W or FA/W, showed
significant differences among the low LVEF group, the normal LVEF group and the control group (7.9% vs 2.1% vs 1.4%, p =
0.02).Myocardial UFA/TG was strong correlated with LV mass (r = 0.39, p < 0.001) and margninally correlated with LV end-diastolic
volume (LVEDV) (r = 0.24, p = 0.039), while myocardial FA/TG was negatively correlated with LV mass (r = -0.39, p < 0.001) and
LVEDV (r = -0.24, p = 0.039).
CONCLUSION
Increased myocardial UFA was observed in post-acute hospitalization HF patients as compared with controls, with a significantly
higher level of UFA in the low LVEF group than in the normal LVEF group. Myocardial UFA was strong correlated with LVEDV, LV
mass and, to a lesser degree, cardiac output. We believe that metabolic imaging for measurement of myocardial UFA content by
1H-MRS may be useful for noninvasively evaluation for HF patients post-acute hospitalization.
SSQ02-04
13N-ammonia PET/MR Myocardial Stress Perfusion Imaging Early Experience
Thursday, Dec. 3 11:00AM - 11:10AM Location: S502AB
Participants
Amir K. Durrani, MD, St Louis, MO (Presenter) Nothing to Disclose
Jeffrey M. Lau, MD, PhD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Richard Laforest, PhD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Jie Zheng, PhD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Agus Priatna, PhD, Ballwin, MO (Abstract Co-Author) Research Consultant, Siemens AG Employee, Siemens AG
Robert J. Gropler, MD, Saint Louis, MO (Abstract Co-Author) Advisory Board, Bracco Group Advisory Board, GlaxoSmithKline plc
Advisory Board, Pfizer Inc Advisory Board, Bayer AG Research Grant, GlaxoSmithKline plc Research Grant, Pfizer Inc Research Grant,
Clinical Data, Inc Research Grant, Lantheus Medical Imaging, Inc
Pamela K. Woodard, MD, Saint Louis, MO (Abstract Co-Author) Research Consultant, Bristol-Myers Squibb Company; Research
Grant, Astellas Group; Research Grant, F. Hoffmann-La Roche Ltd; Research Grant, Bayer AG; Research agreement, Siemens AG;
Research Grant, Actelion Ltd; Research Grant, Guerbet SA; ; ;
PURPOSE
Simultaneous acquisition Positron Emission Tomography/Magnetic Resonance (PET/MR) is a new technology with potential use in
cardiac perfusion imaging. Pharmacologic stress perfusion imaging with 13N-ammonia-PET and MR have previously been validated
separately for detection of coronary artery disease (CAD). In this pilot study, we optimize a protocol for comprehensive cardiac
PET/MR stress perfusion imaging, and evaluate its diagnostic accuracy for CAD when compared to GSPECT-MPI.
METHOD AND MATERIALS
15 patients with reversible myocardial perfusion defect on GSPECT-MPI for whom standard of care coronary angiography was
planned were recruited. Patients received 400mcg Regadenoson, followed 30 seconds later by simultaneous 13N-Ammonia-PET
(10.2 +/- 0.46 mCi) and gadolinium-based (0.075 mmol/Kg) contrast MR perfusion imaging. The procedure was repeated at rest.
PET attenuation correction µ-map was a dual echo VIBE Dixon sequence. PET images were reconstructed with 3D-OSEM (Ordered
Subset Estimation Maximization) with 3 iterations, 21 subsets and post-Gaussian filter of 4 mm. The presence and absence of
ischemia and infarction were assessed by two independent readers. Areas of decreased perfusion on MRI were correlated to PET
myocardial blood flows (MBF) as measured by 2-compartment modeling analysis.
RESULTS
PET/MR demonstrated excellent concordance with coronary angiographic findings. In this small data set, when compared to
GSPECT-MPI, combined PET/MR demonstrated superior diagnostic accuracy (69% vs 54%). The inter-reader concordance was 77%.
Using PET/MR as a diagnostic tool for CAD, in this small cohort, there is a 100% sensitivity, 100% negative predictive value, and a
64% positive predictive value.
CONCLUSION
Early experience with 13N-PET/MR perfusion imaging showed excellent diagnostic accuracy, sensitivity and specificity for CAD
detection.
CLINICAL RELEVANCE/APPLICATION
Perfusion PET/MR offers a comprehensive myocardial ischemic evaluation. Potential benefits including shorter exam time than
SPECT, lower radiation dose, absolute myocardial blood flow quantification, and internal validation between PET and MR findings.
SSQ02-05
Doppler-Ultrasound in Comparison to Electrocardiogram and Pulse Oximetry for Gating Cardiac MRI
at 3T
Thursday, Dec. 3 11:10AM - 11:20AM Location: S502AB
Participants
Fabian Kording, Hamburg, Germany (Presenter) Nothing to Disclose
Jin Yamamura, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gunnar K. Lund, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Friedrich Uberle, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Caroline Jung, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Gerhard B. Adam, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Bjoern Schoennagel, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Electrocardiogram (ECG) triggering for cardiac magnetic resonance (CMR) may be influenced by magnetic interferences with
increasing magnetic field strength. Doppler Ultrasound (DUS) is not objected to magneto-hydro-dynamic effects (MHD) and does
not interact with the electromagnetic field of the MRI. The purpose of this study was to evaluate the performance of Doppler
ultrasound (DUS) as a trigger technique for CMR in comparison to ECG and pulse oximetry (POX) at 3 Tesla.
METHOD AND MATERIALS
Balanced Turbo Field Echo 2D short axis cine CMR and 2D phase-contrast angiography of the ascending aorta was performed in 11
healthy volunteers using ECG, DUS and POX for CMR. The E-wave in early diastole was selected for DUS trigger time points to
obtain a marker for quiescent heart phases which were subsequently compared to quiescent heart phases determined manually
based on ECG triggered cine images by two observer. Trigger signals were recorded simultaneously in reference to standard ECG
trigger signals and compared in terms of trigger quality. Image quality was assessed by endocardial border sharpness (EB) and
functional assessment in terms of LV volumetry and aortic blood flow velocimetry.
RESULTS
The mean sensitivity of trigger recognition for all sequences was similar between DUS (99±1%), ECG (99±1%) and POX (99±1%).
DUS trigger points correlated strong with manually determined cardiac quiescence (R=0.9, Obs. 1; R=0.9, Obs. 2). Mean EB
averaged over the entire cardiac cycle was similar for ECG, DUS and POX with no significant differences (pECG/DUS = 0.6;
pECG/POX = 0.5; pDUS/POX = 0.8). Early diastolic EB was significantly reduced for DUS compared to ECG (pECG/DUS = 0.007) and
POX (pDUS/POX=0.03), but not for ECG versus POX (pECG/POX=0.3). Mean EDV (pECG/DUS=0.8, pECG/POX=0.7), ESV
(pECG/DUS=0.9, pECG/POX=0.6) and mean aortic velocity (pECG/DUS=0.6, pECG/POX=0.6) were not significantly different.
CONCLUSION
This study demonstrated the feasibility of DUS for gating human CMR at 3T. With the benefit of not being influenced by
This study demonstrated the feasibility of DUS for gating human CMR at 3T. With the benefit of not being influenced by
electromagnetic interferences DUS may offer an alternative trigger technique at high magnetic field environments.
CLINICAL RELEVANCE/APPLICATION
Doppler ultrasound measures physiological motion of the heart rather than electrical activation and, hence, may enable a more
accurate gating, especially for higher field strength.
SSQ02-06
Hybrid Cardiac 18F-FDG PET/MRI in Patients with Suspected Myocarditis
Thursday, Dec. 3 11:20AM - 11:30AM Location: S502AB
Awards
RSNA Country Presents Travel Award
Participants
Felix Nensa, MD, Essen, Germany (Presenter) Nothing to Disclose
Ercan Tezgah, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Thorsten D. Poeppel, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Till Neumann, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Nico Reinsch, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Peter Krings, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Amir Sabet, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Juliane Schelhorn, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Kai Nassenstein, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Thomas W. Schlosser, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic performance of hybrid 18F-FDG PET/MRI in comparison to late gadolinium-enhancement (LGE) and T2weighted imaging in patients with suspected myocarditis.
METHOD AND MATERIALS
A total of 60 consecutive patients (24 female, age: 35±13 y) with suspected myocarditis were prospectively assessed using
integrated cardiac 18F-FDG PET/MRI (mMR Biograph, Siemens Healthcare). The MR imaging protocol consisted of functional cine
images, T2-weighted triple inversion recovery images and LGE images 10 minutes after injection of gadobutrol. PET data acquisition
was performed simultaneously to MR imaging. Physiological glucose uptake in the myocardium was suppressed with a high-fat, lowcarbohydrate diet and i.v. administration of unfractionated heparin. Consent diagnosis by three experienced cardiologists, who were
blinded to PET/MR data, was used as standard of reference.
RESULTS
PET/MRI examination was successful in 50 of 60 enrolled patients: 2 patients were excluded due to incomplete PET/MRI
examinations because of claustrophobia, 8 patients were excluded due to failed inhibition of physiological myocardial glucose
uptake. No significant difference in left ventricular ejection fraction was found between patients with clinical evident myocarditis
and those clinically diagnosed as not having myocarditis (59.2±7.2% vs. 60.3±12.8%, p=0.298, n=50). Sensitivity and specificity of
LGE for the detection of clinically evident myocarditis were 71% and 88% (80% accuracy). Sensitivity and specificity of T2weighted imaging for the detection of clinically evident myocarditis were 58% and 88% (74% accuracy). Sensitivity and specificity
of PET for the detection of clinically evident myocarditis were 75% and 88% (82% accuracy). Odd ratios for the detection of
myocarditis were 5.5 for LGE, 5.0 for T2-weighted imaging and 7.0 for PET. Of all combinations, the best diagnostic performance
was obtained when at least one of three parameters (LGE, T2, PET) was positive in the same patient yielding 92% sensitivity, 81%
specificity, and 86% diagnostic accuracy.
CONCLUSION
Hybrid 18F-FDG PET/MRI can improve the non-invasive diagnosis in patients with suspected myocarditis.
CLINICAL RELEVANCE/APPLICATION
FDG PET/MRI might guide the therapeutic strategy in patients with suspected myocarditis by providing a more accurate diagnosis
and - with FDG uptake - a surrogate parameter for the activity of inflammation.
SSQ02-07
Correlating Corrected Coronary Opacification Gradients to PET Myocardial Perfusion: CT Angiography
in Functional Assessment of Coronary Lesions
Thursday, Dec. 3 11:30AM - 11:40AM Location: S502AB
Participants
Leonid Chepelev, MD,PhD, Ottawa, ON (Presenter) Nothing to Disclose
Ran Klein, PhD, Ottawa, ON (Abstract Co-Author) Consultant, Jubilant DraxImage Inc; Shareholder, Jubilant DraxImage Inc
Brittany Reiche, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Benjamin Chow, MD, Ottawa, ON (Abstract Co-Author) Research Grant, General Electric Company Support, TeraRecon, Inc
Frank J. Rybicki III, MD, PhD, Ottawa, ON (Abstract Co-Author) Research Grant, Toshiba Corporation;
PURPOSE
To explore the potential use of corrected coronary opacification (CCO) gradients in predicting functional severity of coronary artery
disease as assessed by PET myocardial perfusion imaging.
METHOD AND MATERIALS
We retrospectively evaluated 42 consecutive patients who underwent CCTA and 82Rb PET MPI within 180 days of each other. CCO
was defined as mean coronary intraluminal attenuation normalized to mean aortic attenuation within the same axial slice. Coronary
artery geometries and corresponding CCO measurements were automatically derived based on expert vessel centerline annotations
with a 1.5mm diameter cutoff and fused with PET perfusion polar maps using software developed by our group in Java and MATLAB.
CCO gradients, corrected and uncorrected by coronary artery diameter, were measured in the distal, proximal, and entire coronary
arteries, excluding non-diagnostic, calcified, stenotic, and stented regions. The CCO gradients were correlated to PET myocardial
perfusion in the immediate vessel vicinity and projected perfusion territory of a given vessel.
RESULTS
The maximal Pearson correlation coefficients were observed when considering distal 40% vessel segments and immediately adjacent
(±30 degrees on polar map) perfusion territories while omitting calcific and stenotic vessel regions. For the correlation between CCO
and PET myocardial perfusion in the immediate vicinity, this yielded absolute Pearson correlation coefficients of 0.71±0.18,
0.70±0.25, and 0.80±0.23 for LAD, LCX, and RCA respectively. Correction of CCO by vessel diameter at the distal 40% vessel
segments yielded coefficients that were not significantly different: 0.70±0.20, 0.70±0.24, and 0.80±0.22, respectively.
CONCLUSION
The correlation between CCO gradients and PET MPI data supports their use in functional lesion assessment.
CLINICAL RELEVANCE/APPLICATION
Corrected coronary opacification gradients may supplement functional assessment of coronary artery lesions and potentially predict
the functional status of the myocardium using existing CCTA data.
SSQ02-08
Quantitative Assessment of Diffuse Myocardial Fibrosis in Patients with Diabetic Cardiomyopathy by
T1-Mapping: Correlates with Diabetic History
Thursday, Dec. 3 11:40AM - 11:50AM Location: S502AB
Participants
Xiao-Chun Zhang, Chongqing, China (Presenter) Nothing to Disclose
Shang Yongning, Chongqing, China (Abstract Co-Author) Nothing to Disclose
Jun Zhao, Chongqing, China (Abstract Co-Author) Nothing to Disclose
Tianjing Zhang, Beijing, China (Abstract Co-Author) Employee, Siemens AG
Jian Wang, Chongqing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study was to use cardiac magnetic resonance (CMR) T1-mapping technique to evaluate diffuse myocardial
fibrosis and to explore its relationship with diabetic history.
