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Cardiac and Vessel Explorer save physicians time

Best Practice
Paetsch, Ingo, M.D. Berlin, German Heart Institute Germany

Cardiac and Vessel Explorer viewing and postprocessing save physicians time

Cardiologist Ingo Paetsch, MD, Director of the CMR imaging department at the German Heart Institute (Berlin, Germany) has been involved in Cardiac MR for more than 10 years. He uses both Achieva 1.5T and 3.0T for cardiac MR. In the past months, he has been one of the first to use the Cardiac Explorer and Vessel Explorer packages.
 Ingo Paetsch, MD
Ingo Paetsch, MD

 

Cardiac Explorer software facilitates rapid viewing of cardiac CMR images. "It's particularly useful in stress CMR imaging when looking for myocardial ischemic reactions in the presence of coronary artery stenoses," Dr Paetsch says. "For both cine imaging and non-cine dynamic functional imaging in stress CMR Cardiac Explorer is extremely helpful. Side-by-side viewing of rest and multiple stress scans for comparative purposes - which is the hallmark of pharmacological stress CMR testing - is easily accomplished."

 

In the Institute's recently developed combined stress CMR protocol using a single stressor agent2,3, multiple cine views are acquired at each step of the protocol. "With just two mouse clicks Cardiac Explorer displays multiple views at different stress levels together with the non-cine dynamic images."

 

"Cardiac Explorer mimics a physician's line of thought," says Dr. Paetsch. "Incoming images are automatically placed in predefined viewports and can be reviewed almost immediately thus avoiding the tedious job of manual sorting. The side-by-side comparison of multiple cine views assists the cardiologist not only to rapidly establish a diagnosis but also helps to continuously monitor wall motion changes during the scan procedure, which is important as early recognition of wall motion abnormalities leads to termination of the test. Cardiac Explorer represents the cardiologist's "best friend" during the stress CMR examination."

 

More time saving is seen in the Cardiac Explorer module for left ventricular functional analysis. Automatic endoand epicardial contour detection routinely enables measurement of LV volumes and mass using the disk summation method (SimpsonĀ“s rule) in each patient in less than 30 seconds.

 

 

Synchronized display of multiple cine short axis views of a dobutamine CMR stress study. From left to right: increasing levels of graded dobutamine dosage. From top to bottom: basal, equatorial and apical short axis orientation. Missing wall thickening of the inferolateral segment in all three short axis views under maximum dobutamine stress can easily be recognized to assist in diagnosis.

Vessel Explorer helps evaluate coronary arteries

Vessel Explorer not only facilitates 3D reconstruction of large thoracic or mid-sized peripheral arteries, but also of the coronary arteries with 2 to 4 mm luminal diameter range. "The benefits of Vessel Explorer are enormous," says Dr. Paetsch. "Interactive and simultaneous display of 3D volume rendering, MIPs and MPRs ensures easier anatomical identification of complex vessel anatomy and speeds up path identification for additional reconstructions highlighting a specific pathology. Several vessel parameters are simultaneously provided (luminal diameter, percentage of stenosis, vessel length, ostial area, etc). A single click on a vessel displays its cross-section view, and curved planar reformats can be obtained with just a few more clicks.

 

In CMR and electrophysiological interventions, Vessel Explorer permits fast review of 3D angiographic datasets before and during interventions.

 

 

Vessel Explorer used for reconstruction of a 3D whole-heart coronary MR angiography. Targeted reconstruction of the right coronary artery (RCA) is exemplified using maximum intensity projection, multiplanar curved reformatting and corresponding cross-sectional view of RCA lumen.

      
    

 

Vessel Explorer is used for reconstruction of a 3D left atrial and pulmonary venous MR angiogram. Assessment of ostial area and luminal diameter of pulmonary veins assists electrophysiological procedure planning (top). Simultaneous display of surface rendering improves anatomical orientation and can directly be used for ostial area and luminal diameter measurements (bottom).
 

Packages speed processing, reporting and enhance reproducibility

"Cardiac Explorer and Vessel Explorer increase our reproducibility and make results less user-dependent," Dr. Paetsch says. "Especially with ExamCards, you need to 'teach' Cardiac Explorer only once to sort and display images. Despite the increased speed and ease of use, both flexibility and customizability are very well preserved in these two packages."

 

"More than 20 CMR studies are conducted every day at the Institute, and our policy is to finish the report immediately after the examination with the patient taking it directly back to the referring physician. A CMR study delivers a huge amount of images for every patient, consisting of multiple cine views as well as dynamic images and scar images," explains Dr. Paetsch. "We are extremely happy with Cardiac Explorer to free our mind of tedious image sorting and other manual processing before actually reviewing the case - which is a physician's true task."

References

1 R Gebker, C Jahnke, R Manka, A Hamdan, B Schnackenburg, E Fleck, I Paetsch

Additional Value of Myocardial Perfusion Imaging During Dobutamine Stress Magnetic Resonance for the Assessment of Coronary Artery Disease.

Circ Cardiovasc Imaging 2008; 1:122-130.

 

2 I Paetsch, C Jahnke, A Wahl, R Gebker, M Neuss, E Fleck, E Nagel

Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion.

Circulation 2004; 110:835-842.

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Best Practice
Achieva 1.5T, Achieva 3.0T
Release 2.5, Release 2.6
Nova, Nova Dual, Pulsar, Quasar, Quasar Dual
Aorta, Cardiac, Cardiac Morphology, cmr, Coronary arteries, Function Cine, Function Non-Cine, mra, stress study
 

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