Cardiac MRI and CT Rotation

General information

For general questions, contact any advanced imaging faculty.

For questions about a case on a particular day, contact the covering faculty for the day.

  • Go to faculty call schedule at: webpaging.ucsd.edu
  • Click On Call Search on left of page
  • Search under Radiology Cardiac

Radiology contact information and additional schedule information: radres.ucsd.edu.

Use of images in Conferences and/or Publications

  • If you would like to display images at conference (eg. Cath Conference), the expectation is that you make an appointment with an advanced imager at least 24 hours before conference to review in person.

Contacts

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Cardiac MRI

Indications for cardiac MRI

  • Evaluate and risk stratify specific cardiomyopathies
    • Cardiac Amyloidosis
    • Cardiac Sarcoidosis
    • Hypertrophic cardiomyopathy
    • Iron overload cardiomyopathy
    • Arrhythmogenic cardiomyopathy
    • Ischemic Cardiomyopathy
      • Evaluate Viability
      • Define area of infarct including assessment of no-reflow
  • Suspected myocarditis
  • Pericardial disease (primarily constriction)
  • Patients with limited quality echos
  • Quantify left or right ventricular function
  • Quantify shunt fraction
  • Characterize native and prosthetic heart valves
    • Quantify regurgitation severity
    • Bicuspid aortic valve evaluation, including aortic root assessment
  • Cardiac mass/thrombus
  • Vasodilator Stress testing
  • Suspected coronary anomalies
  • Congenital disease
  • Evaluation of suspected aortic dissection or thoracic aortic aneurysm
  • Pulmonary vein anatomy

Ordering information

  • For inpatients:
    • Place order in EPIC as soon as possible. This reserves your place in line. Please ensure appropriate level of urgency is indicated (STAT, discharge pending, routine, etc.).
    • Page cardiologist/radiologist on call
  • For outpatients:
    • Place order in EPIC
    • Call/email with questions or special considerations

Considerations/contraindications

  • Most metallic implants (eg all stents, valves and joints) are safe in MRI. Call if questions.
  • Pacemakers/ICDs are contraindications to cardiac studies
  • Patients with risk factors (age >60, diabetic, prior renal disease, etc.) for renal insufficiency need a recent (within 6 weeks) creatinine.
  • Moderate to severe acute renal insufficiency (GFR below 45) – contraindication to gadolinium contrast
  • Chronic severe renal insufficiency/dialysis (GFR <30) – contraindication to gadolinium contrast
  • Many studies can be performed without contrast. Call to discuss.

Equipment

  • GE 1.5T magnet in Thornton (preferred)
  • GE 1.5T magnet in Hillcrest
  • GE 3.0T magnet in Hillcrest (larger bore; reserved for special circumstances)

References

  • Society of Cardiovascular Magnetic Resonance web site: www.scmr.org
  • Cardiovascular Magnetic Resonance. Pennell DJ. Circulation. 2010 Feb 9; 121:692-705.
  • ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J. Am. Coll. Cardiol., June 8, 2010; 55: 2614 - 2662.
  • Cardiovascular Magnetic Resonance Imaging, edited by Raymond Kwong, Totowa, N.J., Humana, 2008.

Cardiac CT

Appropriate indications for cardiac CT

  • Coronary artery disease
    • Chest pain with intermediate pre-test probability
    • Chest pain with equivocal stress test
    • Rule out CAD in patient with new onset CHF, low pre-test probability
    • Noninvasive coronary arterial imaging, including internal mammary artery prior to repeat cardiac surgical revascularization
  • Evaluate for coronary anomalies
  • Structure and function (eg. EF assessment) in patients with contraindications to cardiac MRI
  • Congenital disease
  • Cardiac mass evaluation
  • Pericardial disease (eg. pericardial calcification)
  • Pulmonary vein anatomy
  • Coronary vein mapping prior to placement of biventricular pacemaker
    • Evaluation of suspected aortic dissection or thoracic aortic aneurysm
  • Prior to TAVR or atrial snare procedures
  • Preoperative planning prior to minimally invasive valve surgery, mass resection, etc.

Ordering information

  • General Considerations
    • Patients with atrial fibrillation must be imaged at Hillcrest on 320 scanner
    • Patients with risk factors (age >60, diabetic, prior renal disease, etc.) for renal insufficiency need a recent creatinine (within 6 weeks)
    • Renal insufficiency is a relative contraindication that should be considered on a case-by-case basis. Typical contrast load is 80-150 mL
  • For inpatients:
    • Place order in EPIC
    • Call the covering cardiologist/radiologist
    • For coronary artery CTA, Give oral metoprolol (typically 100 mg) unless contraindicated. We would like patients to have heart rates less than 60 at the time of the scan. Most common reason for scan delay is elevated heart rate.
  • For outpatients:
    • Place order in EPIC. Call/email with questions or special considerations.
    • Most patients referred for coronary artery indications should receive 50- 100 mg of metoprolol PO approximately 1 hour before the appointment. This order can be placed at the discharge pharmacy for patient to pick up. While helpful, this step is not mandatory.
    • If beta-blockers and/or nitroglycerin are contra-indicated please note that when placing the order.
    • CT TAVR protocol – Epic keyword TAVR. These patients do not require extra beta blocker or nitroglycerin.

Equipment

  • 2 GE 64 slice GE scanners at SCVC/Thornton
  • 1 GE 64 slice GE scanner in Hillcrest
  • 1 Toshiba 320 slice scanner in Hillcrest

References

  • Society of Cardiovascular Computed Tomography web site: www.scct.org
  • The Present State of Coronary Computed Tomography Angiography: A Process in Evolution, James K. Min, Leslee J. Shaw, and Daniel S. Berman, J. Am. Coll. Cardiol., March 9, 2010; 55: 957 - 965.
  • ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J. Am. Coll. Cardiol., June 8, 2010; 55: 2663 - 2699.
  • Cardiac CT Imaging: Diagnosis of Cardiovascular Disease, Matthew J. Budoff (Editor), Jerold S. Shinbane (Editor), Springer; 2nd ed. 2010.
  • Atlas of Cardiovascular Computed Tomography, Matthew J. Budoff (Editor), Jagat Narula (Editor), Stephan S. Achenbach (Editor), Springer; 2007.

Didactics

Monthly Advanced Cardiovascular Imaging Conference

  • Joint conference with radiology residents
  • Last Monday of every month at noon, 4th floor conference room of Sulpizio, telecast to VA and Hillcrest
  • Cases are chosen jointly between faculty and residents.
  • Radiology residents will generate CT/MRI powerpoint images. Echo fellows are responsible for compiling clinical details of the case, echo and cath images.
  • All fellows are expected to attend as their schedule allows.

Guided study

Research opportunities

Interested fellows should contact faculty directly.