Brandon Mikolich

EFFECT OF THIRD PARTY PAYOR PRE-AUTHORIZATION POLICY ON CONCORDANCE OF NUCLEAR STRESS PERFUSION IMAGING AND CORONARY ARTERIOGRAPHY

Non-invasive testing, primarily nuclear multiplanar perfusion imaging (MPI), predicts abnormal findings on coronary angiography(CATH) in 41% of patients(Patel et al NEJM 362:886-95). Due to radiation doses associated with MPI studies, concern has risen about over-utilization. In September 2010 the

IS CARDIAC MRI A COST-SAVING STRATEGY FOR NEW CARDIAC PATIENTS?

The most commonly used cardiac imaging modalities are 2D Echo(2DE) and nuclear myocardial perfusion imaging(MPI). Cardiac MRI(CMR) is considered 2nd line for evaluation of chest pain, dyspnea, palpitations and syncope. Despite widespread availability, 2DE and MPI have inherent limitations that may

TRANSIENT ISCHEMIC DILATION: A NEW PERSPECTIVE UTILIZING CARDIAC MRI

Stress-induced global LV myocardial ischemia is difficult to detect by nuclear myocardial perfusion imaging (MPI). Digital LV volume software is used to assess changes in overall scintigraphic LV volume after stress, and is termed transient ischemic dilation(TID). The mechanism of TID is thought to

ARE NEW DIAGNOSTIC CRITERIA FOR PERICARDITIS NEEDED

Current criteria for diagnosing pericarditis include non-ischemic chest pain, PR segment depression and/or J point/ST segment deviation on ECG, pericardial rub and pericardial effusion on 2-D echo. Unfortunately, these criteria are transient and difficult to detect. Cardiac MRI is capable of

What is the role of cardiac MRI in the diagnosis of left ventricular non-compaction?

Background The prevalence of left ventricular non-compaction is not well established. Using 2-D echocardiography, less than 1% of patients are diagnosed with this entity. Using cardiac MRI, approximately 3% of patients have evidence of LV non-compaction. This variance may be related to the difference in spatial resolution between these 2 imaging techniques. Using a large institutional cardiac imaging database, 2-D echo and cardiac MRI results were compared in patients with LV non-compaction. Methods Of 1,255 patients in our cardiac imaging database, 38 patients (3%) with a diagnosis of LV non-compaction were identified. Twenty-two of these 38 patients had undergone both 2-D echo and cardiac MRI exams. The reported diagnoses with each imaging modality were tabulated, along with measurements of left ventricular antero-septal and infero-posterior wall thickness for both modalities. The 2-D echo and cardiac MRI wall thickness dimensions were statistically compared using a paired sample t-test. Results All 38 patients had a diagnosis of LV non-compaction on cardiac MRI, using criteria of non-compacted/compacted myocardium > 2.5 to 1.0 and deep LV trabeculations. None of the 22 patients with both 2-D echo and cardiac MRI exams had a diagnosis of LV non-compaction on their 2-D echo study. However, 15 of 22 patients (68%) had a diagnosis of LVH on their 2-D echo study, while only 3 had LVH on their cardiac MRI study. The mean ASWT on 2-D echo was 1.38 cm, while the mean ASWT on cMRI was 1.16 cm (p<0.005). The mean IPWT on 2-D echo was 1.31 cm, while the IPWT on cMRI was only 0.89 cm (p<0.001). Conclusions These data suggest that LV non-compaction, identifiable on cardiac MRI, is frequently diagnosed as LVH on 2-D echo. This discrepancy appears to be explained by the statistically significant difference in both antero-septal and infero-posterior LV wall thickness measurements between the 2 imaging modalities. It is suspected that this difference is related to the inferior spatial resolution of 2-D echo relative to cMRI. On the basis of these data, patients with LVH on 2-D echo should be considered for a cardiac MRI exam to determine if the increased LV wall thickness is truly LVH or an undiagnosed LV non-compaction cardiomyopathy.

Left ventricular hypertrophy: is it really?

Background Patients with left ventricular hypertrophy (LVH), typically assessed by 2D echocardiography, are at a greater risk for heart failure and sudden cardiac death. An accurate diagnosis of LVH is essential to clinical evaluation and treatment. However, 2D echo has inferior spatial resolution and less than optimal measurement positioning, relative to cardiac MRI. This “real-world” study, based on finalized 2D echo reports, sought to compare assessment of LVH on 2D echo to results by cardiac MRI (cMRI). Methods

Is cardiac MRI adenosine stress perfusion imaging a more appropriate diagnostic tool for obese patients

Background Cardiac nuclear stress perfusion imaging is subject to artifact related to obesity, breast attenuation and diaphragm overlap. These factors are responsible for “false positive” results among patients undergoing evaluation for coronary atherosclerosis, leading to potentially unnecessary invasive coronary arteriography. Cardiac MRI adenosine stress perfusion imaging is unaffected by both obesity and breast tissue attenuation, resulting in sensitivity and specificity rates in excess of 90%. Accordingly, cardiac MRI adenosine stress perfusion imaging may be a more appropriate form of testing for obese patients. Methods Interrogation of the institutional cardiac MRI database revealed 110 patients who had undergone both cardiac nuclear stress perfusion imaging and cardiac MRI adenosine stress perfusion imaging studies, separated in time by no more than 3 months. Each type of perfusion imaging study was categorized as Normal (no ischemia) or Abnormal (evidence of ischemia). The Body Mass Index (BMI) was also extracted from the database for each patient. Concordance for the 2 tests was computed over a range of BMI values and graphically plotted for trend analysis. Patients were also grouped according to standard WHO bodyweight definitions: Normal (BMI 30 kg/m2) for statistical comparison of concordance. Results Concordance for nuclear and cardiac stress perfusion imaging studies was 61.5% for BMI 35 kg/m2. A one-way ANOVA was computed to compare concordance between the 2 tests for patients categorized as Normal (BMI 30). Obese patients had a statistically significant decreased concordance between both tests when compared to normal weight patients (p <0.05). Conclusions