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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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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, ([email protected] ) (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, ([email protected]) (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, ([email protected]) (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, ([email protected]) (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