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Cardiac Magnetic Resonance Imaging in the Evaluation of Cardiac Sarcoidosis
Method: Eight patients with lesions of indeterminate significance by catheter angiography underwent IVUS before returning for CT coronary angiography (CTCA) on a Siemens Dual Source 64 MDCT. A total of 21 lesions were assessed, 6 within the LMCA, 11 within the LAD and 4 within the RCA. The CT operator was blinded to both the IVUS images and measurements. Results: The average MLA’s for all vessels on IVUS and CT were 6.29 mm2 and 6.33 mm2 , respectively (R-value 0.9, P 0.001). Average MLAs of the LMCA, LAD and RCA by IVUS and CT were 10.9 versus 10.9 mm2 , 4.7 versus 4.5 mm2 and 5.2 versus 4.6 mm2 respectively. Using conventional cut-off values outlined above, CT correctly diagnosed the presence or absence of a high-grade stenosis in 17 of 21 lesions (80%). Conclusion: CT provides an accurate non-invasive means of assessing lesion severity with the use of MLA measurements. doi:10.1016/j.hlc.2008.05.148 148 This abstract has been withdrawn.
Abstracts
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n < 5. A total of 121 patients (30%) had 0 calcium score (CS) and normal findings, 73 pts had CS > 400 (highest CS = 2805). Of those high risk individuals (n = 85), five (6%) underwent angiography confirming significant CAD. A total of 29 patients (7%) underwent coronary angiography, and 13 (3.1%) had PCI as a result of lesions identified on CT. Further details regarding radiation dose, procedural results, distribution of coronary calcium, lesions, coronary/cardiac anomalies, subsequent correlation with angiographic findings will be presented. The service continues to attract interest from GPs and patients alike. Conclusion: With preparation and cooperation, we were successful in implementing MSCT locally. MSCT will increasingly be an important non-invasive imaging modality for evaluation of asymptomatic CAD, and guide appropriateness of therapy for individuals. doi:10.1016/j.hlc.2008.05.151 151 Cardiac Magnetic Resonance Imaging in the Evaluation of Cardiac Sarcoidosis Vance Manins, Jonathon Habersberger ∗ , Andrew Taylor
doi:10.1016/j.hlc.2008.05.149
Alfred Hospital, Melbourne, Australia
149 This abstract has been withdrawn.
Background: Cardiac involvement in systemic sarcoidosis is common; however current diagnostic tools are imprecise. Recognition of cardiac sarcoidosis (CS) is important as it carries a relatively poor prognosis. Gadolinium-enhanced cardiac magnetic resonance imaging (Gad-CMR) is emerging as an excellent technique in determining the presence of, and extent to which cardiac muscle is affected by sarcoidosis. We report a single centre’s experience to date with this technique, and compare the sensitivity of Gad-CMR in detecting CS to standard assessment by the Japanese Ministry of Health and Welfare guidelines. Methods: We performed a retrospective analysis on patients with systemic sarcoidosis referred to the Alfred Hospital, Melbourne for evaluation of possible cardiac involvement. All patients who underwent Gad-CMR scanning in the course of their evaluation were included in the analysis. Results: Eleven of the twenty patients had Gad-CMR images supportive of the diagnosis of CS. Eight of these eleven patients met the JMHW criteria for the diagnosis of CS; three abnormal Gad-CMR scans consistent with diagnosis of CS were seen in patients who did not met JMHW criteria. No patients with normal Gad-CMR scan met JMHW criteria for CS. Conclusion: Gad-CMR detected changes consistent myocardial sarcoidosis in 11 of 20 patients known to have systemic sarcoidosis. According to the JMHW guidelines, only eight patients fulfilled the criteria for diagnosis of CS. This finding is consistent with published literature that suggests Gad-CMR may be superior to standard JMHW assessment for CS.
