Cardiac MRI

Patients’ risk of developing a radiation-induced cancer is actually far lower than reports suggest, ECR delegates concerned about the level of radiation associated with cardiac CT were told in Vienna.

Restrictions on coronary CT angiographypayments respond to self referral, utilization

Cardiac MR codes grant a victory despite continued Medicare ban on blood flow measurement payment

Dual-source or 64-slice CT examination proves quick, noninvasive, and effective in triaging patients with low to moderate risk of heart disease

CMS stirs up hornet’s nest with threat to disallowan option for local Medicare coverage decisions and prohibit cardiac CT angiography for all but trial patients

tudies of chest pain patients with conventional 64-slice and dual-source CT add to a growing base of evidence suggesting that CT is well suited to rule out acute coronary syndrome in the emergency room and to identify coronary artery in-stent restenosis. An initial study of 256-slice CT presented at the RSNA meeting was encouraging, but the specter of high radiation exposure—especially exams covering the entire chest—challenged researchers to find better ways to reduce dose.

The American Society of Echocardiography has issued a new consensus statement for interpreting and responding to results of carotid artery ultrasound. The guidelines set carotid artery wall thickness values greater than the 75th percentile as the threshold for aggressive treatment.

Cardiac CT boosts self-referred utilization, other nonradiology specialists see modest growth

Researchers stress need for better dose reduction strategies as whole-chest exams earn positive reviews

he explosive growth of Medicare outpatient imaging from 2000 to 2005 explains why federal regulators have singled out radiologists for restraints. Medicare payments for outpatient medical imaging jumped 93% during that period, from $6 billion to more than $11 billion.

Studies of chest pain patients with conventional 64-slice and dual-source CT add to a growing base of evidence suggesting that CT is well suited to rule out acute coronary syndrome in the emergency room and to identify coronary artery in-stent restenosis. An initial study of 256-slice CT presented at the RSNA meeting was encouraging, but the specter of high radiation exposure-especially exams covering the entire chest-challenged researchers to find better ways to reduce dose.

Investigators begin recruiting the first of 7300 volunteers this month for a massive clinical trial to determine if a combination of blood tests, body measurements, and imaging exam can outperform the Framingham tests for assessing older adults who carry an intermediate risk of a major cardiovascular event, including myocardial infarction and stroke.

Increasing efforts to screen and diagnose coronary artery disease have used imaging modalities such as catheter angiography, ultrasound, and MRI. Electron-beam CT was, for a long time, the only CT system able to image the coronary arteries without motion artifacts. But multislice CT has advanced rapidly over the last decade, and state-of-the-art 64-slice and dual-source CT now offer high-quality imaging of the coronary arteries, myocardium, and valves, providing morphological and even functional information.

In the October 2006 issue of Diagnostic Imaging, I wrote a brief article describing the benefits of using prospective gating when performing coronary CT angiography.

Hospitalists given focused training for conducting cardiac exams with hand-carried ultrasound systems still could not match echocardiography technicians at acquiring images, though they came closer at measurement and interpretation. Hand-carried ultrasound devices are growing in popularity, but training methods for noncardiologists have not been well defined.

The first description of sarcoidosis dates back to 1869, though the disease was not named until 1899. The first report of cardiac involvement in patients with systemic sarcoidosis came in 1929.

Next month Spectrum Dynamics will begin shipping its long-awaited D-SPECT Cardiac imaging product, featuring solid-state cadmium-zinc-telluride detectors and proprietary image reconstruction techniques that cut the time typically needed to do a SPECT heart scan by 75% or more. The Danville, CA-based company will target high-volume private cardiac labs and hospitals that put a premium on throughput and image quality.

The Cardiac Diagnostic Laboratory at Barnes-Jewish Hospital in St. Louis has stopped using Definity, the echocardiographic contrast agent marketed by Bristol-Myers Squibb, according to an Oct. 11 memo obtained by Diagnostic Imaging.

The U.K. Clinical Advisory Committee on Diagnostic Imaging has found that CT screening of the colon, heart, and lungs is clinically effective and exposes patients to safe levels of radiation.

Questions remain from practitioners, payers, and administrators regarding the economic impact of coronary CT angiography on established diagnostic modalities and the effects on reimbursement within imaging. To address these concerns, we have developed the CCTA Data Registry, which now consists of more than 20,000 cases. Preliminary results indicate that coronary CTA is being utilized appropriately and affects savings for the healthcare system.

The cardiovascular community has witnessed historic changes in the way cardiovascular disease is evaluated. Recently, the greatest growth has been in cardiac CT to noninvasively diagnose coronary (Figure 1) and noncoronary cardiac disease (Figure 2).

Though the latest generation of 64-slice CT scanners often excels, the technology is still not good enough to confidently assess in-stent restenosis, according to Dr. Stephan Achenbach, a professor of medicine at the University of Erlangen in Germany.

Radiation dose from coronary CT angiography can be dramatically reduced by technologies either currently or soon to be on the U.S. market.

Three-D ultrasound designed for cardiac imaging may be just what interventionalists need to improve the administration of nerve blocks, according to researchers at the Mayo Clinic in Jacksonville, FL.

The American College of Cardiology-backed Task Force on Clinical Competence will extend a certification deadline by two years, enabling more physicians to qualify to perform and interpret cardiac CT.

The inaugural CVI Philadelphia dinner symposium on cardiovascular imaging, held in early August, was deemed a success by organizer Dr. Jeffrey Hellinger, director of cardiovascular imaging and the 3D laboratory at Children’s Hospital of Philadelphia.

A study by University of Maryland researchers has found that CT angiography exams performed after coronary artery bypass surgery can help physicians identify unsuspected, clinically relevant cardiac and noncardiac conditions.

The first substantive clinical trials of dual-source CT suggest it will deliver on a promise to improve the detection of coronary artery disease. A Dutch study published in the August 21 issue of the Journal of the American College of Cardiology found it is 95% sensitive and 95% specific on a per-segment basis for diagnosing significant stenoses.

Cardiac CT angiography holds the key to finding diseases outside of the coronary arteries -- if, that is, diagnosticians are willing to look.

One of the promises of dual-source CT coronary angiography is the ability to scan patients without administering beta blockers. It was reported in the March issue of Diagnostic Imaging, however, that some imagers continue to use beta blockers, albeit with an improved workflow because they don't need to check for optimal heart rate. But several studies recently published and presented at conferences attest to the viability of scanning patients without beta blockers in a variety of cardiac situations.