Journal of Cardiovascular Magnetic Resonance最新文献

{"title":"ΔR1_blood, a surrogate of blood-pool gadolinium concentration, is related to BMI, gender, LVEDVi, cardiac index and field strength at cardiac magnetic resonance late enhancement imaging.","authors":"Patrick Doeblin, Shing Ching, Wensu Chen, Natalia Solowjowa, Stefanie Maria Werhahn, Rebecca Elisabeth Beyer, Misael Estepa, Christian Stehning, Jeffrey Ji-Peng Li, Henryk Dreger, Sebastian Kelle","doi":"10.1016/j.jocmr.2025.101929","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101929","url":null,"abstract":"<p><strong>Background: </strong>Late Gadolinium Enhancement (LGE) imaging is the cornerstone of tissue characterization via cardiac magnetic resonance imaging. The contrast-enhancing effect of gadolinium is caused by a linear increase of tissue longitudinal R1 relaxation rates (R1=1/T1). The change in R1 of blood pre- and post-contrast (ΔR1_blood) is therefore a surrogate for the blood-pool gadolinium concentration, which in turn correlates linearly to the tissue gadolinium concentration. The total volume of distribution for gadolinium is the extracellular volume of the body, which differs with body composition, potentially leading to variations in blood-pool and tissue gadolinium concentrations.</p><p><strong>Methods: </strong>This study is a hypothesis-generating secondary analysis of a dataset of 1098 patients who underwent contrast CMR between August 2014 and November 2020 at a tertiary center. ΔR1_blood was calculated from T1 relaxation time maps acquired before and approx. 15minutes after application of 0.15mmol/kg gadobutrol. Explorative data analysis and multiple linear regression was performed to assess the influence of body mass index (BMI), gender, age, cardiac index (CI), Hematocrit (HCT) and left ventricular end-diastolic volume index (LVEDVi) on ΔR1_blood.</p><p><strong>Results: </strong>In bivariate analysis, ΔR1_blood showed moderate correlation to BMI and weak correlation to LVEDVi, Hct and CI. The correlation to BMI was higher in women (r=0.52 at 1.5T and r=0.47 at 3T) than in men (r=0.27 at 1.5T and r=0.37 at 3T). Multiple linear regression showed independent predictive value of BMI, BMI:gender, gender, cardiac index (CI), field strength (FS) and LVEDVi (R² =.268, P<.001), with BMI remaining the strongest individual predictor (b = 0.032 [0.025; 0.040], η² = 0.13, P<.001).</p><p><strong>Conclusion: </strong>ΔR1_blood, a measurement of gadolinium contrast enhancement in the blood-pool and a surrogate of plasma C_Gd at the time of late enhancement imaging, showed moderate association with BMI, FS and gender and weak association with LVEDVi and CI. Further research is necessary to assess the need for individualized gadolinium dosing.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101929"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operational Costs of 4D Flow MRI: A Break-Even Analysis.","authors":"Joshua Engel, Tyler A Jacobson, Michael Markl, Bradley D Allen, Maria Ibanez","doi":"10.1016/j.jocmr.2025.101928","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101928","url":null,"abstract":"<p><strong>Introduction: </strong>Aortic hemodynamics derived from 4D flow MRI (4DF) have shown many advantages for risk stratification and treatment planning. However, clinical adoption has been limited to academic medical centers due to high costs, long scan and post-processing times, and low reimbursement. We quantify these barriers to identify break-even points and assess methods of improving clinical adoption.