METHOD AND MATERIALS
Thirty three patients with diabetic cardiomyopathy (DCM) (16 men, 17 women, mean age 46±8 years) and 48 healthy controls were
performed in Siemens Trio 3.0T, the WIP sequence. T1 Mapping was used for measurement of T1 values, ECV values were
calculated from pre and post T1 values. The results' correlation with patients' diabetic history were analyzed as well.
RESULTS
Pre-contrast myocardial T1 time and myocardial extracellular volume (ECV) in patients with DCM was significantly higher than the
measurement in control cases, and post-contrast myocardial T1 time in DCM patients was significantly lower than that in control
cases (p<0.001, respectively). In DCM patients, diabetic history was correlated with pre-contrast T1, ECV and post--contrast T1
(r=0.92, 0.95 and -0.93, respectively. p<0.001).
CONCLUSION
Diffuse myocardial fibrosis in patients with DCM can be assessed by CMR T1-mapping. The study results demonstrate that increased
diabetic history is likely to be a major contributor to the severity of diffuse myocardial fibrosis.
CLINICAL RELEVANCE/APPLICATION
As a new imaging modality, CMR T1-mapping can provide four dimensional data to quantitatively assess the severity of diffuse
myocardial fibrosis in DCM patients, which is useful for the clinical decision.
SSQ02-09
Rate of Incidental Findings at Myocardial Perfusion Scintigraphy
Thursday, Dec. 3 11:50AM - 12:00PM Location: S502AB
Participants
Andrea O. Vergara Finger, MD, Burlington, VT (Presenter) Nothing to Disclose
Sean Reynolds, MD, Burlington, VT (Abstract Co-Author) Nothing to Disclose
Janusz K. Kikut, MD, Burlington, VT (Abstract Co-Author) Nothing to Disclose
PURPOSE
The SNMMI/ASNC/SCCT consensus guidelines on cardiac SPECT/CT and PET/CT advocate for reporting of incidental findings (IF) on
noted on PET/CT and SPECT/CT and SPECT cardiac imaging. However, the definition of a reportable incidental finding is left to the
discretion of the interpreting physician. The incidence of IF is reported at 34% in the literature; however, the incidence of clinically
important findings is significantly lower, reported as around 5%. However, image quality is often quite different between SPECT/CT
and PET/CT with image quality substantially better for the latter. We retrospectively evaluated the rate of IF defined as an
unknown or potentially unknown new diagnosis and compared the rate in SPECT/CT as compared to PET/CT to see if the improved
image quality available at PET/CT affected the IF rate.
METHOD AND MATERIALS
A total of 10,520 Sestamibi SPECT/CT and Rb-82 PET/CT cardiac studies performed at our institution in from 2011-2014 were
retrospectively evaluated by querying the dedicated IF field of a NM structured reporting database (Vericis, Merge Healthcare,
Chicago, IL). All IF were evaluated by ABR certified readers. Only significant findings as determined by the interpreting radiologist
were placed into the field. IF were categorized into those seen on the emission scan and those seen on CT.
RESULTS
IF were discovered on 370 (3.5%) of studies. Of these, 9 (0.08%) were noted on the emission scan, while 362 (3.4%) were noted
on the CT. The rate on Sestamibi SPECT/CT was 166/9446 (1.7%) while the rate on Rb-82 PET was 204/1074 (19.0%).
CONCLUSION
IF considered significant by the interpreting radiologist are more prevalent in our practice than previously reported especially when
CT quality approaches diagnostic quality as with PET/CT. On hybrid imaging, they are more common on the CT portion of the study
than on the emission scan. This underscores the recommendation for reporting these findings and argues for having physicians
familiar with conventional CT imaging interpret the CT portion of hybrid imaging studies.
CLINICAL RELEVANCE/APPLICATION
The majority of IF at hybrid cardiac imaging appear on CT, arguing for having interpreters experienced in conventional CT review
the CT portion of the study.
SSQ03
Cardiac (General Topics II)
Thursday, Dec. 3 10:30AM - 12:00PM Location: S504CD
CA
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
Andre J. Duerinckx, MD, PhD, Washington, DC (Moderator) Nothing to Disclose
James C. Carr, MD, Chicago, IL (Moderator) Research Grant, Astellas Group Research support, Siemens AG Speaker, Siemens AG
Advisory Board, Guerbet SA
Sub-Events
SSQ03-02
The Impact of Iterative Reconstruction on Detectability and Quantification of Calcifications in CT
Coronary Calcium Scoring: Individual Lesion-by-lesion Comparison
Thursday, Dec. 3 10:40AM - 10:50AM Location: S504CD
Participants
Jelmer M. Wolterink, MSc, Utrecht, Netherlands (Abstract Co-Author) Research Grant, Pie Medical Imaging BV
Tim Leiner, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Speakers Bureau, Koninklijke Philips NV; Research Grant, Bayer AG;
Research Grant, Bracco Group
Martin J. Willemink, MD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Max A. Viergever, Utrecht, Netherlands (Abstract Co-Author) Research Grant, Pie Medical Imaging BV;
Ivana Isgum, PhD, Utrecht, Netherlands (Presenter) Research Grant, Pie Medical Imaging BV; Research Grant, 3mensio Medical
Imaging BV;
PURPOSE
The amount of coronary artery calcium (CAC) as quantified in cardiac CT is a strong and independent predictor of cardiovascular
events. Cardiac CT can be reconstructed using iterative reconstruction (IR), which reduces objective image noise compared with
filtered back projection (FBP). We have investigated the impact of IR on the detectability and quantification of CAC lesions.
METHOD AND MATERIALS
The study included 101 consecutive patients who underwent non-contrast-enhanced ECG-triggered cardiac CT for CAC scoring
(256-detector row CT, 120 kVp, 55 mAs). Five series with 3 mm slice thickness were reconstructed for each CT: one with FBP and
four with increasing IR levels (iDose4 L1, L3, L5, L7). CAC lesions (>= 130 HU) in the FBP series were identified by an expert and
matching lesions in the IR series were identified at corresponding locations. Calcium volume (in mm³) and calcium mass (in mg) of
matching lesions in different series were compared. The Friedman test (significance level P < 0.05) was used to analyze overall
differences among series. The Wilcoxon signed-rank test with Bonferroni correction (significance level P < 0.007) was used to
analyze pairwise differences between series.
RESULTS
The FBP series contained 416 CAC lesions with median (interquartile range) volume 16.0 (5.6-41.1) mm³ and mass 3.3 (0.9-10.6)
mg. Out of these, 14 (3%), 25 (6%), 35 (8%) and 42 (10%) lesions with volume/mass below 2.4 mm³/0.4 mg, 4.7 mm³/0.8 mg, 4.7
mm³/0.8 mg, and 6.3 mm³/0.9 mg were identified in the FBP series but not in the L1, L3, L5 and L7 series, respectively. For lesions
identified in all series, calcium volume and mass differed significantly among series (P < 0.05). A significant reduction in calcium
volume and mass was present between the FBP series and each IR series (P < 0.007), as well as between series with increasing IR
levels (P < 0.007).
CONCLUSION
IR causes significant reductions in volume and mass of CAC lesions. Small low-density lesions are increasingly likely to be missed in
CAC scoring when higher IR levels are used.
CLINICAL RELEVANCE/APPLICATION
CAC scoring in IR CT may underestimate cardiovascular risk, especially in patients with small low-density CAC lesions.
SSQ03-03
In vivo Coronary Artery Plaque Assessment with Computed Tomography Angiography – Is There an
Impact of Iterative Reconstruction on Plaque Volume and Attenuation Metrics?
Thursday, Dec. 3 10:50AM - 11:00AM Location: S504CD
Participants
Zhongyi Chen, Montreal, QC (Presenter) Nothing to Disclose
Irina Boldeanu, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Simon Nepveu, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Madeleine Durand, MD,MSc, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Anne S. Chin, MD, Palo Alto, CA (Abstract Co-Author) Nothing to Disclose
Carl Chartrand-Lefebvre, MD, Montreal, QC (Abstract Co-Author) Equipment support, Koninklijke Philips NV; Equipment support,
Bayer AG;
Claude Kauffmann, PhD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Gilles P. Soulez, MD, Montreal, QC (Abstract Co-Author) Speaker, Bracco Group Speaker, Siemens AG Research Grant, Siemens AG
Research Grant, Bracco Group Research Grant, Cook Group Incorporated Research Grant, Object Research Systems Inc
Cecile Tremblay, MD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
PURPOSE
Coronary computed tomography (CT) angiography allows to evaluate coronary plaque characteristics, such as low attenuation
(lipid-filled) component, and can impact on plaque vulnerability assessment and patient prognostication. The objective of the study
is to determine the effect of iterative reconstruction (IR) on coronary plaque volume and composition assessment.
METHOD AND MATERIALS
Approval was obtained from Institutional Review Board and written consent from all subjects. Asymptomatic patients without known
coronary artery disease were prospectively enroled for low-dose 256-slice CT. Images were reconstructed with both filtered back
projection (FBP) and hybrid IR algorithm (iDose4, Philips) levels 1, 3, 5 and 7 (noise reduction 11, 23, 37, 56%, respectively). Noise,
signal-to-noise (SNR) and contrast-to-noise ratio (CNR) in aorta and coronary arteries were measured. Coronary plaques were
assessed using a Hounsfield unit (HU)-mapping method, according to five intervals: <51 HU, 51-100 HU, 101-150 HU, 151-350 HU
and >350 HU. For each plaque, total absolute volume, absolute and percentage HU-interval volumes were calculated. ANOVA
repeated-measure analyses were used.
RESULTS
Fifty-three patients (mean age 53.6 yo) were included. In comparison to FBP, IR reduced image noise ad 53%, increased SNR ad
111% and CNR ad 99% (p<0.0005, respectively). Plaque characterization performed in 35 patients for a total of 96 plaques showed
a mean total plaque volume of 99.1±116.3 to 100.2±117.6 mm3 across all IR levels and FBP (p=0.628). In per-HU-interval analysis
within the 101-150 HU interval, absolute plaque volume showed slight differences between FBP (11.7±12.6 mm3) and IR level 7
(10.8 ±11.7 mm3) (p=0.03) and between IR levels 5 (11.4±12.8 mm3) and 7 (p=0.03). For percentage volume, a slight difference
was observed within the 101-150 HU interval between FBP (12.6± 5.1%) and IR level 7 (11.9±4.8%) (p=0.04). Absolute and
percentage plaque volume was similar across other IR levels and HU-intervals.
CONCLUSION
Total coronary plaque volume measured at all IR noise reduction levels was similar to FBP. Plaque volumetric assessment in low HUinterval domains was slightly affected at high IR levels.
CLINICAL RELEVANCE/APPLICATION
Total coronary plaque volume with IR is similar to FBP. However low attenuation plaque volume, a marker for plaque vulnerability, is
slightly modified at high IR levels.
SSQ03-04
Myocardial Involvement in Anderson Fabry Disease Can Be Assessed and Quantified Using Magnetic
Resonance Post-contrast T1 Mapping
Thursday, Dec. 3 11:00AM - 11:10AM Location: S504CD
Participants
Julian Donhauser, MD, Wurzburg, Germany (Presenter) Nothing to Disclose
Gordian G. Schmid, Wurzburg, Germany (Abstract Co-Author) Nothing to Disclose
Andreas M. Weng, Wurzburg, Germany (Abstract Co-Author) Nothing to Disclose
Herbert Koestler, PhD, Wuerzburg, Germany (Abstract Co-Author) Research support, Siemens AG
Dietbert Hahn, MD, Kuernach, Germany (Abstract Co-Author) Nothing to Disclose
Thorsten A. Bley, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Christian O. Ritter, MD, Wuerzburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Anderson Fabry disease (AFD) is a rare intracellular lipid disorder which can lead to LV-hypertrophy and myocardial fibrosis. We
propose that besides late gadolinium enhancement (LGE), T1-mapping is a promising diagnostic tool in AFD allowing an early
detection of cardiac involvement. Furthermore we suggest, that MRI findings correlate with serum biomarkers indicating myocardial
damage.
METHOD AND MATERIALS
46 patients (20 LGE positive [group 1], 26 LGE negative [group 2]) with manifest AFD were examined. In addition, 28 healthy
subjects were examined as a reference [group 3]. T1-mapping was performed with a modified Look-Locker IR sequence (MOLLI) at
a 3T MR-scanner after i.v. gadolinium administration. Results were derived from 8 slices moving continuously from basal to apical.
Separate ROIs were drawn in the anterior, inferior, septal, lateral and inferolateral wall. In addition, an average value from the
entire myocardial ring (SAX) was acquired for each slice. Absolute T1 values were compared in between those three groups. In
addition, T1 values of the patient groups were correlated with the biochemical markers NT-proBNP, Troponin T and lyso-Gb3.
RESULTS
Final results show visible changes in the T1-maps wherever fibrosis in the LGE imaging was observed. Absolute T1 values for several
ROIs were significantly lower in group 1 compared to group 2 and 3 (inferolateral wall: p<0.01; others: p<0.05), even in areas
where no fibrosis was detected by LGE imaging (anterior and septal wall). T1 mapping was not able to distinguish between LGEnegative patients and healthy controls. NT-proBNP and Troponin T levels were significantly higher in group 1 compared to group 2
(p<0,01). Lyso-Gb3 serum levels were elevated in 100% [group 1] and 86% [group 2] of patients, there was no significant
difference in lyso-Gb3 values in between those groups.
CONCLUSION
Our data suggest that T1-mapping is a sensitive tool to detect early replacement fibrosis in AFD, and might be more sensitive than
visual LGE analysis in the detection of regional myocardial involvement. Elevated levels of Troponin T and NT-proBNP indicate
myocardial involvement and correlate with findings in cardiac MRI.
