Thoracic Imaging 2003 - Society of Thoracic Radiology

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March 3, 2003 General Session Monday 90 Cardiovascular Imaging: Pulmonary Vascular Americana 3 Moderator: Lawrence Goodman, MD 2:00 - 2:20 Epidemiology of Venous Thromboembolic Disease Lacey Washington, MD 2:20 - 2:40 MDCT Pulmonary Angiography James Gruden, MD 2:40 - 3:00 CT Structural and Functional Imaging of PE Joseph Schoepf, MD 3:00 - 3:20 Non Thrombotic Pulmonary Embolism Lawrence Goodman, MD 3:20 - 3:40 Pulmonary Hypertension Aletta Frazier, MD 3:40 - 4:00 Session Discussion 4:00 - 4:15 pm Coffee Break Americana 4 Benjamin Felson Memorial Lecture Americana 3 Moderator: Ella Kazerooni, MD 5:30 - 7:30 PM General Reception Americana Lawn
Cardiac MRI: Established Indications Charles S. White, M.D. University of Maryland Baltimore, MD Overview Role of MRI as Compared with Other Techniques The traditional imaging techniques used for cardiac imaging are echocardiography, cardiac catheterization and nuclear cardiology. This approach to cardiac imaging in part reflects the earlier development of these techniques as well as the referral patterns of cardiac patients. MRI of the heart was first made possible in the early 1980's by the development of ECG triggering (gating). More recent innovations permit a wide range of cardiac assessment by MRI. Cardiac MRI has major advantages because of the high intrinsic contrast between the blood pool and surrounding structures, the large field-of-view and ability to image in any plane, and versatility of multiple sequences. Nevertheless, cardiac MRI plays a secondary role to the techniques described above and is still used mainly when these techniques fail provide diagnostic information or are ambiguous. There are certain indications for which cardiac MRI provides superior information and these applications will be highlighted. General Considerations Cardiac MR imaging requires that the patient remain in the magnet for some length of time. A good examination is difficult in patients who are uncooperative or disoriented. However, if the patient is only mildly uncooperative, it is possible to obtain much useful information with fast imaging techniques, depending on the indication. Similar to MR imaging studies of other parts of the body, cardiac MRI is contraindicated in patients with a variety of foreign devices, including certain aneurysm clips, cochlear implants and penile prostheses. MRI is also contraindicated in patients who have pacemakers or implantable cardioverter defibrillator (ICD) devices. In general, MRI can be performed in patients who have prosthetic cardiac valves. Patients who have undergone recent cardiac surgery (CABG or valve surgery) can probably be studied 1-2 weeks after the procedure although this has not been documented conclusively. Cardiac MRI Set Up ECG-gating is mandatory in order to achieve a study of good quality. Gating is triggered to the R-wave and thus image degradation occurs in patients who have irregular cardiac rhythms such as atrial fibrillation in which the R-R interval is highly variable. Because a high quality study depends on effective ECG triggering, it is advisable to ensure that the technologist obtains a good ECG-tracing both outside and inside the machine prior to beginning the examination. The tracing is often somewhat degraded once the patient is moved into the machine bore. To achieve a proper tracing it may be necessary to relocate the ECG leads on the patient several times. If no ECG-tracing can be obtained, a less desirable alternative is to gate from the pulse oximeter (peripheral gating). Respiratory artifact may also substantially degrade the image. Respiratory gating is time consuming and is not widely used. Another strategy employs respiratory compensation, which consists of reordering the sequence information to smooth out respiratory variations. A respiratory bellows is wrapped around the abdomen to perform these techniques. A more recent approach uses “navigator” pulses to track the