</p><p><strong>Methods: </strong>We modeled the costs, resource utilization, and reimbursement under case scenarios of base scans of cardiac MRI, MR angiography, adult congenital, and 4DF add-on to the MRI protocol. Price estimates were generated from market research by the purchasing department at a large academic medical center. Time estimates were derived from workflow efficiency studies at the same center. Reimbursement rates were from CMS for 2024b. The opportunity cost of 4DF was calculated as the margin from utilizing incremental scanner time for a mixture of alternate studies. Break-even points were modeled as the number of scans needed for the yearly margin of performing 4DF to exceed performing the base scans alone. Sensitivity analyses were performed for ranges of CPT 75565 reimbursement, 4DF exam time, and 4DF annual software cost.</p><p><strong>Results: </strong>The incremental variable cost per 4DF scan was $101.40 at a 4DF scan time of 15minutes, after accounting for the opportunity cost of scanner utilization. Break-even points were calculated across reimbursement ranging from $40-65/unit of CPT 75565, annual software costs of $10,000-70,000, and 4DF scan times of 5-20minutes. At a scan time of 15minutes and reimbursement of $47.87/unit of CPT 75565, break-even points ranged from 112 to 778 scans as software cost increased from $10,000 to $70,000. Highly accelerated 4DF with a 5-minute scan time instead of standard 15-minute techniques would break even with about half of the scans, with break-even points ranging from 64 to 444 as software costs increased from $10,000 to $70,000.</p><p><strong>Discussion: </strong>Long scan times and high resource utilization limit the financial viability of 4DF outside of high-volume academic medical centers. Further development of accelerated 4D flow imaging techniques and expanded reimbursement criteria are needed to enable wider clinical adoption.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101928"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Pilot Tone-Triggered and ECG-Triggered Cardiac MRI: A Prospective Clinical Feasibility Study.","authors":"Xianling Qian, Yali Wu, Peter Speier, Caixia Fu, Yunzhu Wu, Lude Cheng, Yinyin Chen, Shiyu Wang, Caizhong Chen, Kai Liu, Ling Chen, Hang Jin, Mengsu Zeng","doi":"10.1016/j.jocmr.2025.101925","DOIUrl":"10.1016/j.jocmr.2025.101925","url":null,"abstract":"<p><strong>Background: </strong>ECG-triggered cardiac MRI can be challenging in patients with ECG unreliability. Pilot Tone (PT)-triggered MRI may offer a reliable alternative.</p><p><strong>Purpose: </strong>To evaluate the feasibility of PT-triggered cardiac MRI and compare its performance with ECG-triggered imaging across various sequences in patients with common cardiovascular diseases.</p><p><strong>Materials and methods: </strong>This prospective study included 50 participants (26 males, 24 females; mean age 46.0 ± 19.0 years), including 15 with normal cardiac MRI findings and 35 with various cardiovascular diseases. All participant underwent both PT-triggered and ECG-triggered cardiac MRI scans on a 3-T MRI system. Imaging included T2-weighted imaging (T2WI), MOLLI T1-mapping, T2-mapping, cine, late gadolinium enhancement (LGE), and post-contrast T1-mapping sequences. Image quality and quantitative measurements were evaluated, including T2WI signal intensity, native T1-mapping, T2mapping, and extracellular volume (ECV) values, and comparative signal-to-noise ratio (compSNR) and comparative contrast-to-noise ratio (compCNR) of cine and LGE images, left/right ventricular function. Inter-reader agreement was evaluated using the intraclass correlation coefficient (ICC). Comparisons between the two methods were performed using paired t-test or the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>No significant differences were observed in scanning times (p =.253-.864) or image quality (ICC:.589-1.000, p =.057-1.000) between PT- and ECG-triggered scans and images. Quantitative assessments showed good to excellent consistency (ICC =.843-.987). While PT-triggered LGE images showed higher compCNR (14.14 ± 7.68 vs. 13.24 ± 7.52, p =.016), other quantitative parameters showed no significant differences between PT- and ECG-triggered images. Six participants with hypertrophic cardiomyopathy or heart valve disease experienced false R-wave triggering during ECG gating, leading to motion artifacts, which were not visible in PT-triggered images.