[Experience with cardiac magnetic resonance imaging in patient management at the Markusovszky Hospital, Vas County, Hungary]. / A szív mágneses rezonanciás vizsgálata a Markusovszky Kórház, Kardiológiai Osztály betegellátásában.

INTRODUCTION: At the Markusovszky Hospital, Vas County, Hungary, cardiac magnetic resonance imaging has been routinely used since July, 2009. In the majority of cases this method has been applied for the assessment of myocardial viability in patients with chronic ischemic heart disease and, in a smaller number of cases, for the evaluation of patients with myocarditis, cardiomyopathy and syncope with uncertain etiology in young athletes. AIMS: The aim of the study was to analyze the clinical value of cardiac magnetic resonance imaging in assessing the viability of affected myocardial regions due to chronic occlusion of major coronary arteries. METHODS: Delayed-enhancement cardiac magnetic resonance examination was performed in 88 patients who had 103 myocardial regions affected with chronic occlusion of the coronary arteries. The number of affected myocardial regions which proved to be treatable with coronary artery intervention and the number of regions where revascularization strategy was based on cardiac magnetic resonance imaging findings were analyzed. RESULTS: Based on findings from cardiac magnetic resonance imaging, revascularization strategy was set up in 88 myocardial regions corresponding to 83.5% of all affected myocardial regions included in this study. CONCLUSIONS: Delayed-enhancement cardiac magnetic resonance imaging appears to be a powerful tool to choose the optimal reperfusion strategy in patients with chronic coronary occlusion. Although this diagnostic method is relatively expensive, its accuracy regarding the features of myocardial viability such as transmural extension of the lesion within the affected region is higher than that of other methods (e.g. myocardium scintigraphy or stress echocardiography).

Evolution of coronary computed tomography radiation dose reduction at a tertiary referral center.

PURPOSE: We aimed to assess the temporal change in radiation doses from coronary computed tomography angiography (CCTA) during a 6-year period. High CCTA radiation doses have been reduced by multiple technologies that, if used appropriately, can decrease exposures significantly. METHODS: A total of 1277 examinations performed from 2005 to 2010 were included. Univariate and multivariable regression analysis of patient- and scan-related variables was performed with estimated radiation dose as the main outcome measure. RESULTS: Median doses decreased by 74.8% (P<.001), from 13.1 millisieverts (mSv) (interquartile range 9.3-14.7) in period 1 to 3.3 mSv (1.8-6.7) in period 4. Factors associated with greatest dose reductions (P<.001) were all most frequently applied in period 4: axial-sequential acquisition (univariate: -8.0 mSv [-9.7 to -7.9]), high-pitch helical acquisition (univariate: -8.8 mSv [-9.3 to -7.9]), reduced tube voltage (100 vs 120 kV) (univariate: -6.4 mSv [-7.4 to -5.4]), and use of automatic exposure control (univariate: -5.3 mSv [-6.2 to -4.4]). CONCLUSIONS: CCTA radiation doses were reduced 74.8% through increasing use of dose-saving measures and evolving scanner technology.

Direct chest area measurement: A potential anthropometric replacement for BMI to inform cardiac CT dose parameters?

BACKGROUND: Significant dose reductions for coronary CT angiography (CTA) can be achieved with reduced tube potential (kV); however, the potential effect on image quality is unknown. OBJECTIVE: We sought to evaluate anthropometric measures (chest area, chest circumference, and chest attenuation) as potentially better predictors of the appropriate tube potential versus body mass index (BMI). METHODS: Consecutive patients (n = 183) who underwent routine coronary CTA (with standard department protocols, whereby tube potential was selected according to BMI) between April 2010 and October 2010 were included. All anthropometric measures were obtained by tracing a region of interest encompassing an entire axial full field-of-view image at the mid left atrial level. Linear regression was used to stratify patients into 4 chest area classes (very small to large). Patients were also stratified by standard BMI classes (underweight to obese). Qualitative and quantitative image quality parameters were compared between concordant and discordant chest area and BMI classes. RESULTS: A strong correlation was observed between patients' BMI and chest area (r = 0.84; P < 0.001) and between BMI and chest circumference (r = 0.82, P < 0.001). Concordance between chest area class and BMI class was found in 61%, whereas 17.6% of patients were "potentially underdosed" (chest area class > BMI class) and 21.4% were "potentially overdosed" (chest area class < BMI class). Signal and contrast of the proximal coronaries and left ventricle were significantly different between the groups. CONCLUSION: Patients' chest area and BMI classes were frequently discordant, potentially leading to overdosing or underdosing when using BMI to select tube potential.