CLINICAL RELEVANCE/APPLICATION
T1 mapping may be useful to identify AFD patients with myocardial involvement. This method could be especially useful in follow up
as it offers the possibility to absolutely quantify the extent of fibrosis and monitor therapy effects.
SSQ03-05
Image Quality of Cardiac Magnetic Resonance Imaging in Patients with an ICD System Designed for
the MRI Environment
Thursday, Dec. 3 11:10AM - 11:20AM Location: S504CD
Participants
Torsten Sommer, MD, Bonn, Germany (Presenter) Research Consultant, Medtronic, Inc
Michael R. Gold, MD,PhD, Charleston, SC (Abstract Co-Author) Research Consultant, Medtronic, Inc
Ahmed Al Fagih, MD, Riyadh, Saudi Arabia (Abstract Co-Author) Nothing to Disclose
Sung W. Lee, MD, Washington, DC (Abstract Co-Author) Nothing to Disclose
Michael Peterson, MD, St. Paul, MN (Abstract Co-Author) Nothing to Disclose
Allen Ciuffo, MD, Norfolk, VA (Abstract Co-Author) Research Consultant, Medtronic, Inc
Yan Zhang, MS, Mounds View, MN (Abstract Co-Author) Nothing to Disclose
Nina Kristiansen, Maastricht, Netherlands (Abstract Co-Author) Nothing to Disclose
Emanuel Kanal, MD, Pittsburgh, PA (Abstract Co-Author) Consultant, Boston Scientific Corporation; Consultant, Medtronic, Inc;
Consultant, St. Jude Medical, Inc; Consultant, Bayer AG; Investigator, Bracco Group; Royalties, Guerbet SA;
Juerg Schwitter, MD, Lausanne, Switzerland (Abstract Co-Author) Research Consultant, Medtronic, Inc
PURPOSE
To evaluate the image quality performance of various cardiac MR pulse sequences in a clinical trial of patients (pts) implanted with
an MR-conditional ICD system.
METHOD AND MATERIALS
The Evera MRI randomized clinical trial enrolled 275 pts from 42 centers world-wide. 263 pts were implanted with an Evera MRI
single or dual chamber ICD and randomized to the MRI group (n=175) or control group (n=88). Per protocol 156 MRI pts underwent
an MRI examination at 9-12 weeks post implant. Steady-state free precession (SSFP) and fast gradient echo (FGE) sequences
were acquired each in short-axis (SA) and horizontal long axis (HLA) views to optimize image quality. Acquisitions with correct slice
orientations on both, SA and HLA of at least one sequence type were graded for image quality using a 7-point scale (grade 1:
excellent image quality, grade 6-7: non-diagnostic quality). Grades were analyzed by Generalize Estimating Equation. Presence and
size of ICD- and lead-related artifacts were evaluated.
RESULTS
Complete cardiac MR data were obtained in 104 pts for SSFP covering the left ventricle (LV), in 89 pts for FGE on LV, in 103 pts for
SSFP on the right ventricle (RV), and in 76 for FGE on the RV. The corresponding proportions of diagnostic image quality (grades 15) were 53% (55/104), 74% (66/89), 69% (71/103) and 84% (64/76), respectively. In 107 pts at least one evaluable sequence
was obtained. The odds of having a better image quality (i.e. a lower grade) was greater for RV vs LV (OR: 1.8, 95% CI: 1.5-2.2,
p<0.0001, regardless of sequence type) and greater for FGE vs SSFP (OR: 3.4, 95% CI: 2.5-4.7, p<0.0001, regardless of ventricle
type). Compared to SSFP, the ICD-related artifacts on FGE were smaller (141.0±65 vs 75.3±56.7 mm, respectively, p<0.0001)
irrespective of imaging plane. Lead artifacts were much smaller than ICD artifacts (p<0.0001); differences in lead artifact diameters
between SSFP (8.3±3.3 mm) and FGE (10.2±3.2 mm) were small, but statistically significant (p<0.0001).
CONCLUSION
FGE produces better quality and smaller artifacts for cardiac MRI than SSFP in pts with an MRI ICD system. Diagnostic image quality
is obtainable with FGE in 74% and 84% of studies of the LV and RV, respectively.
CLINICAL RELEVANCE/APPLICATION
Diagnostic image quality of cardiac MRI cine scans in patients with an ICD system designed for the MRI environment can be
obtained in the majority of cases using fast gradient echo sequences.
SSQ03-06
Advanced Modelled Iterative Reconstruction (ADMIRE) in Coronary Computed Tomography
Angiography (CCTA): Effect on Image Quality
Thursday, Dec. 3 11:20AM - 11:30AM Location: S504CD
Participants
Christina Kolb, Dresden, Germany (Presenter) Nothing to Disclose
Ivan Platzek, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Uwe Speiser, 01307 Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Dirk Danowski, 01307 Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Thomas Brauer, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Danilo Seppelt, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Eric Langer, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Christoph Radosa, 01307 Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Manuela Campan, 01307 Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Michael Laniado, MD, Dresden, Germany (Abstract Co-Author) Reviewer, Johnson & Johnson
Ruth Strasser, 01307 Dresden, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose is to assess the effect of ADMIRE on image quality in CCTA.
METHOD AND MATERIALS
30 patients who underwent CCTA on a third generation dual source CT scanner were included in this retrospective study. CCTA
datasets were reconstructed using filtered back projection (FBP) and increasing strength levels of ADMIRE 1-5. The signal-to-noise
ratio (SNR) in the ascending aorta and the proximal part of both coronary arteries were determined for each data set. Furthermore,
a qualitative evaluation of image quality was undertaken independently by two readers using a five-point scale. Repeated measures
analysis of variance was used to compare SNR for different modes of image reconstruction. The Friedman test was applied to
compare image quality scores.
RESULTS
CCTA was performed succesfully in all patients. In the ascending aorta, mean SNR (± SD) was 11.5 (± 4.3) in FBP, 12.9 (± 4.9) in
ADMIRE 1, 14.5 (± 5.7) in ADMIRE 2, 16.3 (± 6.3) in ADMIRE 3, 19.4 (± 7.7) in ADMIRE 4 and 23.6 (± 10.6) in ADMIRE 5. In the
proximal right coronary artery, mean SNR (± SD) was 13.2 (± 6.1) in FBP, 15.4 (± 7.0) in ADMIRE 1, 17.5 (± 7.9) in ADMIRE 2, 21.3
(± 10.5) in ADMIRE 3, 24.6 (± 12.3) in ADMIRE 4 and 30.1 (± 16.4) in ADMIRE 5. In the left main coronary artery, mean SNR was
11.7 (± 4.7) in FBP, 13.5 (± 5.8) in ADMIRE 1, 15.3 (± 6.4) in ADMIRE 2, 17.5 (± 7.1) in ADMIRE 3, 20.7 (± 8.2) in ADMIRE 4 and
25.1 (± 10.2) in ADMIRE 5. In the ascending aorta, the proximal RCA and the left main, higher strength levels of iterative
reconstruction showed significantly higher SNR in comparison to all lower strength levels and FBP (p < 0.001 in all cases). Image
quality scores improved significantly from FBP to ADMIRE 4 (p < 0.05) with each successive level of iterative reconstruction
strength. However, image quality scores did not differ significantly between ADMIRE 4 and 5 datasets (p > 0.05).
CONCLUSION
ADMIRE significantly improves image quality in CCTA, both in regard to SNR and qualitative scores. However, as there was no
significant difference between ADMIRE 4 and 5 for subjective image quality, this high strength levels can be used interchangeably,
depending on the preference of the respective radiologist. As a consequence of our results, further dose reduction seems to be
feasible in CCTA.
CLINICAL RELEVANCE/APPLICATION
As ADMIRE improves image quality compared to FBP, the use of ADMIRE has the potential for further reduction of CCTA radiation
exposure while retaining adequate image quality.
SSQ03-07
Qualitative and Quantitative Evaluation of Myocardial Alterations by Grating-Based Phase-Contrast
Computed Tomography
Thursday, Dec. 3 11:30AM - 11:40AM Location: S504CD
Participants
Susan Notohamiprodjo, MD, Munich, Germany (Presenter) Nothing to Disclose
Nicole Webber, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Lorenz Birnbacher, Garching, Germany (Abstract Co-Author) Nothing to Disclose
Marian Willner, Munchen, Germany (Abstract Co-Author) Nothing to Disclose
Julia Herzen, Garching, Germany (Abstract Co-Author) Nothing to Disclose
Holger Hetterich, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Mathias Marschner, Garching, Germany (Abstract Co-Author) Nothing to Disclose
Doris Mayr, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Harald Bartsch, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Franz Pfeiffer, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Maximilian F. Reiser, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Tobias Saam, MD, Munich, Germany (Abstract Co-Author) Research Grant, Diamed Medizintechnik GmbH; Research Grant, Pfizer Inc
PURPOSE
Grating-based phase-contrast computed tomography (gb-PCCT) relies on X-ray refraction rather than absorption to generate highcontrast images in biological soft tissue. The aim was to evaluate the potential of gb-PCCT for the depiction of structural changes
in different cardiomyopathies.
METHOD AND MATERIALS
Samples of four human heart specimens from patients with hypertensive, ischemic and dilated cardiomyopathy and cardiac
lipomatosis were examined. The gb-PCCT set-up consists of X-ray tube (40 kV, 70 mA), grating-interferometer and detector and
allows the calculation of phase- and absorption-contrast data. Normal myocardium, fibrotic scars, diffuse interstitial fibrosis and
fatty tissue were evaluated by visual inspection and quantitative absorption- and phase-contrast Hounsfield units (HUabs and HUp,
respectively). Histopathology served as standard of reference. Measurements of diagnostic accuracy including sensitivity and
specificity were calculated. Systematic differences in HUabs and HUp were assessed by ANOVA.
RESULTS
A total of 35 corresponding gb-PCCT and histopathology cross-sections were available. Normal myocardium was found in 35
(100%), fibrotic scars in 6 (17.1%), interstitial fibrosis in 7 (20%) and fatty tissue in 25 (71.4%) cross-sections and were
accurately detected by gb-PCCT (sensitivity and specificity >90%). Mean HUp for normal myocardium, fibrotic scars, interstitial
fibrosis and fatty tissue were 52.5, 86.6, 62.4 and -38.6. Corresponding mean HUabs were 54.1, 69.7, 62.3 and -258.9,
respectively. We observed an overlap in HUabs for normal myocardium and interstitial fibrosis but not for HUp. Contrast-to-noise
ratio was significantly higher in phase- than in absorption-contrast for myocardium/fat (32.7 vs. 7.2; p<0.01) and for
myocardium/fibrotic scar (3.6 vs. 0.2; p<0.01).
CONCLUSION
Given its superior soft tissue contrast, gb-PCCT is able to depict structural changes in different cardiomyopathies, which can
currently not be obtained by X-ray absorption based imaging methods.
CLINICAL RELEVANCE/APPLICATION
If current technical limitations can be overcome, gb-PCCT may evolve as a powerful tool for the anatomical assessment of
cardiomyopathy.
SSQ03-08
Diagnostic Performance of Stress Perfusion Cardiovascular Magnetic Resonance with 1.5-T and 3-T
Scanners in Comparison with Invasive Coronary Angiography
Thursday, Dec. 3 11:40AM - 11:50AM Location: S504CD
Participants
Sung Min Ko, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
3-T cardiovascular magnetic resonance (CMR) perfusion has shown higher diagnostic performance for detection of significant
coronary artery disease (CAD) in comparison to 1.5-T perfusion. However, more data are needed for proving superiority of 3-T to
1.5-T perfusion. This study was aimed to compare the diagnostic performances of CMR perfusion at 1.5-T and 3-T in patients with
suspected or known CAD.
METHOD AND MATERIALS
We prospectively enrolled 308 patients (221 men, 69.5±6.4 years) with suspected or known CAD. All patients were scanned at 1.5T or 3-T including adenosine stress and rest perfusion and delayed enhancement imaging. Invasive coronary angiography (ICA)
served as the reference method. Perfusion defects were interpreted visually by 2 radiologists with consensus. A coronary vessel
was considered to be significantly stenosed if there was at least 1 segment with ≥ 70% lumen reduction.
RESULTS
The prevalence of CAD was 56%. Of 308 patients, 162 patients were scanned at 1.5-T and 146 patients at 3-T. Significant
coronary stenoses and old myocardial infarction (MI) were found in 101 (62%) and 66 (41%) patients at 1.5-T and 70 (48%) and
27 (18%) patients at 3-T. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value for
detection of significant coronary stenoses were 77%, 71%, 81%, 70%, and 82% at 1.5-T and 83%, 64%, 91%, 75%, and 86% at
3.0T. The diagnostic performance of 3-T perfusion imaging was not significantly greater than that of 1.5-T (area under receiveroperator characteristic [ROC] curve: 0.81 vs 0.76; p=0.159). The combined perfusion and delayed contrast enhancement CMR
imaging did not provide incremental diagnostic value over perfusion CMR imaging only at both 1.5-T and 3-T in the diagnosis of
CAD. In patients without old MI (n=215), diagnostic accuracy, sensitivity, specificity, positive predictive value and negative
predictive value for detection of significant coronary stenoses were 80%, 57%, 84%, 44%, and 90% at 1.5-T and 85%, 60%, 92%,
69%, and 89% at 3-T. The diagnostic performance of 3-T perfusion imaging was significantly greater than that of 1.5-T (area
under ROC curve: 0.79 vs 0.67; p=0.026).
CONCLUSION
3-T CMR perfusion imaging is superior to 1.5-T in detection of significant CAD in patients without old MI.
CLINICAL RELEVANCE/APPLICATION
3-T CMR perfusion is feasible to detect inducible myocardial ischemia consistent with significant CAD in clinical setting.