</p><p><strong>Conclusion: </strong>PT-triggered cardiac MRI provides comparable image quality and quantitative assessments to ECG-triggered sequences and may offer advantages in minimizing motion artifacts, particularly in patients with conditions affecting ECG reliability, making it a promising alternative for cardiac MRI synchronization.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101925"},"PeriodicalIF":4.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal values of high-resolution transmural perfusion distribution metrics for automated quantitative pixel-wise myocardial perfusion CMR.","authors":"Christel H Kamani, Louise Brown, Thomas Anderton, Raluca Tomoaia, Chin Soo, Gaurav S Gulsin, David A Broadbent, Jian L Yeo, Alice L Wood, Christopher E D Saunderson, Ioannis Botis, Arka Das, Nicholas Jex, Amrit Chowdhary, Sharmaine Thirunavukarasu, Noor Sharrack, Peter P Swoboda, Hui Xue, John P Greenwood, David Adlam, Eylem Levelt, Gerry P McCann, Peter Kellman, Sven Plein","doi":"10.1016/j.jocmr.2025.101927","DOIUrl":"10.1016/j.jocmr.2025.101927","url":null,"abstract":"<p><strong>Background: </strong>The myocardial blood flow (MBF) transmural distribution between the subendocardial (ENDO) and subepicardial (EPI) layers under resting and hyperaemic conditions can aid in the diagnosis of several forms of heart disease. Recently proposed automated in-line myocardial perfusion cardiovascular magnetic resonance (CMR) allows pixel-wise quantification of ENDO- and EPI-MBF, but normal values for these parameters are lacking.</p><p><strong>Objectives: </strong>To establish normal values for transmural distribution of MBF in a healthy population.</p><p><strong>Methods: </strong>138 healthy participants from two centres underwent adenosine stress and rest myocardial perfusion CMR. Global and myocardial slice-specific stress/rest ENDO- and EPI-MBF values were derived using pixel-wise in-line automatic post-processing, and transmural perfusion metrics [ENDO and EPI myocardial perfusion reserve (MPR_ENDO, MPR_EPI); stress and rest ENDO-to-EPI gradient (sGRAD and rGRAD)] were computed using the Gadgetron software.</p><p><strong>Results: </strong>The study cohort comprised 84 males and 54 females (mean age: 50 ± 36) with no cardiovascular disease or risk factors. In the entire cohort, MPR_ENDO (3.3 ± 1.2) was significantly lower (p<0.001) than MPR_EPI (3.9 ± 1.2). sGRAD (0.98 ± 0.09) was significantly lower (p<0.001) than rGRAD (1.11 ± 0.07). \"While there were no sex-specific differences in the majority of these metrics, all correlated inversely with increasing age. We propose specific values for each slice. These are conditional to the pulse sequence, acquisition timing and analysis method used in this work, as mean ± SD values at the basal, mid and apical level for MPR_ENDO (3.7 ± 1.1, 3.3 ± 0.9, 3.6 ± 1.0), MPR_EPI (4.0 ± 1.1, 3.9 ± 1.1, 4.0 ± 1.1), sGRAD (1.00 ± 0.13, 0.92 ± 0.09, 1.06 ± 0.18) and rGRAD (1.10 ± 0.09, 1.09 ± 0.07, 1.18 ± 0.11).</p><p><strong>Conclusions: </strong>Normal global and myocardial slice-specific values of MPR_ENDO, MPR_EPI, sGRAD and rGRAD using in-line automated MBF quantification from first pass myocardial perfusion CMR are presented. While there were no sex-specific differences in any of these metrics, all correlated inversely with increasing age. Understanding the MBF dynamics of the myocardial layers in healthy subjects will help to characterize MBF alterations in patients with coronary artery disease or microvascular dysfunction.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101927"},"PeriodicalIF":4.