Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology

BACKGROUND: Despite common enthusiasm for cardiovascular magnetic resonance (CMR), its application in Europe is quite diverse. Restrictions are attributed to a number of factors, like limited access, deficits in training, and incomplete reimbursement. Aim of this study is to perform a systematic summary of the representation of CMR in the guidelines of the European Society of Cardiology (ESC). METHODS: Twenty-nine ESC guidelines were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". As 3 topics were published twice (endocarditis, pulmonary hypertension, NSTEMI), 26 guidelines were finally included. MRI in the context of non-cardiovascular examinations was not recognized. The main CMR-related conclusions and, if available, the level of evidence and the class of recommendation were extracted. RESULTS: Fourteen of the 26 guidelines (53.8 %) contain specific recommendations regarding the use of CMR. Nine guidelines (34.6 %) mention CMR in the text, and 3 (11.5 %) do not mention CMR. The 14 guidelines with recommendations regarding the use of CMR contain 39 class-I recommendations, 12 class-IIa recommendations, 10 class-IIb recommendations and 2 class-III recommendations. Most of the recommendations have evidence level C (41/63; 65.1 %), followed by level B (16/63; 25.4 %) and level A (6/63; 9.5 %). The four guidelines, which absolutely contained most recommendations for CMR, were stable coronary artery disease (n = 14), aortic diseases (n = 9), HCM (n = 7) and myocardial revascularization (n = 7). CONCLUSIONS: CMR is represented in the majority of the ESC guidelines. They contain many recommendations in favour of the use of CMR in specific scenarios. Issues regarding access, training and reimbursement have to be solved to offer CMR to patients in accordance with the ESC guidelines

Shearlet-based compressed sensing for fast 3D cardiac MR imaging using iterative reweighting

High-resolution three-dimensional (3D) cardiovascular magnetic resonance (CMR) is a valuable medical imaging technique, but its widespread application in clinical practice is hampered by long acquisition times. Here we present a novel compressed sensing (CS) reconstruction approach using shearlets as a sparsifying transform allowing for fast 3D CMR (3DShearCS). Shearlets are mathematically optimal for a simplified model of natural images and have been proven to be more efficient than classical systems such as wavelets. Data is acquired with a 3D Radial Phase Encoding (RPE) trajectory and an iterative reweighting scheme is used during image reconstruction to ensure fast convergence and high image quality. In our in-vivo cardiac MRI experiments we show that the proposed method 3DShearCS has lower relative errors and higher structural similarity compared to the other reconstruction techniques especially for high undersampling factors, i.e. short scan times. In this paper, we further show that 3DShearCS provides improved depiction of cardiac anatomy (measured by assessing the sharpness of coronary arteries) and two clinical experts qualitatively analyzed the image quality

In vivo myocardial tissue characterization of all four chambers using high-resolution quantitative MRI

Quantitative native T(1) Mapping of the myocardium without the application of contrast agents can be used to detect fibrosis in the left ventricle. Spatial resolution of standard native T(1) mapping is limited by cardiac motion and hence is not sufficient to resolve small myocardial structures, such as the right ventricle and the atria. Here, we present a novel MR approach which provides cardiac motion information and native T(1) maps from the same data. Motion information is utilized to optimize data selection for T(1) mapping and a model-based iterative reconstruction scheme ensures high-resolution T(1) maps for the entire heart. Feasibility of the approach was demonstrated in three healthy volunteers. In the T(1) maps, the myocardium of all four chambers can be visualized and T(1) values of the left atrium and right chambers were comparable to left ventricular T(1) values

Применение метода аналитических сетей для оптимизации процесса выбора стратегии развития пассажирского автотранспортного предприятия

В статье обозначена проблема снижения рентабельности пассажирских автотранспортных предприятий и связанные с этим сложности по реализации процедуры стратегического прогнозирования и управления предприятием. Обосновано использование метода аналитических сетей в модели поддержки принятия решений при управлении стратегией автотранспортного предприятия, представленной в работе [1], в качестве инструмента, позволяющего формализовать экспертные знания на основных этапах оценки и выбора проектов стратегического развития. Описаны основные шаги и приведены результаты расчета алгоритма метода аналитических сетей в рамках данной модели.The article outlines the problem of reducing the profitability of passenger motor transport enterprises and the associated difficulties in implementing the procedure of strategic forecasting and enterprise management. The use of the method of analytical networks in the model of decision support in managing the strategy of a trucking enterprise presented in [1] is substantiated as a tool that allows to formalize expert knowledge at the main stages of evaluation and selection of projects for strategic development. The main steps and calculations of the algorithm algorithm for analytical networks within the framework of this model are described

High spatial resolution and temporally resolved t(2) (*) mapping of normal human myocardium at 7.0 tesla: an ultrahigh field magnetic resonance feasibility study

Myocardial tissue characterization using T(2) (*) relaxation mapping techniques is an emerging application of (pre)clinical cardiovascular magnetic resonance imaging. The increase in microscopic susceptibility at higher magnetic field strengths renders myocardial T(2) (*) mapping at ultrahigh magnetic fields conceptually appealing. This work demonstrates the feasibility of myocardial T(2) (*) imaging at 7.0 T and examines the applicability of temporally-resolved and high spatial resolution myocardial T(2) (*) mapping. In phantom experiments single cardiac phase and dynamic (CINE) gradient echo imaging techniques provided similar T(2) (*) maps. In vivo studies showed that the peak-to-peak B(0) difference following volume selective shimming was reduced to approximately 80 Hz for the four chamber view and mid-ventricular short axis view of the heart and to 65 Hz for the left ventricle. No severe susceptibility artifacts were detected in the septum and in the lateral wall for T(2) (*) weighting ranging from TE = 2.04 ms to TE = 10.2 ms. For TE >7 ms, a susceptibility weighting induced signal void was observed within the anterior and inferior myocardial segments. The longest T(2) (*) values were found for anterior (T(2) (*) = 14.0 ms), anteroseptal (T(2) (*) = 17.2 ms) and inferoseptal (T(2) (*) = 16.5 ms) myocardial segments. Shorter T(2) (*) values were observed for inferior (T(2) (*) = 10.6 ms) and inferolateral (T(2) (*) = 11.4 ms) segments. A significant difference (p = 0.002) in T(2) (*) values was observed between end-diastole and end-systole with T(2) (*) changes of up to approximately 27% over the cardiac cycle which were pronounced in the septum. To conclude, these results underscore the challenges of myocardial T(2) (*) mapping at 7.0 T but demonstrate that these issues can be offset by using tailored shimming techniques and dedicated acquisition schemes