Congenital Heart Disease (CME)
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Collapse Navigator 3D SSFP Whole Heart Imaging (CME)

Purpose/ Objective

Volumetric imaging of the whole heart and the great vessels is very important for surgical planning and clinical decision making, particularly in complex congenital heart diseases. However, volumetric imaging is challenging due to presence of respiratory and cardiac motion. Gadolinium contrast injection is still a concern for patients with severe renal impairment and contrast allergy, as well as the need for intravenous cannulation. With use of a navigator 3D SSFP sequence, volumetric bright blood imaging can be achieved without the need for contrast injection. However, this sequence is still limited by the intrinsic limitations of SSFP sequences (e.g. presence of dephasing artifacts in regions with turbulence) and the need for additional scanning time due to dual gating. Volumetric imaging of the whole heart and the great vessels is very important for surgical planning and clinical decision making, particularly in complex congenital heart diseases. However, as the heart is beating and the diaphragms are moving, respiratory and ECG navigation must be performed to minimize motion artifacts. With use of a balanced SSFP sequence, bright blood imaging can be achieved without the need for contrast injection.

Following this activity, learns will understand the following about the sequence:

  1. Understand the underlying technical principles of the sequence
  2. Understand the usual technical parameters used and the background principles.
  3. Understand the limitations of the sequence.
  4. Understand the common applications.

 

Planners

Kenneth Cheung and Christopher Lam

 

Accreditation Statement

The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

 

Credit Designation Statement

The Society for Cardiovascular Magnetic Resonance (SCMR) designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Instructions for Claiming CME

  • Attend the sessions in full for which credit is sought
  • Complete the post-activity evaluation
  • A certificate of completion will be available once the evaluation is submitted

 

Financial Disclosures

The planners and faculty for this activity did not have any relevant relationships to disclose, unless listed below:

Nothing to Disclose

 

Any resulting conflicts of interest were resolved prior to the start of the activity according to ACCME Criteria & Standards.

 

Disclosure of Commercial Support

SCMR received no funding to support this activity.

 

Bibliography

Uribe S, Tangchaoren T, Parish V, Wolf I, Razavi R, Greil G, Schaeffter T. Volumetric cardiac quantification by using 3D dual-phase whole-heart MR imaging. Radiology. 2008 Aug;248(2):606-14. SCMR Standardized Imaging Protocols 2020 Update Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson. 2020 Feb 24;22(1):17.

Formats Available: On-Demand
Original Course Date: March 27, 2020

Approved Credit:
  • ACCME: 0.50 hours Total General Hours

  • REGISTERREGISTER Navigator 3D SSFP Whole Heart Imaging (CME)
    Collapse Ventricular Function (CME)

    Purpose/ Objective

     

    CMR assessment of global and regional ventricular function presents particular challenges in subjects with simple and complex congenital heart disease. There are several specific techniques that could be used to maximize the accuracy and reproducibility of ventricular function assessment. Clinicians must also know under what circumstances these measurements may be limited, common pitfalls in this assessment, and how to best apply these CMR techniques in the care of patients with congenital heart disease. Following this activity, learns will understand assessment of regional and global systolic ventricular function using cardiac MRI techniques, learn to avoid common pitfalls in the assessment of right and left ventricular systolic function and understand the challenges with assessment of ventricular function in complex congenital heart disease.

     

    Accreditation Statement

     

    The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

     

    Credit Designation Statement

     

    The Society for Cardiovascular Magnetic Resonance (SCMR) designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

     

    Instructions for Claiming CME

     

    • Attend the sessions in full for which credit is sought
    • Complete the post-activity evaluation
    • A certificate of completion will be available once the evaluation is submitted

     

    Financial Disclosures

     

    The planners and faculty for this activity did not have any relevant relationships to disclose, unless listed below:
     

    Dr. Samyn is an employee and received salary from GE Healthcare. She has equity and/or stock options in Philips Healthcare and Siemens Medical Solutions.

     

    Any resulting conflicts of interest were resolved prior to the start of the activity according to ACCME Criteria & Standards.

     

    Disclosure of Commercial Support

     

    SCMR received no funding to support this activity.