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-efficient simultaneous fat and water cardiac cine imaging using spiral MRI.","authors":"Tzu Cheng Chao, Dinghui Wang, James G Pipe, Tim Leiner","doi":"10.1016/j.jocmr.2025.101926","DOIUrl":"10.1016/j.jocmr.2025.101926","url":null,"abstract":"<p><strong>Background: </strong>Cardiac cine imaging is routinely used in patient with suspected or known cardiac dysfunction. Water and fat (W/F) separated cardiovascular magnetic resonance (CMR) will be helpful to distinguish adipose tissue, blood and myocardium. Inclusion of a multi-echo acquisition in the conventional balanced steady-state free precession (bSSFP) cine sequence can introduce artifacts and reduce temporal resolution. Spiral MRI is known for its signal-to-noise ratio (SNR) efficiency and has the potential to improve temporal efficiency for W/F separated cine imaging. The present work implements a spoiled gradient echo sequence (SPGR) with spiral trajectory to obtain W/F separated cine images simultaneously.</p><p><strong>Methods: </strong>Three different sequences were performed for comparison, a Cartesian 2-TE bSSFP sequence, a Cartesian 3-TE bSSFP sequence, and the proposed spiral SPGR sequence. Five volunteers were recruited for the scans on a 1.5T scanner with spatial resolution 1.7×1.7×8.0mm³ over a 400×400mm² FOV. In addition to qualitative comparisons, a quantitative measurement is performed in terms of the contrast to noise ratio (CNR).</p><p><strong>Results: </strong>The proposed method to obtain W/F separated cine images provides better temporal efficiency and fewer artifacts compared to conventional Cartesian bSSFP sequences. The 2-TE bSSFP features the highest artifact level including susceptibility artifacts and fat/water swaps. The proposed method reduces scan time by approximately 50% with similar spatial and temporal resolution with lower specific absorption rate (SAR). The contrast between the blood pool and myocardium is higher when using the spiral readout (p≤0.05). The results suggest that the presented sequence has potential to facilitate simultaneous imaging for water and fat components in a cine scan while shortening exam time and lowering SAR.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101926"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Segmentation of Thoracic Aortic Lumen and Vessel Wall on 3D Bright- and Black-Blood MRI using nnU-Net.","authors":"Matteo Cesario, Simon J Littlewood, James Nadel, Thomas J Fletcher, Anastasia Fotaki, Carlos Castillo-Passi, Reza Hajhosseiny, Jim Pouliopoulos, Andrew Jabbour, Ruperto Olivero, Jose Rodríguez-Palomares, M Eline Kooi, Claudia Prieto, René M Botnar","doi":"10.1016/j.jocmr.2025.101923","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101923","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance angiography (MRA) is an important tool for aortic assessment in several cardiovascular diseases. Assessment of MRA images relies on manual segmentation; a time-intensive process that is subject to operator variability. We aimed to optimize and validate two deep-learning models for automatic segmentation of the aortic lumen and vessel wall in high-resolution ECG-triggered free-breathing respiratory motion-corrected 3D bright- and black-blood MRA images.</p><p><strong>Methods: </strong>Manual segmentation, serving as the ground truth, was performed on 25 bright-blood and 15 black-blood 3D MRA image sets acquired with the iT2PrepIR-BOOST sequence (1.5T) in thoracic aortopathy patients. The training was performed with nnU-Net for bright-blood (lumen) and black-blood image sets (lumen and vessel wall). Training consisted of a 70:20:10% training: validation: testing split. Inference was run on datasets (single vendor) from different centres (UK, Spain, and Australia), sequences (iT2PrepIR-BOOST, T2 prepared CMRA, and TWIST MRA), acquired resolutions (from 0.9 mm³ to 3 mm³), and field strengths (0.55T, 1.5T, and 3T). Predictive measurements comprised Dice Similarity Coefficient (DSC), and Intersection over Union (IoU). Postprocessing (3D slicer) included centreline extraction, diameter measurement, and curved planar reformatting (CPR).