Dobutamine stress magnetic resonance imaging for the detection of coronary artery disease in women

The diagnostic capability of DSMR for the detection of haemodynamically relevant, obstructive CAD is independent of gender

High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k-t SENSE

PURPOSE: To prospectively evaluate the feasibility and diagnostic accuracy of high spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR) for the detection of coronary artery disease (CAD). METHODS AND RESULTS: DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 78 patients prior to clinically indicated invasive coronary angiography. For DSMR-perfusion an in-plane spatial resolution of 1.5×1.5mm(2) was attained by using 8×k-space and time sensitivity encoding (k-t SENSE). Image quality and extent of artifacts during perfusion imaging were evaluated. Wall motion and perfusion data were interpreted sequentially. Significant CAD (stenosis≥70%) was present in 52 patients and involved 86 coronary territories. One patient did not reach target heart rate despite maximum infusion of dobutamine/atropine. Two studies (3%) were non-diagnostic due k-t SENSE related artifacts resulting from insufficient breathhold capability. Overall image quality was good. Dark-rim artifacts were limited to the endocardial border at a mean width of 1.8mm. The addition of DSMR-perfusion to DSMR-wall motion data improved sensitivity for the detection of CAD (92% vs. 81%, P=0.03) and accurate determination of disease extent (85% vs. 66% of territories, P<0.001). There were no significant differences between DSMR-perfusion and DSRM-wall motion regarding overall specificity (83% vs. 87%, P=1) and accuracy (89% vs. 83%, P=0.13). CONCLUSION: High spatial resolution DSMR-perfusion imaging at maximum stress level was feasible, improved sensitivity over DSMR-wall motion for the detection of CAD and allowed an accurate determination of disease extent. Specificity of DSMR-perfusion with k-t SENSE improved compared to prior studies using lower spatial resolution

Influence of left ventricular hypertrophy and geometry on diagnostic accuracy of wall motion and perfusion magnetic resonance during dobutamine stress

The accuracy of DSMR-wall motion is influenced by LV geometry. In patients with concentric remodeling and concentric hypertrophy, additional first-pass perfusion imaging during high-dose dobutamine stress improves the diagnostic accuracy for the detection of coronary artery disease

Small animal Look-Locker inversion recovery (SALLI) for simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates: initial experience

Phantom studies demonstrated systematic behavior of the T1 measurements, and T1 error could be reduced to 1.3% ± 7.4 by using a simple linear correction algorithm. The pre- and postcontrast T1 of myocardium and blood showed narrow normal ranges. In the area of infarction, SALLI demonstrated hypokinesia (on cine images), myocardial edema (on precontrast T1 maps), and myocardial necrosis (on postcontrast T1 maps and late gadolinium enhancement images). Conclusion: An MR imaging method enabling simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates is presented. SALLI allows for simultaneous and time-efficient assessment of cardiac T1 behavior, function, and late gadolinium enhancement at high heart rates

Approaches and Frameworks for Managing Contaminated Sediments - A European Perspective

Sediment is an essential, integral and dynamic part of the hydrologic system. In natural and agricultural basins, sediment is derived from the weathering and erosion of minerals, organic material and soils in upstream areas and from the erosion of river banks and other in-stream sources. As surface-water flow rates decline in lowland areas, transported sediment settles along the river bed and banks by sedimentation. However, because sediments are the ultimate reservoir for the numerous potential chemical and biological contaminants that may be contained in effluents originating from urban, agricultural, and industrial lands and recreational activities, contaminated sediments in rivers and streams, lakes, coastal harbors, and estuaries have the potential to pose ecological and human health risks. The management of sediment quality and quantity in support of ecological and socioeconomic goals is a cause of extensive research, investment and regulatory and public scrutiny, both in Europe and internationally. This chapter examines the management of sediment from a European perspective. The first section discusses the role of sediment management in achieving European ecosystem objectives. Section two summarizes the findings of the EC-funded, demand driven European Sediment Research Network (SedNet). Section three describes a framework risk assessment and management in a major European region, the Venice Lagoon. The next three sections describe aspects of sediment management in an EC accession country, and the host country for this workshop - Slovakia. Section four describes river and lake sediment contamination and related legislation in Slovakia. Section five discusses the assessment and management of Persistent Organic Pollutants (POPs), a major risk driver in Slovakia. Section six discusses a specific class of POPs - PCBS in sediments of a specific region of Slovakia. Finally, Section seven discusses some barriers to successful sediment risk assessment and management, and lists science and infrastructure needs to address these barriers. Whilst all the authors of this chapter are living and/or working in Europe, and the focus is on European perspectives, much work has benefited from international collaborations and we feel that many of the observations and recommendations will have relevance to a broader audience