     

    Bibliography

    • Int J Clin Practice 2009, 63, 20-35
    • Kilner PI, et al. European Heart Journal, 31:794, 2010
    • Comparison of Accuracy of Axial Slices Versus Short-Axis Slices for Measuring Ventricular Volumes by Cardiac Magnetic Resonance in Patients With Corrected Tetralogy of Fallot Fratz S., Schuhbaeck A., Buchner C., Busch R., Meierhofer C., Martinoff S., Hess J., Stern H. (2009) American Journal of Cardiology, 103 (12), pp. 1764-1769.
    • Cardiac magnetic resonance imaging and the assessment of Ebstein anomaly in adults Yalonetsky S., Tobler D., Greutmann M., Crean A.M., Wintersperger B.J., Nguyen E.T., Oechslin E.N., (...), Wald R.M. (2011) American Journal of Cardiology, 107 (5), pp. 767-773.
    • The functional right ventricle and tricuspid regurgitation in Ebstein's anomaly Fratz S., Janello C., Muller D., Seligmann M., Meierhofer C., Schuster T., Schreiber C., (...), Stern H. (2013) International Journal of Cardiology, 167 (1), pp. 258-261.
    • Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. Grothues F1, Smith GC, Moon JC, Bellenger NG, Collins P, Klein HU, Pennell DJ. American Journal of Cardiology, 2002 Jul 1;90(1):29-34.
    • Schulz-Menger et al, 2013 JCMR, 15(1),1.
    • Suinesiaputra et al, 2015 JCMR, vol 17(1) p.63
    • Beerbaum et al. 2009 JMRI, 30(5), 956-966
    • Masood JMRI 2000; 12:873-833
    • Orwart et al. 2015 Heart Epub Ahead of Print
    • Fratz S, et al Guidelines and Protocols for Cardiovascular Magnetic Resonance in Children and Adults with Congenital Heart Disease: SCMR Expert Consensus Group on Congenital Heart Disease. JCMR 2013 Jun 13;15:51
    • Slavin GS & Bluemke DA. 2005 Radiology; 234:330-338
    • Luijnenburg SE, et al. Intra-observer & inter-observer variability of biventricular function, volumes & mass in patients with CHD measured by CMR imaging (1) Int J Cardiovasc Imaging 2010;26:57-64
    • Bonnemains L, et al. Assessment of RV Volumes & Fuction by Cardiac MRI: Quantification of the Regional & Global Interobserver Variability (1) Magnetic Resonance in Medicine 2012;67:1740-1746
    • Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU: Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequesnce, J Magn Reson Imaging 2003;17:323-329
    • Buechel EV, Kaiser T, Jackson C, Schmitz A, Kellenberger CJ: Normal right and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonace. JCMR 2009; 11:19
    • Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S: Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. JCMR 2005;7:755-782
    • Robbers-Visser D, Boersma E, Helbing WA: Normal biventricular function, volumes, and mass in children aged 8 to 17 years. JCMR 2009;29:552-559
    • Sarikouch S, Peters B, Gutberlet M, Leismann B, Kelter-Kloepping A, Koerperich H, Kuehne T, Beerbaum P: Sex-specific pediatric percentiles for ventricular size and mass as reference values for cardiac MRI: assessment by steady-state free-precession and phase-contrast MRI flow. Circ Cardiovasc Imaging 2010;3:65-76
    • Buechel ER, Dave HH, Kellenberger CL, Dodge-Khataml A, Pretre R, Berger F, Bauersfeld U: Remodelling of the right ventricle after rearly pulmonary valve replacement in children with repaired tetralogy of fallot: assessment by cardiovascular magnetic resonance European Heart Journal 2005;26:2721-2727
    • Grothues F, Moon JC, Bellenger NG, Smith GS, Klein HU, Pennell DJ. Interstudy reproducibility of right ventricular volumens, function and mass with cardiovascular magnetic resonance. AM Heart J 2004;147:218-223
    • Aldakih et al., J Magn Reson Imaging 2003;18(1):25-32
    • Fratz et al., AM J Cardiol, 2009:103(12):1764-9
    • Vogel-Claussen et al., J Comput Assist Tomogr. 2006;30(3):426-32
    • Maceria et al. Eur Heart J 2006
    • Grothues et al., Am Heart J. 2004;147(2):218-23 

     

    Formats Available: On-Demand
    Original Course Date: June 01, 2018

    Approved Credit:
  • ACCME: 1 hour Total General Hours

  • REGISTERREGISTER Ventricular Function (CME)