</p><p><strong>Results: </strong>The optimal configuration was the 3D U-Net. Bright blood segmentation at 1.5T on iT2PrepIR-BOOST datasets (1.3 and 1.8 mm³) and 3D CMRA datasets (0.9 mm³) resulted in DSC ≥ 0.96 and IoU ≥ 0.92. For bright-blood segmentation on 3D CMRA at 0.55T, the nnUNet achieved DSC and IoU scores of 0.93 and 0.88 at 1.5 mm³, and 0.68 and 0.52 at 3.0 mm³, respectively. DSC and IoU scores of 0.89 and 0.82 were obtained for CMRA image sets (1 mm³) at 1.5T (Barcelona dataset). DSC and IoU score of the BRnnUNet model were 0.90 and 0.82 respectively for the contrast-enhanced dataset (TWIST MRA). Lumen segmentation on black blood 1.5T iT2PrepIR-BOOST image sets achieved DSC ≥ 0.95 and IoU ≥ 0.90, and vessel wall segmentation resulted in DSC ≥ 0.80 and IoU ≥ 0.67. Automated centreline tracking, diameter measurement and CPR were successfully implemented in all subjects.</p><p><strong>Conclusion: </strong>Automated aortic lumen and wall segmentation on 3D bright- and black-blood image sets demonstrated excellent agreement with ground truth. This technique demonstrates a fast and comprehensive assessment of aortic morphology with great potential for future clinical application in various cardiovascular diseases.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101923"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highly Efficient, Free-Breathing Whole-Chest Equilibrium Phase bT1RESS MR Angiography: Initial Clinical Experience.","authors":"Robert R Edelman, Amit Pursnani, Kevin Lee, Hang Chen, Reza Nezafat, Tess Wallace, Nondas Leloudas, Derek Clarke, Ioannis Koktzoglou","doi":"10.1016/j.jocmr.2025.101922","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101922","url":null,"abstract":"<p><strong>Background: </strong>A fundamental limitation of both CTA and contrast-enhanced MRA (CEMRA) is that angiographic image quality greatly deteriorates when scans are obtained after the first pass, so that the useful post-contrast scan window is limited to a few tens of seconds. To overcome this limitation, we recently described a breath-hold, slab-selective technique called equilibrium phase balanced T1 relaxation-enhanced steady-state (bT1RESS) that permits diagnostic CEMRA to be obtained for tens of minutes after contrast agent infusion. Further improving upon this technique, we implemented a highly efficient free-breathing version for very rapid whole-chest imaging and tested it in a series of patients.</p><p><strong>Main body: </strong>This study was IRB approved. 34 patients with cardiovascular indications were imaged using a standard CMR protocol plus a post-contrast prototype navigator-gated, whole-chest bT1RESS sequence using either 2×2 or 3×2 (slice x phase) GRAPPA acceleration.</p><p><strong>Results: </strong>Median scan time for 20 patients using 3×2 acceleration was 1.25minutes vs. 2.21minutes for 14 patients using 2×2 acceleration. Mean blood pool-to-muscle signal intensity ratio for bT1RESS obtained >20minutes post-contrast was 88% of the value for scans obtained <5minutes post-contrast. Inline reconstruction time for a complete 128-slice data set was <15seconds. Good-to-excellent image quality and visualization of the aorta, pulmonary arteries and veins, coronary origins, coronary sinus, left atrial appendage, atria and ventricles were obtained in all cases with 3×2 acceleration and all but one case with 2×2 acceleration. There was also excellent correlation (0.92/0.93, p<0.001) between left/right end-diastolic ventricular volumes obtained from short axis cine stacks vs. bT1RESS, and good-to-excellent correlation (0.84/0.64), p<0.001) for left/right end-diastolic atrial volumes.</p><p><strong>Discussion and conclusion: </strong>Free-breathing, whole-chest bT1RESS shows promise as a highly efficient and useful method for cardiovascular imaging. Diagnostic quality scans can be acquired regardless of post-contrast scan delay. Given the very short scan and reconstruction times, navigator-gated bT1RESS can be easily incorporated into any CMR protocol to allow volumetric evaluation of the thoracic vasculature and heart. With further development, the technique could also prove useful for rapid 3D functional evaluation of the heart.