diaphragm. Only imaging with the diaphragm in a predefined window is accepted. For many situations, cardiac imaging in adults can be performed using the standard body coil. However, improvement in signal-to-noise is achieved by using a specialized phased cardiac coil. For infants, a head coil can be used. Overview of Sequences Used in Cardiac MRI Cardiac sequences can be divided generically into darkblood and bright-blood (gradient-echo) sequences. For darkblood imaging multislice T1-weighted spin-echo sequences are giving way to double inversion sequences that are faster, and can be done in a breath hold. T2-weighted images are infrequently used but may be appropriate in patients with cardiac masses or pericardial disease. Gradient-echo sequences (bright blood) are useful to supplement spin-echo sequences. They can be used to perform fast imaging and obtain physiologic information. Gated, gradientecho images can be placed in a cine format that allows visualization of cardiac motion at a single level in any plane throughout the cardiac cycle. When fast gradient techniques are applied, the entire cardiac cycle can be imaged in a single breathhold. Gradient-echo techniques are also sensitive to turbulence which causes loss of signal. Gradient-echo techniques can be phase-encoded so that information about blood flow and velocity can be obtained. Steady state free precession (True FISP, balanced FFE) sequences are now widely used to improve segmentation between myocardium and blood pool. Selected Topics in Adult Cardiac MRI 1) Cardiac and paracardiac lesions 2) Pericardial disease 3) Valvular and ischemic heart disease 4) Cardiomyopathies and dysplasias 5) Functional cardiac imaging 1) Cardiac and Paracardiac Lesions Thrombus is a frequent cause of a cardiac lesion. Thrombus is particularly common in the left atrium in patients with atrial fibrillation and is often located along the back wall or in the atrial appendage. Thrombus may be difficult to distinguish from a cardiac tumor. Enhancement after gadolinium chelate administration is more typical of tumor than thrombus. Metastatic cardiac lesions are about ten to forty times more prevalent than primary cardiac tumors. Common sites of origination of metastatic lesions include lung, breast and skin. Lymphomatous involvement of the heart is also common. Spread of extracardiac tumors may occur through the systemic (renal cell carcinoma, hepatocellular carcinoma) or pulmonary (lung carcinoma) veins. The most common primary cardiac tumor is the myxoma, which is almost always benign histologically. Seventy-five percent are located in the left atrium where most are attached by a pedicle to the atrial septum near the fossa ovalis. The tumor occurs in the right atrium in about 20% of patients and is found in a ventricle occasionally. Atrial myxomas are usually pedunculated and may prolapse through valves, causing regurgitation. Tumor fragments may embolize and cause systemic or pulmonary symptoms. Rhabdomyomas are less common tumors that typically manifest in infancy and have a strong association with tuberous sclerosis. Another interesting tumor-like condition is called lipomatous hypertrophy of the interatrial septum, which consists of a large quantity of unencapsulated fat that is deposited in and widens the atrial septum, and may even project into the right atrium. Malignant primary tumors of the heart are 97 MONDAY
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
Page 13 and 14: Program Committee Ella A. Kazerooni
Page 15 and 16: Small Airway Disease Americana 3 Mo
Page 17 and 18: Benjamin Felson Memorial Lecture Am
Page 19 and 20: Session 2-B Concurrent Session Clin
Page 21 and 22: Workshops (choose 1) 1:00 - 1:45 D1
Page 23 and 24: Sunday
Page 25 and 26: March 2, 2003 General Session Sunda
Page 27 and 28: SUNDAY 46 One type of direct-readou
Page 29 and 30: CT-PET Imaging Suzanne Aquino, M.D.
Page 31 and 32: SUNDAY 58 an accompanying decreased
Page 33 and 34: SUNDAY 60 Radiofrequency Ablation i
Page 35 and 36: SUNDAY 62 17. Sewell PE, Vance RB.
