Cardiovascular ‘dinner club’ draws multidisciplinary group

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.

The event, which was organized fairly quickly, drew more than 50 participants, forcing servers at the hotel to set up additional tables. Attendees included radiologists, cardiologists, technologists, radiology managers, and IT and 3D lab personnel.

Hellinger, trained as an interventional radiologist, developed the CVI Philadelphia concept from the IR Angio Dinner Club, which now has chapters across the country. He hopes to have monthly meetings, the next tentatively scheduled prior to the RSNA conference so vendors can discuss their new products or upgrades.

Dr. Harold Litt, chief of cardiovascular imaging in radiology at the Hospital of the University of Pennsylvania, gave the major presentation for the evening. He detailed how including CTA in the workup of low to intermediate risk chest pain patients helps save money and time.

A study by Litt and colleagues showed that 96% of 308 patients who had an initial negative CTA did not undergo additional testing. Fewer than 2% of patients had caths, and all were positive. Seventy-five percent of the positive caths led to interventions.

"The interventional cardiologists whom I talked to about this are very excited. When 100% of your caths are positive and 75% lead to interventions, they like that a lot," Litt said.

Dr. Mark Fogel, a cardiologist at CHOP, detailed how cardiac MR can be used to examine the right ventricular outflow tract, the origin of the most common type of ventricular tachycardia occurring in patients with congenital heart disease.

While CT can be used effectively in select cases, MR should be the first-line modality for children with congenital heart disease because it imparts no ionizing radiation, Fogel said. Other advantages of cardiac MR include its wide field-of-view and ability to assess anatomy as well as function, quantify blood flow, and use myocardial tagging to look at wall motion abnormalities.

Plans are afoot to build an MRI suite next to the cath lab in 2008 so physicians can perform interventional cardiac MRI, Fogel said.

Dr. Daniel D. Saket, chief resident at HUP, presented a case study of a 54-year-old man who, while in for a surgical consultation, described several syncopal-like episodes. He had presented several months prior with atrial fibrillation. A transthoracic echocardiogram was normal. CT angiography showed an anomalous right coronary artery arising from the pulmonary artery, which included retrograde flow. Cardiac morphology was otherwise normal.

Another case presented by Dr. Matthew Harris, attending cardiologist at CHOP, involved an incidental cardiac shunt found in a neonatal patient not diagnosed by echocardiography. Traditionally, many children with chronic lung disease develop shunts and need chest x-rays, echocardiography, and diagnostic catheter angiography to examine the lungs and cardiopulmonary structures. Today, these children can be examined with an all-in-one CTA study with a low amount of contrast media and low dose, Harris said.

A Vitrea workstation was used throughout the evening by presenters. (Vital Images and MedRad sponsored the dinner.) Ryan Hennen from Vital Images previewed the soon-to-be-released Vitrea 4.0. This version further simplifies and automates coronary evaluation with CTA, he said. Within 10 seconds of loading the images, the program had identified, segmented, filleted, and labeled all primary coronary arteries in each of 10 phases. It also gives a remodeling index, plaque burden, and characterizes the plaque.

For more information on CVI Philadelphia, contact Dr. Jeffrey Hellinger at hellinger@email.chop.edu.

For more information from the Diagnostic Imaging archives:

MR imaging spots silent but deadly cardiac conditions

Dual-source CT boosts patient flow, diagnostic confidence

Cardiac CTA reveals significant incidental disease beyond the heart

Coronary CT angiography finally finds itself an affordable home