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101922"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis of Exercise Cardiac Magnetic Resonance Imaging in Suspected Dilated Cardiomyopathy - A Single-Center Experience.","authors":"Sameera Senanayake, Sheryl Wei Xuan Lieo, Aisyah Binte Latib, Sanjeewa Kularatna, Nicholas Graves, Michelle Swee Leng Kui, Declan P O'Regan, Mark Yan Yee Chan, Derek John Hausenloy, Calvin Woon Loong Chin, Thu-Thao Le","doi":"10.1016/j.jocmr.2025.101924","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101924","url":null,"abstract":"<p><strong>Background: </strong>Exercise cardiovascular magnetic resonance (ExCMR) imaging using supine in-scanner ergometer has shown promise in differentiating pathological dilated cardiomyopathy (DCM) from physiological exercise-induced cardiac remodeling. Since 2020, the National Heart Centre Singapore (NHCS) has incorporated ExCMR into its clinical workflow for patients with suspected DCM. This study aims to compare the costs associated with ExCMR versus conventional CMR in the evaluation of DCM.</p><p><strong>Method: </strong>A retrospective analysis was conducted on patients referred for conventional CMR between 2016 and 2019, and those referred for ExCMR from 2020 to 2023. Both imaging modalities followed standardized protocols, with ExCMR incorporating additional assessments during peak exercise. Costs were recorded in Singapore dollars (SGD) prior to the application of healthcare subsidies.</p><p><strong>Results: </strong>The total cost for conventional CMR was SGD 1,831.36, while ExCMR was associated with a higher initial cost of SGD 2,336.48. However, ExCMR resulted in significantly fewer abnormal imaging findings and a reduced need for follow-up investigations (6.5% vs. 56.8%, p<0.001). A decision tree analysis and probabilistic sensitivity analysis (PSA) revealed that diagnosing 1,000 suspected DCM patients with ExCMR could result in a cost savings of approximately SGD 182,323 compared to conventional CMR, with a 64% probability of being cost-effective.</p><p><strong>Conclusion: </strong>These findings indicate that ExCMR offers a physiologically informative approach for diagnosing DCM, with the potential to reduce over-diagnosis of cardiac dilatation in active, healthy adults. Although further research is necessary to assess long-term outcomes, ExCMR appears to be a cost-effective imaging modality for DCM diagnosis, warranting reconsideration of its perceived higher cost.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101924"},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Geographic Accessibility to Cardiac Magnetic Resonance (CMR) Readers Across the United States: An Analysis of Medicare Part B Data.","authors":"Ahmad El Yaman, Ahmed Sayed, Maria Alwan, Asim Shaikh, Mahmoud Al Rifai, Maan Malahfji, Dipan J Shah, Ibrahim M Saeed, Chiara Bucciarelli-Ducci, Mouaz H Al-Mallah","doi":"10.1016/j.jocmr.2025.101921","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101921","url":null,"abstract":"<p><strong>Background: </strong>Cardiac Magnetic Resonance (CMR) has a growing role in the diagnosis and management of cardiac disease. However, there is little recent data on the availability of CMR physicians (readers) in the US.</p><p><strong>Objective: </strong>To demonstrate the geographic proximity and accessibility of patients to CMR services and CMR physicians across the US.</p><p><strong>Methods: </strong>Using Medicare Part B data in 2022, we analyzed the number and characteristics of CMR readers, their geographical location, and the volume of CMR scans between 2013 and 2022. CMR procedure types were identified using HCSPC codes 75557, 75559, 75561, and 75563.