SSQ03-09
Comparison of the Plaque Attenuation Values on Non-enhanced- and Enhanced 320-row Coronary
CT Angiographs Using a Subtraction Technique: In vivo Evaluation of the Effect of Intracoronary
Attenuation on Coronary Plaque Measurements
Thursday, Dec. 3 11:50AM - 12:00PM Location: S504CD
Participants
Masafumi Kidoh, Kumamoto, Japan (Presenter) Nothing to Disclose
Daisuke Utsunomiya, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Seitaro Oda, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yoshinori Funama, PhD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Takeshi Nakaura, MD, Amakusa, Japan (Abstract Co-Author) Nothing to Disclose
Tomohiro Namimoto, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Hideaki Yuki, MD, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
Yasuyuki Yamashita, MD, Kumamoto, Japan (Abstract Co-Author) Consultant, DAIICHI SANKYO Group
Kenichiro Hirata, Kumamoto, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The characterization of plaques based on their CT number is important for the detection of vulnerable atherosclerotic plaques. An
earlier in vitro study showed that intravascular attenuation affected the attenuation of coronary atherosclerotic plaques. We
attempted to validate this finding in vivo and here we introduce a new subtraction coronary CT angiography (CCTA) technique to
address this issue.
METHOD AND MATERIALS
This prospective study received institutional review board approval; prior informed consent to participate was obtained from all
patients. We performed subtraction CCTA on a 320-detector row CT scanner in 113 patients. Our inclusion criterion was 50-70%
stenosis by non-calcified plaques in the proximal coronary artery. Patients with total occlusion and multi-vessel disease were
excluded. Consequently, 30 patients (30 plaques) were included in this study. Two CT datasets, one with- and the other without
coronary artery enhancement, were obtained to remove calcium from the images. The CT number of the plaque and the adjacent
vessel lumen were measured in a circular region of interest (ROI) on curved planar reconstruction (CPR) images. The ROI setting
was consistent between the two CT datasets. We performed linear regression analysis of the changes in the CT number (ΔHU) for
the lumen and the plaque. We also evaluated the relationship between plaque attenuation on non-enhanced coronary artery images
and luminal attenuation with and without contrast enhancement.
RESULTS
The ΔHU for the plaque and the lumen showed a strong correlation (r=0.62). There was no significant correlation between plaque
attenuation on non-enhanced coronary artery images and luminal attenuation with and without contrast enhancement (r=0.14 and
0.2, respectively).
CONCLUSION
Intravascular attenuation modified the attenuation of coronary atherosclerotic plaques and CT images without coronary artery
enhancement in subtraction CCTA may be helpful for the characterization of the plaques.
CLINICAL RELEVANCE/APPLICATION
Intravascular attenuation modified the attenuation of coronary atherosclerotic plaques in our in vivo validation study.
CAS-THA
Cardiac Thursday Poster Discussions
Thursday, Dec. 3 12:15PM - 12:45PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
FDA
Discussions may include off-label uses.
Participants
Balazs Ruzsics, MD, PhD, Charleston, SC (Moderator) Nothing to Disclose
Sub-Events
CA252-SDTHA1
Revisiting Contrast Induced Nephropathy in Azotemic Patients with Aortic Stenosis being Considered
for TAVI
Station #1
Participants
Samir Abboud, MD, Chicago, IL (Presenter) Nothing to Disclose
Jessie Aw-Zoretic, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
James C. Carr, MD, Chicago, IL (Abstract Co-Author) Research Grant, Astellas Group Research support, Siemens AG Speaker,
Siemens AG Advisory Board, Guerbet SA
Jeremy D. Collins, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
PURPOSE
Patients with severe aortic stenosis being considered for transcatheter aortic valve implantation (TAVI) often have multiple comorbidities, frequently including renal dysfunction. Contrast-enhanced computed tomographic angiography (CTA) of the aortic root
and aorto-iliac vessels is the accepted assessment prior to TAVI to determine device sizing and treatment plan. Our aim was to
evaluate the incidence and outcomes of contrast nephropathy in azotemic patients undergoing CTA assessment for TAVI with a
reduced contrast dose protocol.
METHOD AND MATERIALS
An IRB and HIPAA compliant retrospective review was performed to evaluate renal function immediately prior to and following CTA
with Iopamidol contrast for pre-TAVI assessment from 2013 through to 2015. Thirty patients with chronic renal insufficiency in
addition to aortic stenosis (AS) were identified. Renal failure was defined as an estimated GFR (mL/min/1.73 sq m) of < 45. Contrast
load was optimized based on the patient's body habitus and renal function; all subjects were hydrated with 250 mL of NS prior to
contrast administration. The GFR and Creatinine (Cr, mg/dL) post-procedure was compared to baseline for evaluation of evidence of
contrast induced nephropathy. The GFR and Cr were also evaluated up to 6 months post CTA for evidence of renal function
recovery or delayed nephropathy.
RESULTS
The mean baseline GFR was 39+/-7 (Cr 1.6+/-0.3). Patients received an average dose of 67+/-24 mL Iopamidol 370. In 3/30
patients the GFR decreased from baseline by > 10. Of these, none required dialysis, and all three showed return of renal function to
baseline subsequently. The GFR increased from baseline by > 10 in 8/30 patients. The average deviation from baseline in this
population was 7.4+/-7.7; this was not a significant deviation (p = 0.34).
CONCLUSION
A regimen of prehydration with normal saline and optimizing the contrast load per patient is a safe strategy to implement for preTAVI assessment. Only ten percent of patients developed significant renal impairment post CTA which subsequently reversed. No
subjects required hemodialysis or demonstrated permanent reductions in renal function.
CLINICAL RELEVANCE/APPLICATION
Patients with severe AS and concurrent significant renal dysfunction require contrast enhanced CTAs putting these patients at
increased risk for acute renal decompensation. It is important to be aware if contrast administration leads to irreversible decline in
renal function.
CA253-SDTHA2
Morphological and Functional Evaluation of Quadricuspid Aortic Valves using Cardiac CT
Station #2
Participants
Sung Min Ko, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ji Hun Kang, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
Most previous studies on quadricuspid aortic valves (QAV) were isolated case reports or review articles focusing on surgical results
or echocardiographic findings. This study was aimed to identify the usefulness of cardiac computed tomography (CCT) to assess
the morphology and function of QAV.
METHOD AND MATERIALS
We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and
seven patients underwent cardiovascular magnetic resonance (CMR). Valvular morphology assessed by CCT was compared with
that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic
regurgitation (AR) by TTE and the regurgitant fraction by CMR. Ascending aortic diameters were measured by CCT.
RESULTS
Nine patients had pure AR, and one had concomitant aortic stenosis and regurgitation. Two patients had a subaortic fibrotic
membrane and one showed a subaortic stenosis. The dimensions of the ascending aorta increased > 4.0 cm in diameter in four
patients. All CCT scans accurately detected QAVs, but one QAV was misdiagnosed on TTE. In accordance with the Hurwitz and
Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in seven of 10
patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n=4), and type F (n = 2) on CCT.
A very high correlation existed between ROA by CCT and regurgitant fraction by CMR (r = 0.99) and good correlation existed
between ROA by CCT and regurgitant severity by TTE (r = 0.62).
CONCLUSION
CCT allowed for a morphological and functional assessment of QAV.
CLINICAL RELEVANCE/APPLICATION
Cardiac computed tomography is a useful imaging modality for comprehensively assessing QAV, including detection, classification,
QAV-related cardiovascular abnormalities, AR severity, and dimensions of the ascending aorta.
CA254-SDTHA3
Resorption of Microembolized Ischemic Myocardium Assessed and Characterized on MRI and
Microscopy
Station #3
Participants
Maythem Saeed, DVM, PhD, San Francisco, CA (Presenter) Nothing to Disclose
Loi Do, MS, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Roland Krug, PhD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Steven W. Hetts, MD, San Francisco, CA (Abstract Co-Author) Consultant, Silk Road Medical Inc Consultant, Medina Medical Inc
Research Grant, Stryker Corporation Data Safety Monitoring Board, Stryker Corporation
Mark W. Wilson, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To quantify coronary microemboli effects on previously ischemic myocardium and infarct resorption rate using MRI and microscopy.
METHOD AND MATERIALS
The left anterior descending coronary artery (LAD) was occluded, under fluoroscopy, for 45min (group I, n=8) and combined with
microemboli (group II, n=8). A 1.5T MR scanner was used at 3 days and 5 weeks to acquire delayed contrast enhanced MRI (DEMRI). Inversion recovery gradient-echo sequence was used to delineate damaged myocardium. Imaging parameters: TR/TE/flip
angle=5ms/2ms/15°; FOV=26×26cm; slice thickness=6mm without gap; read and phase matrix size=256x162, NEX=2 and TI=220240ms. DE-MRI images were acquired after delivery of 0.15mmol/kg Gd-DTPA (10 min). After the second imaging session, the hearts
were excised, sliced, fixed and stained with Masson trichrome for microscopic quantification using planemetry. Cardiac injury
biomarkers (creatine kinase MB and troponin I) collected in the first 3 days and tissue samples at 5 weeks were used to
confirm/deny MI.
RESULTS
On DE-MRI, group I showed small subendocardial infarct with the extent of 3.3±2.2g, while group II showed significantly larger
infarct of 9.8±0.6g (P<0.01) at 3 days. At 5 weeks, group I showed substantial shrinkage (60%, 1.3±0.9g) compared with group II
(22%, 7.7±0.5, P<0.01), suggesting that the healing process in microembolized ischemic myocardium is slow (Fig). On microscopy,
the infarct sizes were significantly greater in group I (2.8±0.4) and II (13.4±2.4) compared to DE-MRI. There was no significant
difference in plasma cardiac injury biomarkers between groups I and II at 24hrs but elevation of troponin I was higher in group II
than I at 72hrs. Microscopy revealed microemboli randomly distributed in the LAD territory, vascular remodeling, and inflammatory
cells (group II, Fig).
CONCLUSION
DE-MRI has the potential to detect additional loss of cellular integrity in the territory exposed to microembolization as well as the
difference in infarct resorption. However, this technique has limited spatial resolution for measuring true microinfarct when
compared to microscopy.
CLINICAL RELEVANCE/APPLICATION
Infarct resorption is delayed by dislodged microemboli and MRI may be useful in testing the efficacy of newer distal protective
devices in eliminating microemboli during coronary revascularization.
CA255-SDTHA4
Beam Hardening Correction for Myocardial Perfusion Imaging using Computed Tomography
Station #4
Participants
Jacob Levi, MSc, Cleveland, OH (Presenter) Employee, Koninklijke Philips NV
Rachid Fahmi, PhD, Cleveland, OH (Abstract Co-Author) Institutional Grant support, Koninklijke Philips NV
Brendan Eck, Willoughby, OH (Abstract Co-Author) Research Grant, Koninklijke Philips NV
Anas Fares, MD, Cleveland, OH (Abstract Co-Author) Institutional Research Grant, Koninklijke Philips NV
Amar Dhanantwari, PhD, Highland Heights, OH (Abstract Co-Author) Employee, Koninklijke Philips NV
Mani Vembar, MS, Cleveland, OH (Abstract Co-Author) Employee, Koninklijke Philips NV
Hiram Bezerra, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
David L. Wilson, PhD, Cleveland, OH (Abstract Co-Author) Co-owner, BioInVision Inc Research Grant, Koninklijke Philips NV
PURPOSE
Beam hardening artifacts (BHA) is preventing accurate blood flow measurement in myocardial perfusion imaging computed
Beam hardening artifacts (BHA) is preventing accurate blood flow measurement in myocardial perfusion imaging computed
tomography (MPI-CT). We are using a beam hardening correction (BHC) algorithm with an advanced cost function in order to
reduce the BHA in MPI-CT.
METHOD AND MATERIALS
In order to evaluate the BHA, we measure the difference between the average HU values in the affected ROI to the average HU of
unaffected ROIs. We are using a polynomial technique with an advanced cost function to allow a semi-automatic correction of BHA
in MPI-CT scans, obtained by a conventional CT scanner. Our method is designed to work with reconstructed images and does not
require RAW projection data. This makes our technique robust regardless to the type of scanner used.In order to validate our BHC,
we use a prototype spectral detector CT (SDCT) scanner (Philips Healthcare) to generate mono-energetic (monoE) images. BHA in
those images are greatly reduced or eliminated. We use those monoE images as the ground truth for comparison.In order to
preserve the blood flow accuracy, we apply the same correction to the whole MPI-CT time series.
RESULTS
BHA in the conventional image was 28.7 ± 3.6 HU. That means that BH ROI was "darker" in 28.7 HU in comparison to the average of
other ROIs in the myocardium. After BHC the BHA went down to 2.2 ± 3.5 HU. The rest of the image had differences of ±5.23 HU
compared to the 70keV image. We observe even better results in unenhanced image (image with no iodine) subjected to the same
correction.
CONCLUSION
Using the polynomial BHC technique with our cost function greatly reduces BHA in MPI-CT. This will allow a more accurate
calculation of myocardial blood flow.
CLINICAL RELEVANCE/APPLICATION
Reducing BHA in MPI-CT scans will allow a non-invasive blood flow measurements in the myocardium with a conventional CT
scanner. This will greatly improve and reduce risk of heart disease detection.
CA256-SDTHA5
A Method for Characterizing Pulmonary Hemodynamics in Pulmonary Hypertension using CT Test
Bolus Imaging
Station #5
Participants
Rahul N. Sawlani, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Kaushik S. Shahir, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Lawrence R. Goodman, MD, Milwaukee, WI (Abstract Co-Author) Author, Reed Elsevier
Kenneth Presberg, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Sikandar Ansari, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Dhiraj Baruah, MD, Milwaukee, WI (Presenter) Nothing to Disclose
PURPOSE
Currently, invasive cardiac catheterization is the only method to accurately assess the severity of pulmonary hypertension by
providing hemodynamic measures such as pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP). Recent
work has demonstrated strong correlation between bolus kinetics measured in the main pulmonary artery on MR angiography and
these physiologic parameters. (1,2) We propose a method for characterizing PVR and mPAP using test bolus imaging performed for
routine CT pulmonary angiography (CTPA). Swift, Andrew J et al. Pulmonary circulation (2014). Skrok, Jan et al. Radiology (2012).