Page 37 and 38: SUNDAY 64 cal ventilation will be r
Page 39 and 40: SUNDAY 66 radiologic, and histopath
Page 41 and 42: SUNDAY 68 application. The untreate
Page 43 and 44: SUNDAY 70 The Expanded Spectrum of
Page 45 and 46: SUNDAY 72 Hypersensitivity Pneumoni
Page 47 and 48: SUNDAY 74 Small Airway Diseases Mic
Page 49 and 50: SUNDAY 76 The “Head-cheese Sign
Page 51 and 52: SUNDAY 78 “Holes” in the Lung:
Page 53 and 54: SUNDAY 80 Pleural Effusions Gerald
Page 55 and 56: SUNDAY 82 Asbestos Related Pleural
Page 57 and 58: SUNDAY 84 Other Pleural Neoplasms S
Page 59 and 60: SUNDAY 86 Image-Guided Therapy of M
Page 61 and 62: Notes 88
Page 63: March 3, 2003 General Session 7:00
Page 67 and 68: Cardiac MRI: New Developments Gauth
Page 69 and 70: 5. The volume of contrast medium re
Page 71 and 72: Acute Aortic Syndrome Ernest M. Sca
Page 73 and 74: as well as separation of the cusps
Page 75 and 76: Pulmonary Veins: Imaging for Radiof
Page 77 and 78: Imaging of Cardiopulmonary Support
Page 79 and 80: plied to the hollow fibers by an ex
Page 81 and 82: swelling of the entire leg, calf sw
Page 83 and 84: Multi-channel Pulmonary CTA: New Te
Page 85 and 86: terminate scintigrams, CT correctly
Page 87 and 88: CT Strucural and Functional Imaging
Page 89 and 90: curves (TDCs) are generated by manu
Page 91 and 92: 7. Crawford T, Yoon C, Wolfson K, e
Page 93 and 94: 80. Fleischmann D, Rubin GD, Bankie
Page 95 and 96: 127 MONDAY
Page 97 and 98: 129 MONDAY
Page 99 and 100: REFERENCES Bergin CJ, Rios G, King
Page 101 and 102: Notes 134
Page 103 and 104: March 4, 2003 General Session 7:00
Page 105 and 106: Adult Manifestations of Congenital
Page 107 and 108: will usually display the limbs of t
Page 109 and 110: Imaging of the Pericardium Paul L.
Page 111 and 112: Cardiomyopathy Martin J. Lipton, M.
Page 113 and 114: TUESDAY 150 Nuclear Cardiology Upda
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TUESDAY 152 ties. The predominant 1
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TUESDAY 154 Imaging protocols: Util
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Manpower Shortage in Radiology: Sol
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159 TUESDAY
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161 TUESDAY
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163 TUESDAY
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NIBIB Update for Thoracic Radiology
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vertically along the right atrium t
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Multidetector Pediatric Chest CT: P
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The Spectrum of Pulmonary Infection
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Immune deficiency occurs frequently
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TUESDAY 180 The Internet and the Pr
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TUESDAY 182 Workshop A1: Lymphoma:
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TUESDAY 184 Digital Images: Camera
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TUESDAY 186 Analysis of Mediastinal
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Unusual Manifestations of Lung Canc
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Wednesday
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March 5, 2003 General Session Wedne
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WEDNESDAY 208 principle is that “
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WEDNESDAY 210 years and a current o
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WEDNESDAY 212 lesions generally mim
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WEDNESDAY 214 capable of studying t
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WEDNESDAY 216 Small T1 Lung Cancer:
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WEDNESDAY 218 REFERENCES Seely JM,
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WEDNESDAY 220 Therefore, radiologis
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WEDNESDAY 222 sectional area varies
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WEDNESDAY 224 Lung Cancer Staging A
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Metastatic Disease to Lung Gordon L
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Thoracic Metastates from Osteosarco
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STR tutorial: Use of MD CT reconstr
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ogenic edema, fat embolism, heroin
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WEDNESDAY 236 Pulmonary Arterial Hy
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WEDNESDAY 238 pathological process,
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Thursday
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THURSDAY 250 Pulmonary Tuberculosis
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THURSDAY 252 1. Clinical criteria:
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THURSDAY 254 AIDS patients are also
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THURSDAY 256 Viral Infection on HRC
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THURSDAY 258 Imaging of Coccidioido
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THURSDAY 260 from the laryngeal sur
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THURSDAY 262 Inflammatory Diseases
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Virtual Endoscopy in the Thorax: Pr
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Notes 269 THURSDAY
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SECOND LEVEL THIRD LEVEL
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