</p><p><strong>Results: </strong>Among Medicare Beneficiaries in 2022, there were 48,622 CMR scans, up from 17,944 in 2013 (170.9% increase). The lowest scans and reader density were in West Virginia (125.8 procedures and 2.2 readers per million beneficiaries respectively) and the highest in the District of Columbia (4,566.5 procedures and 52.9 readers per million beneficiaries respectively). No CMR scans were billed in Puerto Rico. Among states and territories that billed for CMR, 50.8 million US citizens were located more than 50 miles from CMR readers and 18.1 million were located more than 100 miles away. Out of 991 readers, 51.9% were radiologists and 48.1% were cardiologists. The median number of scans interpreted by cardiologists was higher than radiologists across all graduation year intervals, and male and female readers interpreted a similar median number of scans. The relative proportion of female readers increased markedly when assessing physicians who graduated after 2010.</p><p><strong>Conclusion: </strong>This study highlights significant geographic disparities and barriers to accessing CMR in the US.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101921"},"PeriodicalIF":4.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MEAsUREMENT of myocardial blood flow in atrial fibrillation USING high-resolution, free-breathing IN-LINE quantitative cardiovascular magnetic resonance.","authors":"Richard J Crawley, Karl-Philipp Kunze, Anmol Kaushal Mbbs, Xenios Milidonis, Jack Highton, Blanca Domenech-Ximenos, Irum D Kotadia, Çan Karamanli, Nathan C K Wong, Robbie Murphy Mbbs, Ebraham Alskaf, Radhouene Neji, Mark O'Neill, Steven E Williams, Cian M Scannell, Sven Plein, Amedeo Chiribiri","doi":"10.1016/j.jocmr.2025.101917","DOIUrl":"https://doi.org/10.1016/j.jocmr.2025.101917","url":null,"abstract":"<p><strong>Background: </strong>Stress perfusion cardiovascular magnetic resonance (CMR) in the presence of atrial fibrillation (AF) has long been challenging due to electrocardiogram (ECG) mis-triggering. However, non-invasive ischaemia imaging is important due to an increased risk of myocardial infarction in patients with AF, which has been attributed to underlying microvascular dysfunction. Myocardial blood flow (MBF) in patients with AF is poorly understood, and few studies have attempted to quantify this through non-invasive imaging.</p><p><strong>Objectives: </strong>This study used high-resolution free-breathing fully-automated quantitative perfusion CMR to assess the feasibility in patients with AF and investigate whether MBF differed compared to those in sinus rhythm.</p><p><strong>Methods: </strong>Patients were recruited for stress perfusion CMR using a research sequence at 3-Tesla. Image acquisition occurred during both vasodilator-induced hyperaemia and at rest. Stress and rest MBF maps were automatically generated. Analysis of perfusion maps included assessment of myocardial perfusion reserve (MPR) and endocardial-to-epicardial MBF ratios.</p><p><strong>Results: </strong>442 patients were analysed; 63 of whom had a history of AF and were in AF during the scan. Both MBF during hyperaemia (stress MBF) and MPR were reduced in patients with AF compared to those in sinus rhythm (median stress MBF 1.85 [1.52-2.243] vs. 2.35 [1.98-2.77] ml/min/g, p<0.001; median MPR 1.95 [1.62-2.19] vs. 2.37 [2.05-2.80], p<0.001). No significant difference was seen between the two groups at rest (p=0.451). When considering co-factors affecting MBF, multivariate linear regression analysis identified the presence of AF as a significant independent contributor to stress MBF and MPR values. Both endocardial and epicardial stress MBF and MPR were reduced in AF compared with sinus rhythm (both p<0.001) and endocardial/epicardial ratios were similar between the groups.</p><p><strong>Conclusion: </strong>Automated quantitative MBF assessment can be performed in patients with AF. At hyperaemia, MBF is reduced in AF compared to sinus rhythm.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101917"},"PeriodicalIF":4.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}