METHOD AND MATERIALS
25 patients with known pulmonary hypertension who had a CTPA study within one month of right heart catheterization were
included in this IRB-approved retrospective cohort. Several parameters were measured from the CTPA including size of the central
pulmonary arteries, PA/Aorta ratio, and arterial-bronchial (A/B) ratio. In addition, the full-width at half-maximum (FWHM) was
calculated from the attenuation-time curve as follows. Density (HU) over time was measured in the main pulmonary artery and
fitted to the gamma variate function modeling first pass bolus kinetics (3) using a least squares method (MATLAB R2009b,
MathWorks). A correlation coefficient of R2>0.9 was required to ensure accuracy of fit, and FWHM was then calculated and plotted
against PVR and mPAP. 3. Thompson, Howard K et al. Circ Res (1964).
RESULTS
Of the 25 patients, 18 had adequate gamma variate fits (R2>0.9). Inadequate data (N=7) was a result of inadequate scan duration,
motion, or extensive streak artifact. There is a strong direct linear correlation (N=18) between FWHM and PVR (R2=0.80) and
exponential correlation with mPAP (R2=0.68).
CONCLUSION
CT test bolus imaging is simple, practical, and most importantly noninvasive. Patient-specific bolus kinetics can be accurately
extracted from these scans to noninvasively predict PVR and to a certain extent mPAP.
CLINICAL RELEVANCE/APPLICATION
Invasive testing (catheter angiography) is currently the gold standard to assess severity and prognosis in patients with pulmonary
hypertension. With our proposed method, physiologic parameters can be accurately measured non-invasively with a simple, readily
available CTPA test bolus. This has the potential to assess and trend treatment response.
CA150-EDTHA6
Cardiac MRI in Acute Chest Pain with Coronary Arteries Anatomicaly Normal. Signs, Pitfalls,
Differential Diagnosis and Schematic Diagnostic Approach
Station #6
Participants
Jose Gutierrez Chacoff, MD, Santiago, Chile (Presenter) Nothing to Disclose
Diego Navarrete, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Susana Prat-Gonzalez, MD, PhD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Teresa M. de Caralt, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Rosario J. Perea, MD, PhD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Daniel Barnes, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
MRI is an accurate method to make differential diagnosis in patients with acute chest pain and non-diagnostic electrocardiography
and enzymesMyocarditis, tako tsubo syndrome, pericarditis and epicardial fat necrosis may simulate acute coronary disease. To
know the MRI signs and pitfalls allow to rule out ischemia and get the right diagnosis. Moreover, coronary vasospasm may produce
ischemic changes with or without infartPresence and distribution of late myocardial enhancement, edema and contractility
alterations, are the most important myocardial features to differentiate ischemia from other cardiac causes of painIn every cardiac
MRI of a patient with acute chest pain must be evaluated the pericardium, thoracic aorta and epicardial fat, looking for non-cardiac
causes of pain
TABLE OF CONTENTS/OUTLINE
Aims Introduction MRI Technique and protocols Signs you must know -myocardial thickening -T2 hyperintensity -Early enhancement
-Late enhancement -Contractility alterations -Perfusion alterations - Pericardial thickening and effusion Pitfalls you must know
Ruling out ischemia Pathologic conditions you must know: -Myocarditis -Tako Tsubo -Coronay vasospasm -Pericarditis and
Myopericarditis -Acute aortic syndrome -Epicardic fat necrosis Schematic diagnostic approach Messages to take home
CAS-THB
Cardiac Thursday Poster Discussions
Thursday, Dec. 3 12:45PM - 1:15PM Location: CA Community, Learning Center
CA
AMA PRA Category 1 Credit ™: .50
Participants
Balazs Ruzsics, MD, PhD, Charleston, SC (Moderator) Nothing to Disclose
Sub-Events
CA258-SDTHB2
Aortic Valve Imaging and 3D Contrast Enhanced MR Angiography Using Gadobenate Dimeglumine at
1.5T and 3T
Station #2
Participants
Varun Chowdhary, MD, BS, Chicago, IL (Presenter) Nothing to Disclose
Michael Markl, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Michael Rose, Chicago, IL (Abstract Co-Author) Nothing to Disclose
James C. Carr, MD, Chicago, IL (Abstract Co-Author) Research Grant, Astellas Group Research support, Siemens AG Speaker,
Siemens AG Advisory Board, Guerbet SA
PURPOSE
To systematically evaluate the performance of Gadobenate Dimeglumine for aortic valve (AV) imaging and 3D contrast enhanced
(CE) angiography (MRA) of the aorta at 1.5T vs 3T in healthy controls and patients with bicuspid aortic valve (BAV).
METHOD AND MATERIALS
Pre- and post-contrast AV imaging using time-resolved (CINE) balanced SSFP MRI and 3D CE-MRA were performed in 85 subjects
(n=36 healthy controls, n=49 patients) at 1.5T, 3T, or both (total 101 scans). Data analysis included image quality grading (4 point
scale) and quantification of regional signal-to-noise ratio (SNR) and contrast-to noise ratio (CNR) in three subgroups: Group 1,
subjects scanned at both the 1.5T and 3T (n=16); Group 2, patients with known or suspected BAV (n=49); Group 3, entire cohort
(n=85).
RESULTS
For group 1, 3D CE-MRA demonstrated significantly increased SNR at 3T compared to 1.5T for all aortic regions (46-85% increase,
p<0.04), but similar image quality for AV imaging. For group 2 and 3, SNR was similarly improved at 3T (group 2: 99-139%, p<0.001;
group 3: 71-99%, p<0.001) with 3D CE-MRA. Furthermore, image quality grading revealed good to excellent image quality for 3D
CE-MRA at both field strengths. For AV imaging, SNR and CNR significantly (p<0.001) benefited from performing imaging post
Gadobenate Dimeglumine injection. In group 2, AV images were superior for the identification of valve morphology and BAV fusion
patterns at 1.5T (insufficient image quality in 9% of subjects) compared to 3T (insufficient quality in 33%).
CONCLUSION
Surveillance MRI for the detection and monitoring of AV and aortic abnormalities with 2D CINE AV imaging and 3D CE-MRA using
Gadobenate Dimeglumine is feasible at both 1.5T and 3T with good to excellent image quality. In particular, SNR was significantly
improved at 3T as compared to 1.5T. For 2D CINE AV images, it was found that SNR and CNR significantly benefit by performing
imaging post Gadobenate Dimeglumine injection. Furthermore, it was found that AV images based on SSFP were superior for the
characterization of valve morphology and BAV fusion patterns at 1.5T compared to 3T.
CLINICAL RELEVANCE/APPLICATION
To establish the effect of MR field strength on 2D CINE SSFP AV images and 3D CE-MRA data of the aorta in BAV patients.
CA259-SDTHB3
Accurately Diagnosing Cardiac Amyloidosis: Recognizing Frequent Misinterpretations and Typical
Cardiac Magnetic Resonance Imaging Characteristics
Station #3
Participants
Chiara Pozzessere, MD, Siena, Italy (Presenter) Nothing to Disclose
Celia P. Corona-Villalobos, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Linda C. Chu, MD, Lutherville, MD (Abstract Co-Author) Nothing to Disclose
Ihab R. Kamel, MD, PhD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Stefan L. Zimmerman, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Kristin Porter, MD, PhD, Baltimore, MD (Abstract Co-Author) Stockholder, Pfizer Inc
PURPOSE
Cardiac amyloidosis is a rare disease and often unsuspected, making it a challenging imaging diagnosis. This study evaluates how
well expert radiologists interpret cardiac magnetic resonance imaging (CMR) in patients with pathologically proven cardiac
amyloidosis and assesses which of the typical CMR findings are most frequently encountered.
METHOD AND MATERIALS
Cardiac biopsies obtained between 2005 and 2014 were reviewed with 154 resultant cases of biopsy proven cardiac amyloidosis. 15
patients underwent pre-procedure contrast-enhanced CMR performed at our institution. Two readers in consensus evaluated the
CMR for the presence of typical findings of cardiac amyloidosis as determined by literature review. CMR findings assessed included:
abnormal TI time (inhomogeneous null point of myocardium and/or shorter than blood), abnormal late gadolinium enhancement
(LGE), pericardial effusion, pleural effusion, concentric myocardial thickening, biatrial enlargement and atrio-ventricular (A-V) valve
thickening. The original CMR interpretation and final diagnosis was also scored for accuracy.
RESULTS
Concentric myocardial thickening and abnormal LGE were present in 93% of biopsy-proven cases of cardiac amyloidosis. Abnormal
TI time occurred in 87% of the cases. Pericardial effusion, pleural effusions, and biatrial enlargement were less frequently observed
(73%, 67%, and 60%, respectively). A-V valve thickening was not a sensitive indicator of cardiac amyloidosis, as it was present in
only 13% of cases. Radiologists correctly interpreted 60% of the cases as most compatible with cardiac amyloidosis. In 13% an
infiltrative disease was suggested. Hypertrophic cardiomyopathy (HCM) was the leading misinterpretation, occurring in 20% of the
cases. In 7% the study was inaccurately interpreted as normal.
CONCLUSION
In 73% of biopsy-proven cases of cardiac amyloidosis expert cardiac radiologists accurately diagnosed cardiac amyloidosis by
specifically suggesting amyloidosis or including it in the differential diagnosis of an infiltrative disease. The leading misinterpretation
for cardiac amyloidosis is HCM. Cardiac amyloidosis should be considered when CMR demonstrates concentric myocardial thickening,
abnormal LGE and abnormal TI time.
CLINICAL RELEVANCE/APPLICATION
Accurately diagnosing cardiac amyloidosis on CMR is challenging; as such, radiologists need to recognize its frequent
misinterpretations and typical CMR characteristics.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ihab R. Kamel, MD, PhD - 2015 Honored Educator
Stefan L. Zimmerman, MD - 2012 Honored Educator
Stefan L. Zimmerman, MD - 2015 Honored Educator
CA261-SDTHB5
Real-time Compressed Sensing Cine Imaging in Patients with Atrial Fibrillation: A Feasibility Study
Station #5
Participants
Juliane Schelhorn, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Ercan Tezgah, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Felix Nensa, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Haemi P. Schemuth, Essen, Germany (Presenter) Nothing to Disclose
Stefan Maderwald, PhD, MSc, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Marcel Gratz, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Michael Zenge, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Harald H. Quick, PhD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Thomas W. Schlosser, MD, Essen, Germany (Abstract Co-Author) Nothing to Disclose
Kai Nassenstein, Essen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cardiac magnetic resonance imaging relies on correct triggering for image acquisition. It is hampered in arrhythmic patients, but
real-time sequences may overcome this problem. This study investigated whether a new real-time cine sequence improves cine
imaging and allows reliable left ventricular volumetry in patients with atrial fibrillation.
RESULTS
Motion artifacts were significantly reduced (p<0.001) in the sparse sequence (median artifact severity, 1; range, 0 to 1) compared
to the standard SSFP sequence (median artifact severity, 2; range, 1 to 3). Only a small difference of 9 ± 15 ml was seen for endsystolic volume (p=0.019) between both sequences, otherwise no significant volumetric differences were detected (end-diastolic
volume, p=0.200; stroke volume, p=0.332; ejection fraction, p=0.136; myocardial mass, p=0.353). Intraclass correlation between
both sequences was good to excellent. Intra-rater agreement was good to excellent for SSFP and excellent for sparse.
CONCLUSION
Real-time cine imaging reduces motion artifacts and enables reliable assessment of left ventricular volumes in patients with atrial
fibrillation.
CLINICAL RELEVANCE/APPLICATION
Real-time cardiac magnetic resonance imaging can solve the trigger problem in arrhythmic patients.
CA262-SDTHB6
Surgical Ventricular Restoration (SVR): Have an Impact on Right Ventricular Remodelling?
Station #6
Participants
Paola Maria Cannao, MD, San Donato Milanese, Italy (Presenter) Nothing to Disclose
Francesco Secchi, MD, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Elda Chiara Resta, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Antonella Camporeale, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Marcello Petrini, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Francesco Sardanelli, MD, San Donato Milanese, Italy (Abstract Co-Author) Speakers Bureau, Bracco Group Research Grant, Bracco
Group Speakers Bureau, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific
Massimo Lombardi, MD, Pisa, Italy (Abstract Co-Author) Nothing to Disclose
Lorenzo Menicanti, MD,PHD, San Donato Milanese, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Right ventricular (RV) dysfunction is an important predictor of long-term outcome in heart failure patients undergoing surgical
ventricular restoration (SVR). While the impact of this procedure on left ventricle is already described , RV morphological changes
remain almost unrecognized. The aim of our study was to combine a morphological parameter, RV remodeling index (RV mass/volume
ratio), with functional evaluation to describe RV changes after SVR and the resulting impact on clinical outcome.
METHOD AND MATERIALS
We evaluated retrospectively 32 patients (mean age 65±9) who underwent CMR (1.5 T) before and 6 months after SVR. For each
patients RV and LV morpho-functional evaluations were performed using CMR, and echocardiographic estimation of PAPs was
considered. Changes in NT-proBNP values, dosed before and 6 months after surgery at the time of scanning, were considered as
markers of patients outcome.
RESULTS
Six months after SVR, EDV and ESV of left ventricle were significantly reduced (P<.001), while EF was significantly increased
(P<.001). LV stroke volume did not show significant changes (P=.18). There was an increase in RV EDV (P=.05), probably due to
the loss of the compressive effect exerted by the dilated LV. There was not significant difference of RV EF pre vs post (P=.54).
