New Cardiology Imaging Tools Include MRI Myocardial Tissue Quantification to Help Fight Cardiovascular Disease

New imaging tools have been designed for a more precise diagnosis of cardiovascular diseases using computed tomography (CT), magnetic resonance imaging (MRI), and molecular imaging, as well as utilizing a universal angiography system with sophisticated features for cardiology.

An MRI application has been designed for myocardial tissue quantification, in addition to precise and effective myocardial perfusion due to a new application for CT systems. Siemens Healthcare (Erlangen, Germany) presented its latest cardiology imaging technology at the Congress of the European Society for Cardiology (ESC), held August 30 to September 3, 2014, in Barcelona (Spain).

Early detection of heart failure with MRI cardiac magnetic resonance imaging (CMR) provides detailed information about the morphology and function of the heart. Current ESC guidelines consider CMR to be the gold standard for the diagnosis and treatment of acute and chronic heart failure. This is largely due to MRI’s accuracy in measuring heart volume, mass, and wall motion, including evaluation of ischemia and viability.

The MyoMaps application not only enables visual diagnosis but also offers physical quantification of myocardial tissue with MyoMaps. The tool makes it possible to record microscopic changes in myocardial tissue and represent them as pixel-based, colored images. This enables the diagnosis and quantification of diffuse myocardial pathologies, scar tissue, and edemas in the very early stages of the disease. It also allows for early detection and quantification of iron overload, which can result in heart failure.

With these findings, physicians can diagnose and begin treating heart patients earlier than before and improve the course of disease. MyoMaps is now available for the 1.5-Tesla scanner Magnetom Aera and the 3.0-Tesla scanner Magnetom Skyra, and will be available for more scanners in the future.

Using CT to evaluate the total range of myocardial perfusion, one of the developments in computed tomography highlighted by Siemens at this year’s ESC congress is the Syngo.CT cardiac function-enhancement application for myocardial perfusion. With this application, both CT angiography and functional assessment of coronary lesions, using perfusion imaging, can be performed using only one modality. This means more convenience for the patients, offers a faster approach to diagnosis for the physician, and saves time. Combined with the Somatom Force CT scanner, it is very easy to incorporate the tool into daily routine, since it offers substantially improved spatial coverage of the heart.

CT angiography is used to examine the coronary arteries and identify stenosis, indicating risks to myocardial blood supply. The evaluation of myocardial perfusion provides physicians with important additional data to enable them to decide whether the patient is suffering from a hemodynamically relevant stenosis requiring intervention in the cath lab. Precise and insightful diagnostics are particularly important in the case of patients with moderately severe stenosis, where a diagnosis based only on CT angiography findings is not possible.

Physicians can achieve this evaluation using Syngo.CT Cardiac function-Enhancement and an examination using the Somatom Force or Somatom Definition Flash. They can choose from the entire range of myocardial perfusion, regardless of whether the process involves first-pass enhancement for the qualitative identification of perfusion defects, late enhancement to diagnose tissue affected by scar lesions, or the quantitative evaluation of myocardial blood flow via dynamic myocardial perfusion.

Three new applications for the Biograph mCT Flow positron emission tomography-computed tomography (PET-CT) scanner from Siemens Healthcare will also be featured at this year’s ESC congress. “Phase matching can be used with PET/CT examinations to enhance quantification and image quality. Identical displays, for instance, are automatically provided for the cardiac phase in both PET and CT measurement, enabling physicians to compare both datasets directly against each other.

The Smart auto cardiac registration application automatically aligns the PET and CT images based on anatomical landmarks, providing for the correct values for PET attenuation correction at all times, even if the CT and PET data are acquired in different time points. This previously had to be done manually, which meant more time was needed and the results were less reproducible.

HD•Cardiac is a new application that enables respiratory motion management on PET cardiac scans without the need for an external respiratory trigger device. This device had earlier been needed to synchronize the acquisition with the respiratory cycle. Now, however, electrocardiography (ECG) gating and respiratory gating are performed together. There is no need for an additional respiratory gating unit next to the ECG, because the movement of the heart caused by breathing can be corrected by the PET data itself. The result is reduced respiratory motion blur, improved visualization of PET images and less complicated patient positioning.

Minimally invasive procedures are becoming more and more popular world-wide. In cardiology, these mainly include dilation of narrowed coronary arteries (coronary stenosis) or revascularization of peripheral artery disease, and implanting pacemakers. Siemens Healthcare developed Artis one angiography system with advanced features for all of these routine interventions, and will showcase it at the ESC 2014 congress.

The angiography system is similar in positioning flexibility to a ceiling-mounted system, while requiring much less space: Artis one needs only 25 square meters, compared to the usual 45 square meters for ceiling-mounted systems. It has multiple axes that can be moved independently of each other, enabling physicians and clinical staff to select the most appropriate system position with ease to suit every procedure, regardless whether the physician stands on the patient’s right, as in the case of a coronary examination, or on the left, for pacemaker implantations.

The inclusion of Clearstent Live provides Artis one with a feature that was previously available only for the premium product family Artis Q and Artis Q.zen. This cardiology application enables the physician to mask out movement of the beating heart in order to place the stent in precisely the right position. The new HeartSweep functionality makes use of the system’s double axis rotation and enables to capture all cardiac standard projections in one movement of the C-arm. This can be done in only five seconds and with only one injection of contrast agent.

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