Standardized reading and reporting of CT/MRI exams Innovations in Cardiothoracic Imaging May 2011 Tokuda Hospital Sofia, BG

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1 Standardized reading and reporting of CT/MRI exams Innovations in Cardiothoracic Imaging May 2011 Tokuda Hospital Sofia, BG Luigi Natale, MD MRI Dept., Centro Oncologico Fiorentino Catholic University of Sacred Heart, Rome ITALY

2 AGENDA Reading Reporting Guidelines Nothing to disclose Disclosure

3 CT/MR reading What we need to know before: Coronary and cardiac anatomy Coronary and cardiac pathophysiology and ATS pathology Coronary anomalies (origin, course, termination) Other technique (US, NM, ICA) planes and segmentation CT/MR technical features, and signs Post-processing tools and use

4 CT/MR reading The answers: Education Training Personal experience N of procedures Certification of specific societies

5 CT/MR reading WS or PC/MAC post-processing software CT/MR image quality (artefacts) CT: identification of the best data set (if retrospective) CT/MR anatomy morphology CT coronary arteries (at least origin with MR) CT/MR cavities: density signal intensity CT/MR myocardium: density signal intensity MR function (and CT, in case of retrospective gating)

6 CT reading Axial source images MPR Curved MPR (+ vessel analysis) MIP VR Plaque characterization To evaluate: Calcium scoring Presence of ATS: Localization Degree of stenosis Lenght of stenosis Plaque: - calcified - non calcified - mixed

7 CT reading J: W. M. Hoe,Int J Cardiovasc Imaging (2007) 23:

8 CT reading: axial images

9 CT reading

10 CT reading

11 CT reading

12 CT reading

13 MR reading Black blood images (T1-T2) Cine-MRI (+ flow images) Perfusion images Post-Gd images (early and delayed)

14 CORSO CMR

15 CORSO CMR

16 CORSO CMR

17 CORSO CMR

18 MR reading

19 CORSO CMR

20 CT/MR reading

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23 CT/MR reporting Structured report: improves quality through consistency Systematic approach, no omissions Lexicon development standardazes descriptors Common language between cardiologists, radiologists and nuclear med doctors Easier extraction of informations Easier interface with electronic medical records

24 CT/MR reporting Structured report: referred to standard planes Accepted classifications (LV segments AHA, coronary arteries AHA segmentation)

25 CT/MR structured report Structured Reporting: Coronary CT Angiography A White Paper from the American College of Radiology and the North American Society for Cardiovascular Imaging Arthur E. Stillman, MD, Pha,D Geoffrey D. Rubin, M b,d Shawn D. Teague, M c,d Richard D. White, M d D, Pamela K. Woodard, M e,d Paul A. Larson, M f D J Am Coll Radiol 2008;5: Examination Indication Comparison studies Procedure Findings Extracardiac findings Impressions/conclu sions

26 CT/MR structured report Scanner Accredidation (status, entity, society) Physical parameters (indexing) Cardiovascular parameters Administered drugs (stressors) B e

27 CT/MR structured report Templates: within post-processing SW MASS Pie Medical Circle cmr-42 CMR Tools Report-card GE Vital Images Vitrea Philips Viewforum Siemens Leonardo.. ALL DICOM COMPATIBLE!

28 RM cuore (con MDC) CORSO CMR TECNICA: Esame eseguito prima e dopo iniezione di mc paramagnetico mediante sequenze Black blood FSE con triplo impulso di inversione, cine RM FIESTA, di perfusione e di delayed enhancement. RISULTATI: Il diametro telediastolico del ventricolo sn e' aumentato (mm 71). Regolare lo spessore del setto anteriore (11mm) La parete posteriore del ventricolo di sn ha spessore telediastolico di mm 6 Ridotto lo spessore della parete anteriore e dell'apice del ventricolo sn (< 5.5 mm). Nei limiti il diametro telediastolico della camera di afflusso del ventricolo dx (mm 44). Regolare l efflusso. Regolare lo spessore della parete libera del ventricolo dx. Non segni di edema. Allo studio cine RM si osserva oggi acinesia del SIV anteriore e dei segmenti anteriori basale e medio, dei segmenti apicali settale, anteriore e laterale, del segmento medio-laterale; discinesia con aspetto aneurismatico dell'apice; ipocinesia del setto inferiore. Nettamente depressa la funzione sistolica globale del ventricolo sn (VTD= ml/m2; VTS= ml/m2; EF= 19%). Regolare la funzione sistolica globale del ventricolo dx (VTD=99 ml/m2; VTS= 56 ml/m2; EF= 41%). Nelle immagini di delayed enhancement si osserva impregnazione transmurale delle pareti anteriore, setto-anteriore, basali e medie, del setto inferiore medio, dei segmenti apicali anteriore settale ed inferiore, come per miocardio non vitale. Coesistono segni di danno del microcircolo a livello del SIV anteriore basale e medio. Normale lo spessore del pericardio. Modesta falda di versamento pericardico e modesta falda di versamento pleurico bilaterale. CONCLUSIONI : Esiti di infarto anterosettale; 9 segmenti con criteri di non vitalita ; Il ventricolo sn e dilatato. Nettamente ridotta la funzione globale.

29 CT/MR reading & reporting What should be reported? Description and summary of the main findings Clinical implications Suggestions for futher investigations, if needed, either cardiologic or non cardiologic (REMEMBER, WE ARE RADIOLOGISTS!)

30 CT/MR reading & reporting