There was no significant variation in RV remodeling index (P=.35). There was a significant reduction in NT-proBNP values compared
with pre-surgical evaluation (P=.02). Changes in NT-proBNP levels were positively correlated with variations of PAPs. There was no
correlation between changes in NT-proBNP levels and changes in RV ejection fraction (r=-1,013, P=.49), LV ejection fraction (r=0,24, P=.49), RV stroke volume (r=-0,24, P=.19) and LV stroke volume (r=-0,21, P=.25).
CONCLUSION
Surgical ventricular restoration improves a benefit on left ventricle function and on patients outcome but is not correlated with any
morphological or functional modification of right ventricle.
CLINICAL RELEVANCE/APPLICATION
The evaluation of RV in patients who underwent SVR is currently unrecognized. On the basis of our results, RV seems to behave as
"bystander" in front of clinical improvements and LV modifications after this procedure.
CA005-EBTHB
Optimization of Functional Cardiac MRI Imaging to Avoid Common Image Artifacts
Hardcopy Backboard
Participants
Jordan Brown, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
El-Sayed H. Ibrahim, PhD, MSc, Ann Arbor, MI (Presenter) Nothing to Disclose
Jadranka Stojanovska, MD, MS, Northville, MI (Abstract Co-Author) Nothing to Disclose
Luba Frank, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Dharshan R. Vummidi, MRCP, FRCR, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Anil K. Attili, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Maryam Ghadimi Mahani, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Paul P. Cronin, MD, MS, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Prachi P. Agarwal, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Review the principles of MRI cardiac functional imaging and measured parameters.2. Review and illustrate the sources of common
artifacts in MRI cardiac functional imaging.3. Describe strategies for optimizing the imaging parameters to reduce or eliminate
imaging artifacts, with different scenarios based on the patient condition and purpose of the MRI exam.
TABLE OF CONTENTS/OUTLINE
Magnetic resonance imaging (MRI) has been established as the method of choice for evaluating cardiac function. Important cardiac
functional parameters, e.g. ventricular volumes, mass, and ejection fraction, can be measured from the resulting images.
Nevertheless, the appearance of image artifacts results in poor image quality and inaccurate measurement of these parameters.
Understanding the sources of these artifacts and means to correct for them is essential for proper MRI cardiac imaging and
generation of sufficient diagnostic image quality. Herein, we describe and illustrate cases acquired with image artifacts due to
inappropriate setting of the imaging parameters, as well as modifications of the imaging protocol to alleviate these artifacts.
SPSH53
Hot Topic Session: 4D Flow Cardiac MRI
Thursday, Dec. 3 3:00PM - 4:00PM Location: S402AB
CA
MR
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
FDA
Discussions may include off-label uses.
Participants
J. Paul Finn, MD, Los Angeles, CA (Moderator) Research Grant, Bracco Group; ; ;
Robert M. Steiner, MD, Philadelphia, PA (Moderator) Consultant, Educational Symposia; Consultant, Johnson & Johnson
Sub-Events
SPSH53A
4D Flow: Overview of Techniques and Applications
Participants
James C. Carr, MD, Chicago, IL (Presenter) Research Grant, Astellas Group Research support, Siemens AG Speaker, Siemens AG
Advisory Board, Guerbet SA
LEARNING OBJECTIVES
1) Understand the basic principles behind flow imaging with MRI. 2) Become familiar with various techniques for 4d flow. 3) Briefly
introduce current and future clinical applications for 4D flow.
SPSH53B
Assessment of Congenital Heart Disease with 4D Flow
Participants
Christopher J. Francois, MD, Madison, WI (Presenter) Research support, General Electric Company
LEARNING OBJECTIVES
1) How can 4D Flow MRI be used in congential heart disease? 2) What evidence supports the use of 4D Flow MRI in congenital
heart disease? 3) What are current challenges of performing 4D Flow MRI in congential heart disease? 4) What are the future
directions for 4D Flow MRI in congential heart disease?
ABSTRACT
How can 4D Flow MRI be used in congential heart disease? Free breathing high resolution magnetic resonance angiography Flow
visualization Flow quantification What evidence supports the use of 4D Flow MRI in congenital heart disease? Summarize published
data validating flow quantification and distribution in CHD What are current challenges of performing 4D Flow MRI in congential heart
disease? Shorten scan time Respiratory and cardiac motion Accuracy of flow quantification What are the future directions for 4D
Flow MRI in congential heart disease? Energy losses in CHD Combining 4D Flow MRI with computational fluid dynamics and 3D
printing
URL
Active Handout:Christopher Jean-Pierre Francois
http://abstract.rsna.org/uploads/2015/15007123/SPSH53B.pdf
SPSH53C
4D Flow Applications in Adult Cardiovascular Diseases
Participants
Michael D. Hope, MD, San Francisco, CA, (michael.hope@ucsf.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Assess the potential clinical utility of recent advancements in 4D Flow imaging for adult cardiovascular disease. 2) Discuss
possible clinical applications of unique 4D Flow hemodynamic parameters including regional aortic pulse wave velocity, flow
displacement and helicity, and turbulence.
SPSH53D
Clinical Processing of 4D Flow for Congenital and Acquired Structural Heart Disease
Participants
Albert Hsiao, MD, PhD, San Diego, CA, (hsiao@ucsd.edu) (Presenter) Founder, Arterys, Inc; Consultant, Arterys, Inc; Research
Grant, General Electric Company
LEARNING OBJECTIVES
1) Clinical validation for quantitative flow and function. 2) Large volume data sets, data handling, compressed-sensing iterative
reconstruction. 3) Background eddy-current correction. 4) Routine clinical cardiovascular 4D Flow cases.
Active Handout:Albert Hsiao
http://abstract.rsna.org/uploads/2015/15047996/SPSH53D.pdf
RC703
Imaging for Catheter Based Cardiac Intervention (TAVR, EP Procedures, Mitral Procedures)
Thursday, Dec. 3 4:30PM - 6:00PM Location: N229
CA
IR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Sub-Events
RC703A
Mitral Valve Interventions
Participants
Philipp Blanke, MD, Vancouver, BC, (phil.blanke@gmail.com) (Presenter) Consultant, Edwards Lifesciences Corporation ; Consultant,
Neovasc Inc
LEARNING OBJECTIVES
1) To review the anatomy and normal appearance of the mitral apparatus on cardiac CT. 2) To review common mitral valve
pathologies including mitral annular calcifications, myxomatous degeneration, mitral valve prolapse and mitral stenosis and their
appearance on cardiac CT. 3) To learn about recent advances in transcatheter mitral valve interventions and the role of
preoperative computed-tomography.
ABSTRACT
1. To review the anatomy and normal appearance of the mitral apparatus on cardiac CT.2. To review common mitral valve
pathologies including mitral annular calcifications, myxomatous degeneration, mitral valve prolapse and mitral stenosis and their
appearance on cardiac CT.3. To learn about recent advances in transcatheter mitral valve interventions and the role of
preoperative computed-tomography.
RC703B
The Role of Imaging prior to TAVR
Participants
Jonathon A. Leipsic, MD, Vancouver, BC (Presenter) Speakers Bureau, General Electric Company Speakers Bureau, Edwards
Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc
LEARNING OBJECTIVES
1) Discuss the historical role of CTA in TAVR planning. 2) Review more recent data defining new applications for CT in TAVR
planning. 3) Help define the potential future applications and role of MDCT in the future with new devices being introduced into the
field.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Jonathon A. Leipsic, MD - 2015 Honored Educator
RC703C
Imaging to Inform Electrophysiology (EP) and Other Interventions
Participants
Eric E. Williamson, MD, Rochester, MN, (Williamson.eric@mayo.edu​ ) (Presenter) Research Grant, General Electric Company
LEARNING OBJECTIVES
1) Discuss the use of CT for preprocedure planning and postprocedure follow-up of electrophysiology (EP) interventions. 2) Describe
expected and important unexpected findings on preprocedure CT used to guide EP intervention. 3) Describe common and uncommon
complications of EP intervention as seen on postprocedure CT.
ABSTRACT
1. Discuss the use of CT for preprocedure planning and postprocedure follow-up of electrophysiology (EP) interventions2. Describe
expected and important unexpected findings on preprocedure CT used to guide EP intervention3. Describe common and uncomon
complications of EP intervention as seen on postprocedure CT
RC803
Quantitative Measures in Cardiac CT and MR Imaging-Do They Matter?
Friday, Dec. 4 8:30AM - 10:00AM Location: E350
CA
BQ
CT
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Discussions may include off-label uses.
Participants
LEARNING OBJECTIVES
ABSTRACT
Sub-Events
RC803A
Quantitative Assessment of the Cardiac Chambers and Its Clinical Significance
Participants
Bernd J. Wintersperger, MD, Toronto, ON, (bernd.wintersperger@uhn.ca) (Presenter) Speakers Bureau, Siemens AG; Research
support, Siemens AG
LEARNING OBJECTIVES
1) Describe the approach of cardiac MR and CT in assessment of cardiac function and size 2) Understand important differences
between varies imaging strategies 3) Understand the impact and role of cardiac size and function on treatment decisions
ABSTRACT
Introduction:Cardiac performance is generally assessed by volumetric quantifications such as size and output. Follow-up and
changes over time may allow identification of early disease onset, may trigger specific therapies and may allow prediction of patient
prognoses and general outcome.While CT & MR imaging provide more accurate results, echocardiography remains the first line
modality. CT for functional evaluation should be considered a 3rd line option based on the added radiation exposure.Methods:Most
important measures of cardiac function are end-diastolic volume (EDV), stroke volume (SV) and ejection fraction (EF). While the
acoustic window may limit echocardiography, CT & MRI can easily cover all aspects of the atria and ventricles. While results of
clinical echocardiography may only allow a categorization of ventricular EF (grade 1-4) with large variations related to assumptions,
CT and MRI allow highly accurate results in normal & abnormal ventricles. In order to maintain accuracy and precision adequate
imaging parameters with respect to coverage, spatial resolution and temporal resolution are required. Today's functional cardiac MR
imaging is based on cine SSFP methods with cardiac short axis orientation for the left ventricle and short axis or transverse
orientation for the right ventricle. Atrial volumetric assessment is performed rarely but might especially be of interest in patients
with AV valve dysfunction or atrial sources of arrhythmia. While quantitative assessment of regional motion was previously limited
to echocardiography or specific MR techniques (e.g. MR tagging), recent software developments also allow this information being
derived from standard cine MRI. ConclusionBased on its accuracy cardiac MR plays an increasingly important role in assessment of
patients with cardiac diseases. Accurate and precise quantification of cardiac function is increasingly important in therapy decisions
and therapy monitoring.
Handout:Bernd J. Wintersperger
http://abstract.rsna.org/uploads/2015/14000904/RSNA 2015 RC803A Quantitative Measures in Cardiac CT and MR Imaging_
Quantitative Assessment of the Cardiac Chambers and Clinical Significance.pdf
RC803B
Quantitative Assessment Cardiac Valves on MRI
Participants
Jens Bremerich, MD, Basel, Switzerland, (jens.bremeric@usb.ch) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Apply CMR for morphometry and quantification of valvular function. 2) Compare various CMR approaches for assessment of
cardiac valves. 3) Analyse flow data in stenotic or incompetent valves.
ABSTRACT
Introduction: Echocardiography remains first line modality for imaging cardiac valves. In specific cases, however, MR provides
complementary quantitative data. Methods: Most relevant sequences for valve imaging are: 1) Black blood, 2) CineSSFP, and 3)
VENCine. Black blood images are fast spin echo sequences. CineSSFP are used for quantification of valvular morphology and motion.
Temporal resolution is typically 50ms for a segmented breath hold sequence but may be further shortened by means of parallel
imaging or non-breath hold sequences. VENCine is an excellent tool for flow volume and velocity quantification. Volumes are
relevant to calculate regurgitant fraction of incompetent valves, velocities are used to calculate degree of stenosis relying on
modified Bernoulli equation. Results: Aortic regurgitation is difficult to evaluate with Echocardiography but easily quantified on
VENCine with excellent reproducibility. Regurgitant fraction is defined as Volumeantegrade /Volumeretrograde *100 [%]. Aortic stenosis
may also be quantified with MR by measuring the opening area on CineSSFP or by measuring peak velocity in the valve on VENCine
and calculation with modified Bernoulli equation (ΔP = 4 * Vmax2). Mitral regurgitation may also be quantified by MRI.
Echocardiographic quantification relies predominantely on the extent of the regurgitant jet into the left atrium which is not a reliable
sign on MRI, since extent of regurgitant jets depend on various sequence parameters such as field strength and echo time.
Pulmonary regurgitation can also be quantified with MRI which is relevant in congenital heart disease such as after surgical repair in
tetralogy of Fallot. Pulmonary stenosis, Tricuspid stenosis and regurgitation are no routine indications for MRI but are rather
evaluated by echocardiography. Conclusion: Aortic regurgitation is an excellent indication for MRI, it enables accurate and
reproducible quantification.
RC803C
How to Quantify Valve Function on Cardiac CT
Participants
Paul Schoenhagen, MD, Cleveland, OH, (schoenp1@ccf.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the limited role of CT for assessment of valvular function. 2) Discuss clinical indications where anatomic and functional
valvular with CT is indicated. 3) Describe data acquisition and analysis approach for valvular assessment.
ABSTRACT
CT is a predominantly anatomic imaging modality. Compared to predominantly functional modalities its temporal resolution is limited.
In addition, functional/4-D imaging requires retrospective gated data acquisition and is associated with higher radiation exposure.
