Report from SCCT: Cardiovascular imagers should look toward personalized care

The future of cardiovascular imaging will hinge more on personalized medicine than on technological developments, according to Dr. J. Jeffrey Carr, who spoke Friday at the 2007 Society of Cardiovascular Computed Tomography meeting in Washington, DC.Multislice CT technology will undeniably continue to evolve into better equipment for cardiovascular imaging, said Carr, a professor of radiologic sciences and public health sciences at Wake Forest University School of Medicine in Winston-Salem, NC. The next generation of scanners, featuring dual-source imaging capabilities or 256-channel detector arrays, will allow enhanced temporal and spatial resolution of the coronary arteries and lower radiation doses. Winds of change are blowing, however. The four manufacturers responsible for engineering recent multislice CT technologies shared a common research and development vision until the advent of 64-slice scanners. They now seem to be diverging into different application development pathways, and cardiovascular imagers who rely on CT should rethink where they want to take their subspecialty, Carr said."I believe the future will not be based on technology. It will be about helping people," he said.The SCCT could take advantage of CT improvements to develop evidence-based clinical applications and first-rate metrics for the performance and interpretation of exams. Society members should use advanced techniques to integrate imaging with the evolving trend of personalized medicine fostered by human genomics, Carr said.

He listed a number of established and investigational cardiac imaging applications that may help move practice in that direction:

• evaluation of calcified plaque for risk assessment and prevention of cardiovascular disease
• characterization of vessel and plaque morphology for the assessment of preclinical and clinical coronary artery disease
• use of coronary CT angiography for diagnostic and preoperative evaluation in selected patients
• use of 4D models to help guide minimally invasive surgeries and targeted therapies
• vessel and myocardial tissue characterization using structural and functional information
• genomics to interact with imaging phenotypes

CT is already a viable clinical tool that provides high-quality data from the myocardium, coronary arteries, valves, and surrounding structures in the thorax, according to Carr. Physicians therefore should not question the technology as much as their ability to use the data and information content it can provide compared with other cardiac imaging modalities. CT is so dense with information that the skill set of the interpreting physician needs to be incredibly high, he said.

"You can't be a cardiac imager now and just be a plumber. You will have to integrate everything from inflammation to vessel wall morphology with function of the heart. Until now, we've only had individual tests that gave you pieces of the puzzle. Cardiac CT will give you a near-complete picture. But you have to recognize that picture."