doi:10.1016/j.hlc.2008.05.150 150 A Collaborative Cardiology/Radiology Approach to Multi-Slice Cardiac CT Scanning—Report of 1st Year Experience in Set-up, Scanning and Results Gregory Szto 1,∗ , Andrew Watson 2 , Vikki O’Shea 1 , Lou Valerio 2 1 Peninsula Private Hospital, Frankston, Australia; 2 MIA Radiology, Peninsula Private Hospital, Frankston, Australia
Multi-slice cardiac CT (MSCT) is gradually being accepted, with progress hampered by lack of coordinated approach and reimbursement, and high cost of startup. We report our initial 1-year collaborative experience detailing our challenges and successes. Methods: After level II training, a cardiologist and radiologist introduced MSCT with educational talks to GPs and other specialists. Scanning was performed with typical protocol using beta-blockade, breath-hold and a 64-slice scanner. Scan details, results and subsequent cath lab procedures were collected and analysed. Results: From February 2007, 415 patients (282 males, average age 58 years [youngest 25, oldest 88]) underwent CT scanning. Direct GP referral = 16%. Common indications were: Investigate indeterminate chest pains or dyspnoea (n = 139, 33%), equivocal stress ECG (n = 29, 7%), evaluate CP after stent or CABG (n = 63, 15%), evaluate for CAD in high risk individuals (n = 85, 20%). Previous history of stent and CABG were 11.5% and 8.9%, respectively. Unsuccessful scans were 9 (2.2%). Unreadable scans were
doi:10.1016/j.hlc.2008.05.152
ABSTRACTS
Heart, Lung and Circulation 2008;17S:S1–S209
Abstracts
S65
n < 5. A total of 121 patients (30%) had 0 calcium score (CS) and normal findings, 73 pts had CS > 400 (highest CS = 2805). Of those high risk individuals (n = 85), five (6%) underwent angiography confirming significant CAD. A total of 29 patients (7%) underwent coronary angiography, and 13 (3.1%) had PCI as a result of lesions identified on CT. Further details regarding radiation dose, procedural results, distribution of coronary calcium, lesions, coronary/cardiac anomalies, subsequent correlation with angiographic findings will be presented. The service continues to attract interest from GPs and patients alike. Conclusion: With preparation and cooperation, we were successful in implementing MSCT locally. MSCT will increasingly be an important non-invasive imaging modality for evaluation of asymptomatic CAD, and guide appropriateness of therapy for individuals. doi:10.1016/j.hlc.2008.05.151 151 Cardiac Magnetic Resonance Imaging in the Evaluation of Cardiac Sarcoidosis Vance Manins, Jonathon Habersberger ∗ , Andrew Taylor
doi:10.1016/j.hlc.2008.05.149
Alfred Hospital, Melbourne, Australia
149 This abstract has been withdrawn.
Background: Cardiac involvement in systemic sarcoidosis is common; however current diagnostic tools are imprecise. Recognition of cardiac sarcoidosis (CS) is important as it carries a relatively poor prognosis. Gadolinium-enhanced cardiac magnetic resonance imaging (Gad-CMR) is emerging as an excellent technique in determining the presence of, and extent to which cardiac muscle is affected by sarcoidosis. We report a single centre’s experience to date with this technique, and compare the sensitivity of Gad-CMR in detecting CS to standard assessment by the Japanese Ministry of Health and Welfare guidelines. Methods: We performed a retrospective analysis on patients with systemic sarcoidosis referred to the Alfred Hospital, Melbourne for evaluation of possible cardiac involvement. All patients who underwent Gad-CMR scanning in the course of their evaluation were included in the analysis. Results: Eleven of the twenty patients had Gad-CMR images supportive of the diagnosis of CS. Eight of these eleven patients met the JMHW criteria for the diagnosis of CS; three abnormal Gad-CMR scans consistent with diagnosis of CS were seen in patients who did not met JMHW criteria. No patients with normal Gad-CMR scan met JMHW criteria for CS. Conclusion: Gad-CMR detected changes consistent myocardial sarcoidosis in 11 of 20 patients known to have systemic sarcoidosis. According to the JMHW guidelines, only eight patients fulfilled the criteria for diagnosis of CS. This finding is consistent with published literature that suggests Gad-CMR may be superior to standard JMHW assessment for CS.
doi:10.1016/j.hlc.2008.05.150 150 A Collaborative Cardiology/Radiology Approach to Multi-Slice Cardiac CT Scanning—Report of 1st Year Experience in Set-up, Scanning and Results Gregory Szto 1,∗ , Andrew Watson 2 , Vikki O’Shea 1 , Lou Valerio 2 1 Peninsula Private Hospital, Frankston, Australia; 2 MIA Radiology, Peninsula Private Hospital, Frankston, Australia
Multi-slice cardiac CT (MSCT) is gradually being accepted, with progress hampered by lack of coordinated approach and reimbursement, and high cost of startup. We report our initial 1-year collaborative experience detailing our challenges and successes. Methods: After level II training, a cardiologist and radiologist introduced MSCT with educational talks to GPs and other specialists. Scanning was performed with typical protocol using beta-blockade, breath-hold and a 64-slice scanner. Scan details, results and subsequent cath lab procedures were collected and analysed. Results: From February 2007, 415 patients (282 males, average age 58 years [youngest 25, oldest 88]) underwent CT scanning. Direct GP referral = 16%. Common indications were: Investigate indeterminate chest pains or dyspnoea (n = 139, 33%), equivocal stress ECG (n = 29, 7%), evaluate CP after stent or CABG (n = 63, 15%), evaluate for CAD in high risk individuals (n = 85, 20%). Previous history of stent and CABG were 11.5% and 8.9%, respectively. Unsuccessful scans were 9 (2.2%). Unreadable scans were
doi:10.1016/j.hlc.2008.05.152
ABSTRACTS
Heart, Lung and Circulation 2008;17S:S1–S209