ISMRM23 - The Chest Pain Chess Game

ISMRM & ISMRT Annual Meeting & Exhibition • 03-08 June 2023 • Toronto, ON, Canada

The Chest Pain Chess Game

Weekday Course

ORGANIZERS: Michael Atalay, Tobias Wech

Monday, 05 June 2023

718A

08:15 - 10:15

Moderators:
All Sections: Eva Peper & Sebastian Weingärtner

Skill Level: Intermediate

Session Number: M-01

CME Credit

Session Number: M-01

Overview
Diagnosing the cause of chest pain is often clinically challenging. Current and emerging cardiac MRI techniques can provide valuable diagnostic and prognostic insights for patients with both acute and chronic chest pain. This course will review these techniques as well as the broader role of MRI in the evaluation of this patient cohort and—in the context of the latest guidelines—where it fits in to the diagnostic paradigm.

Target Audience
This course is intended for attendees who are interested in cardiovascular diseases and desire to better understand the role of MRI in the evaluation of patients with chest pain and learn more about those current and emerging MR tools and techniques that are particularly well-suited for this task, including quantitative myocardial perfusion imaging and myocardial parameter mapping.

Educational Objectives
As a result of attending this course, participants should be able to:
- Explain the role of MRI in the diagnosis and management of various causes of cardiac-related chest pain;
- Recognize the latest MR techniques for qualitative and quantitative evaluation of myocardial perfusion; and
- Review the established methods and latest developments for parameter mapping for qualitative evaluation of the myocardial tissue.

		Ischemic Cardiomyopathies
08:15		Coronary in the Coal Mine: Perfusion-Related Chest Pain View Presentation Video Andreas Schuster Keywords: Cardiovascular: Myocardium, Contrast mechanisms: Perfusion While acute coronary syndrome (ACS) continues to be subject of invasive coronary angiography the diagnosis and management of chronic coronary syndrome (CCS) largely depends on non-invasive imaging of myocardial ischaemia and viability. Since cardiovascular MRI has repeatedly demonstrated high accuracy for the diagnosis and prognostication of CCS it has received a class I guideline recommendation (highest level). It should therefore be preferred over invasive angiography for CCS. This presentation will touch on the underlying physiology of myocardial ischaemia, address basic measurement principles including novel strategies and discuss them in the context of current guidelines with an emphasis on prognostic implications.
08:45		MR Techniques for Quantifying Myocardial Perfusion View Presentation Video Teresa Correia Keywords: Contrast mechanisms: Perfusion, Cardiovascular: Cardiac, Image acquisition: Quantification Myocardial perfusion imaging is an essential tool for characterising ischemic heart disease. Moreover, quantitative myocardial perfusion methods that provide pixel-wise quantitative myocardial perfusion maps are increasingly being applied as an alternative to visual inspection. Newer methods combine quantitative imaging with acceleration techniques and motion compensation to overcome current limitations of the technique, and thus, improve spatial resolution and heart coverage, reduce image degradation due to motion and accurately detect perfusion defects. In addition, fully automated workflows are facilitating the integration of quantitative myocardial perfusion into clinical practice by making it faster and easier to use.
		Non-Ischemic Cardiomyopathies
09:15		Achy Braky Heart: Non-Coronary Cause of Chest Pain View Presentation Video Bettina Baeßler Keywords: Cardiovascular: Cardiac, Cardiovascular: Myocardium, Cardiovascular: Valves Chest pain can have many different causes. Besides acute and stable coronary syndromes, a variety of differentials exist when it comes to non-coronary cardiac chest pain. MRI can provide detailed images of the heart and surrounding structures, allowing for the identification of abnormalities that may contribute to chest pain. By utilizing advanced imaging techniques, MRI can detect inflammation, valve disease, and other potential causes of chest pain. The presentation will emphasize the value of MRI as a non-invasive and comprehensive tool in assessing patients with cardiac chest pain, potentially reducing the need for invasive procedures and improving patient outcomes.
09:45		MR Methods for Myocardial Parameter Mapping View Presentation Video Chiara Coletti Keywords: Cardiovascular: Cardiac, Contrast mechanisms: Relaxometry, Image acquisition: Quantification Myocardial parametric mapping has expanded the diagnostic potential of CMR for a wide range of cardiovascular diseases. While conventional tissue characterization techniques rely on relative variations in signal intensity to detect abnormalities, parametric mapping provides pixel-wise quantification of relaxation times on absolute scales. This enables the characterization of non-focal cardiomyopathies, as well as intra/inter-subject analysis. T₁, T₂ and ECV mapping sequences are routinely used in clinical protocols, and new biomarkers are emerging to avoid using contrast agents. Solving challenges like long scan time, susceptibility to artifacts and lack of standardization is essential to promote their application in clinical practice.