The role of CT for functional valvular analysis is therefore limited to few clinical scenarios, where it can provide complementary
information. The strength of CT in these situations is the ability for reconstruction in the acquired 3-D/4-D volume. A prominent
example is transcatheter valve replacement/implantation but also assessment of prosthetic valves.
URL
Handout:Paul Schoenhagen
http://abstract.rsna.org/uploads/2015/14000907/schoenhagen_RSNA2015 - valve function 11_30.pdf
RC803D
4D Flow MRI Quantification?
Participants
Christopher J. Francois, MD, Madison, WI (Presenter) Research support, General Electric Company
LEARNING OBJECTIVES
1) Describe MRI physics of 4D flow MRI. 2) Illustrate use of 4D flow MRI for basic hemodynamic function. 3) Demonstrate potential
futures uses of 4D flow MRI for advanced hemodynamic analyses.
ABSTRACT
MRI flow imaging is based on flow-sensitive, phase contrast sequences. This presentation will introduce the basic MRI physics
responsible for imaging flow, extending 1-directional flow imaging to 3-directional flow imaging used in 4D flow MRI.Examples from
valvular and congenital heart disease will be used to illustrate the use of 4D flow MRI to quantify flow velocities and volumes.
Although 4D flow MRI is still very much in the early developmental phase, published data comparing 4D flow MRI to established
techniques for quantifying flow will be reviewed.The future potential for 4D flow MRI to be used to non-invasively quantify more
advanced hemodynamic parameters will be demonstrated. Specifically, the use of 4D flow MRI to measure pressure gradients, pulse
wave velocity, wall shear stress and kinetic energy will be covered.
Active Handout:Christopher Jean-Pierre Francois
http://abstract.rsna.org/uploads/2015/14000908/RC803D.pdf
SST02
Cardiac (Molecular Imaging/Other)
Friday, Dec. 4 10:30AM - 12:00PM Location: S501ABC
CA
MI
MR
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
Participants
Balazs Ruzsics, MD, PhD, Charleston, SC (Moderator) Nothing to Disclose
Pal Maurovich-Horvat, MD,PhD, Budapest, Hungary (Moderator) Nothing to Disclose
Sub-Events
SST02-01
Age Dependency of Myocardial Triglyceride Content: A 3T 1H-Magnetic Resonance Spectroscopy
Study
Friday, Dec. 4 10:30AM - 10:40AM Location: S501ABC
Participants
Bernhard Petritsch, Wurzburg, Germany (Presenter) Nothing to Disclose
Tobias Gassenmaier, MD, Wurzburg, Germany (Abstract Co-Author) Speaker, Siemens AG
Julian Donhauser, MD, Wurzburg, Germany (Abstract Co-Author) Nothing to Disclose
Andreas Kunz, Wurzburg, Germany (Abstract Co-Author) Nothing to Disclose
Thorsten A. Bley, MD, Hamburg, Germany (Abstract Co-Author) Nothing to Disclose
Michael Horn, PhD, Wurzburg, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
The role of myocardial triglyceride (mTG) content in the aging human heart is not entirely understood. The aim of this study was to
measure concentrations of mTG content from healthy volunteers using 1H-magnetic resonance spectroscopy (1H-MRS) and to
determine the association between age, mTG content and systolic heart function (expressed as ejection fraction). Furthermore, the
technical reliability of 1H-MRS at 3 T was evaluated.
METHOD AND MATERIALS
The total study population of 47 healthy volunteers was divided into 4 age classes, according to the age of the subjects (1st
cohort 20 - 29 years (yrs.), n=20; 2nd cohort 30 - 39 yrs., n=10; 3rd cohort 40 - 49 yrs., n=9; 4th cohort 50 - 60 yrs., n=8).
Cardiac MRI and dual triggered 1H-MRS of the myocardium were consecutively performed using a 3 T scanner (MAGNETOM Trio,
Siemens). The mTG content was calculated as quotient of the mTG resonance areas (at 0.9 ppm [CH3 groups] and 1.3 ppm [CH2
groups]) and the tissue water resonance area (at 4.7 ppm), expressed as triglyceride / water resonance ratio in %. Each
participant underwent spectroscopic measurements twice.
RESULTS
mTG content significantly correlates with age (r=0.48; p<0.001). Following age-averaged values for mTG content were determined:
1st cohort 0.25% (± 0.17); 2nd cohort 0.48% (± 0.30); 3rd cohort 0.48% (± 0.18); 4th cohort 0.77% (± 0.70). While we found a
slight correlation between BMI and mTG content (r=0.27; p=0.008), age proved to be the dominant variable accounting for higher
mTG content in healthy humans. There was no significant correlation (r=0.04; p=n.s.) between LV mass and mTG content in
healthy volunteers. No effects of mTG content was seen on systolic heart function (r=-0.01; p=n.s.). Intraclass correlation
coefficient of repeated spectroscopic measurements was high (r=0.965; p<0.001).
CONCLUSION
1H-MRS proved to be a highly reproducible, sensitive tool for myocardial lipid determination. Myocardial TG content is age
dependent and increases with age. Myocardial TG content was independent from LV mass and systolic heart function. Furthermore
a higher scattering of mTG levels was observed with rising age.
CLINICAL RELEVANCE/APPLICATION
Myocardial TG content rises with advancing age. The age-dependent concentration ranges of myocardial lipid metabolites reported
in this study may be helpful for the correction of acquired 1H-MRS data in patients when evaluating metabolic and cardiovascular
diseases infuture studies.
SST02-02
Transplantation of Mesenchymal Stem Cells Overexpressing Integrin-linked Kinase Improves the
Myocardial Repairing Following Acute Myocardial Infarction
Friday, Dec. 4 10:40AM - 10:50AM Location: S501ABC
Participants
Dan Mu, Nanjing, China (Presenter) Nothing to Disclose
Hongming Yu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Chuan Shuai Tian, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Weibo Chen, PhD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Biao Xu, Nanjing, China (Abstract Co-Author) Research Grant, General Electric Company
Bin Zhu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigated the effects of transplanted autologous mesenchymal stem cells overexpressing integrin- linked kinase (ILK) on
myocardial perfusion, myocardial fibrosis and cardiac function in the swine AMI model by MR imaging in vivo.
METHOD AND MATERIALS
MSCs or ILK-MSCs (5×107 cells) were randomly transplanted into the ischemic myocardium via coronary artery 1 week after
establishing the swine acute myocardial infarction model (6 swine per group) by ballon occlusion. The myocardial blood perfusion,
the infarction area and the cardiac function were assessed by MR first pass perfusion, delayed enhanced examination and cine MR
respectively before and 2 weeks after transplantation using MR imaging.The cardiac fibrosis and capillary density were assessed
using immunohistochemistry two weeks later. The data was statistically analyzed with Independent Sample t test using SPSS17.0
software.
RESULTS
Myocardial perfusion was significantly greater in the ILK-MSCs group than in the MSCs group (area under the perfusion
curve:44840±4807mm2 vs. 35681±5548mm2, p<0.05) and was associated with greater neovessel formation (CD31 positive
cells:273.0±28.3cells/field vs. 194.2±30.7cells/field, p<0.05). The variation of infarction areas were larger in the ILK-MSCs group
than in the MSCs group(the infarct size ratio:0.96±0.11 vs. 0.76±0.09, p<0.05) and was associated with less myocardial fibrosis in
Masson staining(the fibrosis area: 46.7±9.0% vs. 62.0±4.9%, p<0.05). Transplantation of ILK-MSCs improved reginal cardiac
function compared with transplantation of MSCs(wall thickness ratio:60.70±6.8% vs. 52.08±5.6% , p<0.05).
CONCLUSION
Transplantation of mesenchymal stem cells modified with ILK enhance the myocardial repairing after AMI.
CLINICAL RELEVANCE/APPLICATION
MR imaging is a reliable method to evaluate the effect of transplantation of MSCs overexpressing ILK on cardiac repairing.
SST02-03
MR Molecular Imaging of Homing of Mesenchymal Stem Cells Overexpressing Intergrin-linked Kinase
after Transplantation via Coronary in Swine Acute Myocardial Infarction
Friday, Dec. 4 10:50AM - 11:00AM Location: S501ABC
Participants
Dan Mu, Nanjing, China (Presenter) Nothing to Disclose
Hongming Yu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Chuan Shuai Tian, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Weibo Chen, PhD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Biao Xu, Nanjing, China (Abstract Co-Author) Research Grant, General Electric Company
Bin Zhu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To in vivo detect the homing ability of MSCs overexpressing integrin- linked kinase (ILK) after transplantation via coronary in swine
model of AMI using MR molecular imaging technique.
METHOD AND MATERIALS
MSCs or ILK-MSCs(5×107 cells)genetically modified with adenovirus containing GFP or GFP/ILK and labeled with ultrasmall
superparamagnetic iron oxide(USPIO) were transplanted into the ischemic myocardium via coronary artery 1 week after establishing
the swine myocardial infarction model by ballon occlusion.The cell cardiac homing and migration were tracked in vivo at 24h, 1w and
2w after transplantation using MR molecular imaging on clinical 1.5T MR scanner.The GFP expression was calculated from frozen
section and the iron particles in transplanted cells was detected by prussian blue staining 2 weeks later. The data was statistically
analyzed with Independent Sample t test for two group comparison using SPSS17.0 software.
RESULTS
In vivo MR molecular imaging manifested in both Groups that the hypointense area (MSCs:97.60±4.05mm2;ILKMSCs:109.8±6.96mm2) at 1 week was larger (p<0.05) than those at 24 hours(MSCs:80.06±5.47mm2;ILK-MSCs:89.98±6.15mm2)
and the signal intensity variation (MSCs:359.8±44.94; ILK-MSCs:473.6±44.85) was smaller(p<0.05) than those at 24 hours (MSCs:
457.2±43.80; ILK-MSCs:662.4±40.98 ). The hypointense area (MSCs:32.52±7.65mm2; ILK-MSCs:19.00±3.10mm2) and intensity
variation (MSCs:218.6±71.86; ILK-MSCs:108.6±77.87) were all decreased 2 weeks later compared to those at 1week ( p<0.05).
The area and intensity variation of ILK-MSCs group was larger/higher in former 2 time points compared with those of MSCs group(
p<0.05), but smaller/lower in 2 weeks( p<0.05) because of dilution of iron particles in each cells attribute to the promoted cell
proliferation caused by ILK modification, which was explained by more GFP positive(420.0±8.8/field vs.106.5±8.3/field,p<0.001) and
prussian blue staining positive cells (275±54/field vs. 144±54/field, p<0.001) in ILK-MSCs group in two weeks.
CONCLUSION
USPIO labeled MSCs can be reliably detected and tracked in vivo using serial MR molecular imaging. Transplantation of ILK-MSCs
after myocardial infarction can increase the homing rate of MSCs.
CLINICAL RELEVANCE/APPLICATION
MR molecular imaging can identify and dynamically monitor transplanted cells in vivo for verification of effect of ILK on MSCs
homing.
SST02-04
Ferumoxytol-poly-l-lysine Labeling and Non-invasive MR Imaging of Mesenchynal Stem Cells
Friday, Dec. 4 11:00AM - 11:10AM Location: S501ABC
Participants
Dan Mu, Nanjing, China (Presenter) Nothing to Disclose
Hongming Yu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Chuan Shuai Tian, Nanjing, China (Abstract Co-Author) Nothing to Disclose
Weibo Chen, PhD, Shanghai, China (Abstract Co-Author) Nothing to Disclose
Biao Xu, Nanjing, China (Abstract Co-Author) Research Grant, General Electric Company
Bin Zhu, Nanjing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the efficiency and the safety of labeling mesenchymal stem cells(MSCs) in vitro with ferumoxytol- poly-l-lysine (PLL) ,
a new negative agent for cell lebeling and to detect the imaging characteristics.
METHOD AND MATERIALS
MSCs were incubated with ferumoxytol-PLL. Labeling efficiency was examined by Prussian blue staining, transmission electron
microscopy and Colorimetric ferrozine assay. MTT growth curves were obtained at a range of iron concentrations from 5 to 200
ug/ml to assess the effects of the labeling on cell viability and to confirm the safe iron concentration for cell labeling. The effect of
ferumoxytol- PLL at iron concentration of 50ug/ml on cell migration,proliferation and cell cycle were determined by transwell
migration assay, EdU staining assay and flow cytometry anlaysis after Propidium iodide staining respectively. Different number MSCs
labeled with ferumoxytol-PLL at different iron concentrations were imaged using a 3.0T MR system with T2WI and T2*WI
sequences. The signal intensity was measured and statistically compared.
RESULTS
The labeling efficiency was 100%. Transmission electron microscopy showed the iron particles in the cytoplasm. The iron content of
each cells was liner correlated with the iron concentration of the labeling media. Higher labeling concentration (more than 100
μg/ml) can affect cell viability detected by MTT assay. There were not significant impairments were documented in cell
proliferation, migration and cell cycles at 50 μg/ml dose when comparing iron-labeled MSCs to unlabeled controls.The ferumoxytolPLL labeling caused a stronger low signal attenuation effect on T2WI and T2*WI. The signal intensity was negatively correlated
with cell numbers and iron concentration of the labeling media.
CONCLUSION
MSCs can be easily and efficiently labeled by ferumoxytol-PLL without interference on the cell viability, migration, proliferation and
cell cycle. MRI visualization of SPIO- labeled MSCs is feasible in bothT2WI and T2*WI.
CLINICAL RELEVANCE/APPLICATION
Ferumoxytol- poly-l-lysine (PLL) can efficiently label MSCs for MR molecular imaging.
SST02-05
Free-Breathing 3D T1-weighted Fat-saturated Contrast-enhanced Gradient-echo Sequence with
Radial Data Sampling in Thoracic and Cardiovascular MRI
Friday, Dec. 4 11:10AM - 11:20AM Location: S501ABC
Participants
Christer Ruff, MD, Tuebingen, Germany (Presenter) Nothing to Disclose
Robert Grimm, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Fabian Bamberg, MD, MPH, Munich, Germany (Abstract Co-Author) Speakers Bureau, Bayer AG; Speakers Bureau, Siemens AG;
Research Grant, Bayer AG; Research Grant, Siemens AG;
Ulrich Kramer, MD, Tuebingen, Germany (Abstract Co-Author) Nothing to Disclose
Konstantin Nikolaou, MD, Tuebingen, Germany (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group
Speakers Bureau, Bayer AG
Mike Notohamiprodjo, Munich, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate free-breathing radially sampled fat-saturated T1-weighted gradient-echo acquisitions (radial volumetric interpolated
breath-hold examination (VIBE)) with self-gated radially sampled, breath-hold (BH) and free-breathing (FB) cartesian sampled VIBE
acquisitions for post-contrast imaging of the thorax and cardiovascular system.
METHOD AND MATERIALS
This IRB approved prospective study was performed according to the declaration of Helsinki. 20 patients referred for myocardial
infarction, myocarditis and cardiomyopathy were imaged at 1,5T (Aera, Siemens Healthcare). Gadobutrol (Bayer Healthcare)enhanced cartesian sampled isotropic (voxel-size 1.4x1.4x1.4mm3) VIBE sequences acquired during BH (18s) were compared to FB
radially sampled sequences (approx. 4min) featuring respiratory self-gating. Multiplanar reformations were performed with SyngoVia
(Siemens). All image data sets (Cartesian, Radial and Radial VIBE with self-gating) were evaluated by two independent readers (5poinz-Likert-scale): overall image quality, large vessel depiction, small vessel depiction, heart depiction, thoracic wall/diaphragm
sharpness and streaking artifacts. Statistical analysis was performed with paired t-tests.
RESULTS
Respiratory self-gating of the radially sampled VIBE led to significantly improved depiction of large (4.4 +/- 0.5 vs 3.9 +/- 0.7,
p<0.05) and small vessels (4.7 +/- 0.5 vs 3.4 +/-0.8, p<0.05) as well as thoracic wall/diaphragm sharpness (4.9 +/- 0.4 vs 3.6 +/0.5, p<0.05), whereas overall image quality was not impaired by the significantly increasing streaking artifacts (3.6 +/- 0.5 vs 4.7
+/- 0.5, p<0.05).Compared to standard BH cartesian VIBE, radially sampled VIBE with self-gating showed improved large and small
vessels (4.4 +/- 0.5 vs 3.3 +/-0.6, p=0.05; 4.7 +/- 0.5 vs 3.3 +/- 0,6, p<0.05), thoracic wall/diaphragm (4.9 +/- 0.4 vs 3.3 +/0.6, p<0.05) and overall image quality (4 +/- 0.6 vs. 3.3 +/- 0.6, p=0.17).
CONCLUSION
Respiratory self-gated radially sampled VIBE acquired during free-breathing is feasible for thoracic and vascular imaging, particularly
of the thoracic wall and large and small vessels compared to radially sampled VIBE without self-gating and breath-hold Cartesian
sampled VIBE.
CLINICAL RELEVANCE/APPLICATION
Respiratory self-gated radially sampled VIBE acquired during free-breathing is feasible for thoracic and vascular imaging, particularly
of the thoracic wall and large and small vessels.
SST02-06
Could Cardiac Magnetic Resonance Imaging be an Effective Alternative to Transthoracic
Echocardiography for Routine Evaluation of the Heart?
Friday, Dec. 4 11:20AM - 11:30AM Location: S501ABC
Participants
Erkan Yilmaz, MD, Izmir, Turkey (Abstract Co-Author) Nothing to Disclose
Uygar Teomete, MD, Miami Beach, FL (Presenter) Nothing to Disclose
Bahri Akdeniz, Izmir, Turkey (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study is designed to investigate the effectiveness of cardiac magnetic resonance imaging (CMR) in routine evaluation of heart
as an alternative method to transthoracic echocardiography.
METHOD AND MATERIALS
The study included 48 randomised patients underwent both echocardiography and CMR. On CMR examination, cine steady-state
free precession (SSFP) sequence was used to calculate ejection fraction (EF), ventricular and atrial measurements and wall
thickness of left ventricle (LV). Velocity and flow information in the aortic, mitral and tricuspid valves were obtained by using
velocity-encoded sequence. CMR and echocardiography outcomes were compared using by paired samples t-, Pearson's correlation,
McNemar's and Kappa statistical tests.
RESULTS
Measurements of LV inner diameter in end-diastole, septal wall and posterior wall thickness in end-systole showed a good
correlation with CMR and echo (r=0,795, r= 0,798, r=0,536). EF estimated with CMR showed perfect correlation with EF estimated
by using echo (r= 0,80, p<0,01). Our results had a good correlation between two methods in terms of diastolic disfunction. When
compared with echocardiography, CMR revealed good (κ=0,660), poor (κ=0,370), moderate (κ=0,504), very good (κ=1,0) and poor
(κ=0,270) correlations for mitral regurgitation, mitral stenosis, aortic regurgitation, aortic stenosis and tricuspid regurgitation,
respectively. Peak E and peak A velocities in the mitral inflow measured by both two methods showed moderate correlation with κ
values of 0,435 and 0,493. A highly good accordance between the two methods in terms of the measurements of peak velocity in
aortic valve (κ=0,778).
CONCLUSION
We found that volume, flow and thickness measurements of the heart on transthoracic echocardiography examination have a
statistically good correlation with CMR measurements. Also, there is a satisfying diagnostic concordance between two modalities in
evaluating the heart.
CLINICAL RELEVANCE/APPLICATION
CMR can be used an alternative method to transthoracic echocardiography, especially for acoustically poor patients.
SST02-07
Improved Ex-vivo Human Cardiac DTI using Optimal b-values on a Clinical 3T MRI System
Friday, Dec. 4 11:30AM - 11:40AM Location: S501ABC
Participants
Jian Cao, MD, Peking, China (Presenter) Nothing to Disclose
Feng Yang, Beijing, China (Abstract Co-Author) Nothing to Disclose
Yining Wang, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Chao Ma, Beijing, China (Abstract Co-Author) Nothing to Disclose
Lingyan Kong, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Lu Lin, MD, Peking, China (Abstract Co-Author) Nothing to Disclose
Yan Yi, Beijing, China (Abstract Co-Author) Nothing to Disclose
Jing An, Beijing, China (Abstract Co-Author) Research collaboration, Siemens AG
Tianjing Zhang, Beijing, China (Abstract Co-Author) Employee, Siemens AG
PURPOSE
This study aims to investigate the effect of b-value of cardiac DTI in revealing myocardial microstructural remodeling on a 3T MRI
system.
METHOD AND MATERIALS
Seven formalin-fixed healthy human heart samples were acquired at room temperature on a Siemens 3.0T MAGNETOM Skyra MR
scanner for fiber structural analysis using a 20-channel head coil with a DW sequence with multi-shot EPI readout. Each heart
sample was suspended in plastic cylinder filled with liquid paraffin to avoid tissue-air susceptibility artifacts during the acquirement.
DTI acquisitions were the following parameters: TE=67 ms, TR=6500 ms, FOV=200× 200 mm, slice thickness= 2.0 mm, number of
slices=40~45, 100× 100 pixels for each slice, diffusion sensitivity b=600/800/1000 s/mm2, accel factor=2, gradient directions=20,
slice gap=0 mm. Total image acquisition time was about 20 min per sample. Data was post-processed by Matlab based programs.
Diffusion tensor indices, such as FA (Fractional Anisotropy), ADC (Apparent Diffusion Coefficient), fiber length and fiber numbers
with each b-value in the left ventricle were calculated and compared.
RESULTS
In Table 1 is shown variations of DTI indices with different b-values. Gradual decrease on FA value and gradual increase on ADC
value are observed when b value rises from 600 to 1000 s/mm2. Variations of fiber numbers and fiber lengths at different b values
are neither regular nor significant.
CONCLUSION
A b value of 600 s/mm2 would be suggested acquire human cardiac diffusion tensor imaging in order to avoid confusion when using
FA values as an absolute reference for assessing the difference between normal and abnormal zones.
CLINICAL RELEVANCE/APPLICATION
An appropriate b-value would benefit DTI to better reveal the myocardium structural of human hearts. Since no significant
differences occurs in fiber numbers and fiber lengths, a b value of 600 s/mm2 would be suggested acquire human cardiac diffusion
tensor imaging in order to avoid confusion when using FA values as an absolute reference for assessing the difference between
normal and abnormal zones.
SST02-08
CT Coronary Angiography: Effect of Iodine CONcentration on Vascular Attenuation: The CT-CON
Multicentric Study FINAL RESULTS
Friday, Dec. 4 11:40AM - 11:50AM Location: S501ABC
Participants
Marco Rengo, MD, Rome, Italy (Presenter) Nothing to Disclose
Anoeshka S. Dharampal, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Damiano Caruso, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Marco Das, MD, Maastricht, Netherlands (Abstract Co-Author) Research Consultant, Bayer AG; Research Grant, Siemens AG;
Speakers Bureau, Siemens AG; Research Grant, Koninklijke Philips NV
Marc C. Kock, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Andre Niezen, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Fiek Van Tilborg, Bron, Netherlands (Abstract Co-Author) Nothing to Disclose
Koen Nieman, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Toshiba
Corporation Research Grant, Bayer AG Research Grant, General Electric Company
Gabriel P. Krestin, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Consultant, General Electric Company; Research Grant,
General Electric Company; Research Grant, Bayer AG; Research Grant, Siemens AG; Speakers Bureau, Siemens AG
PURPOSE
To explore the relative impacts of iodine concentration versus iodine delivery rate on intra-coronary attenuation. To describe the
effect of iodine concentration on contrast bolus characteristics
METHOD AND MATERIALS
971 patients were prospectively randomized in 4 groups and underwent CT Coronary Angiography (CTCA). Four CM with different
iodine concentrations (300, 350, 370, 400 mgI/ml) were delivered at a fix iodine delivery rate (2.0 mgI/s). Intracoronary attenuation
values were measured and grouped on a per-vessel and per-segment bases. Time-to-peak, and pressure curves during CM injection
were evaluated and compared
RESULTS
Injection fluxes were 6.7 ml/sec, 5.7 ml/sec, 5.4 ml/sec and 5 ml/sec for group A, B, C and D respectively. No significant
differences were observed among four groups in terms of intravascular density on a per-segment and per-vessels analysis. Timeto-peak was significantly earlier in group A (15.3 sec) than in the other three groups. The injection peak pressure was significantly
lower in group A (185.16 psi) and C (189.05 psi) than in group B (215.89 psi) and D (243.33 psi). No extravasations were noted in
all groups
CONCLUSION
Contrast media with different iodine concentrations, if injected at the same IDR, provide similar intravascular attenuation values.
The lower concentration contrast medium provided significantly lower injection pressure values and a significantly shorter time to
peak enhancement
CLINICAL RELEVANCE/APPLICATION
Intravascular attenuation in CT coronary angiography is mainly influenced by iodine delivery rate and is independent by iodine
concentration
SST02-09
Study of the CT Anatomical Configuration of the Aortic Valve: An Automatic 3D-Shape-based
Comprehensive Analysis
Friday, Dec. 4 11:50AM - 12:00PM Location: S501ABC
Participants
Julien Ognard, MD, MSc, Brest, France (Presenter) Nothing to Disclose
Thomas Hebert, Brest, France (Abstract Co-Author) Nothing to Disclose
Nan Kang, MSc, Brest, France (Abstract Co-Author) Nothing to Disclose
Martine Gilard, MD,PhD, Brest, France (Abstract Co-Author) Nothing to Disclose
Michel Nonent, MD, Brest, France (Abstract Co-Author) Nothing to Disclose
Valerie Burdin, PhD, Plouzane, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
In Transcatheter aortic valve implantation (TAVI) procedures, the determination of AVA (Aortic Valve Annulus) geometric features
is crucial to deciding the size and type of the prosthesis valve to be used. The purpose of this study is to asses quantitatively the
variation of aortic valve shape along its principle axis in order to find the center and diameter of AVA, and to determine at each
levels the measurement that could be done during preoperative plannings, according to the shape.
METHOD AND MATERIALS
A number of 25 ECG-gated cardiac CT (64 channels multidetector CT scanner) were analysed. 2 Experts radiologists manually
defined the centerline and the limits of the aortic valve. Threshold techniques and growing regions were used to mask the left
ventricle and the aorta. Principle Component Analysis were used to extract an approximate aortic centerline, with an iterative
procedure. Then we cut through data to get slices which are perpendicular to the centerline. Each cross section is then unfolded
into polar coordinates. The function of distance which describes the contour of tri-leaflet has three pairs of extrema (minima and
maxima) and smallest min distance. for each cross section, we find 3 points on the contour of the aorta with minimum distance to
the barycenter and calculate ellipse fitting.
RESULTS
The method is based on a quantitative study of shape to find an optimal fit to mimic AVA in the aortic root. Analyses of such
The method is based on a quantitative study of shape to find an optimal fit to mimic AVA in the aortic root. Analyses of such
models have shown the aortic root to have variable distensibility along its length. Our contribution includes extracting a robust
centerline of aortic valve automatically, analyzing the shape changes of cross section along the centerline by the help of polar
representation, providing a flexible circle and ellipse fitting for aortic valve part with the coordinates for the center and
corresponding change intervals for radius.
CONCLUSION
We introduced measurements for aortic valve by a quantitative study compared with previous qualitative research.
CLINICAL RELEVANCE/APPLICATION
Understanding the 3D shape characteristics of the aortic valve will help radiologist and cardiologist in the preoperative plannings of
TAVIs. And could even assist engineer-physicians to design and manufacture customized valve that works in the optimum condition