IMAG
CANSCMR
Workshop
Spotlight
Idan Roifman
Cardiologist
Sunnybrook Health Sciences Centre
Kim Connelly, MD, FRACP, PhD, MBBS
Director, Krembil Stem Cell Facility
University of Toronto
Bradley Sarak
Cardiology Resident
University of Toronto
Kate Hanneman
Radiologist
University of Toronto
Andrew Yan
Cardiologist
University of Toronto
Andreas Kumar
Cardiologist
Djeven Deva, MD
Radiologist
University of Toronto
James White
Cardiologist
CanSCMR
Ian Paterson
Cardiologist
Craig Butler
Associate Professor of Medicine; Cardiology
Over the past twenty-five years, cardiovascular magnetic resonance imaging (CMR) has become an increasingly utilized imaging modality. The majority of participants in a 2014 European Cardiovascular Research Institute survey indicated that they have begun using CMR “routinely,” compared to three years prior when the procedure was mostly being used experimentally. Further, CMR procedure volume in the United States has surpassed the one million mark in 2016. Gradual technological improvements have allowed CMR to evolve into a unique modality providing unparalleled information on myocardial structure and function while not exposing patients to ionizing radiation or the risk of interventional procedures. In addition to being regarded as the gold standard in the assessment of cardiac structure and function, CMR is renowned for its ability to characterize myocardial properties at the tissue level, a process called tissue characterization. Tissue characterization is a property unique to CMR and distinguishes it from other non-invasive imaging modalities such as echocardiography, cardiac computed tomography and nuclear imaging. There are a number of ways to characterize myocardial tissue. Commonly used tissue characterization techniques include: Late gadolinium enhancement imaging which is able to accurately detect focal myocardial scar, T1 mapping techniques which have been shown to quantify diffuse myocardial processes including fibrosis, amyloid infiltration and glycosphingolipid deposition, T2 mapping techniques that detect myocardial water content or edema and T2* mapping techniques that detect myocardial iron content or hemorrhage. Via a variety of these techniques, insights can be gained with regards to both etiology of disease states (for example the etiology of non-ischemic dilated cardiomyopathy) as well as disease prognosis (for example ischemic cardiomyopathy and diabetes). However, questions remain regarding the reliability and reproducibility of tissue characterization measurements. Further, their importance in independently predicting downstream clinical outcomes and directing management is incompletely understood. Accordingly, this workshop will examine these issues by offering the following four topics as 12-minute presentations: 1. The role of late gadolinium enhancement imaging in the diagnosis and prognosis of ischemic and non-ischemic cardiomyopathies. 2. T2 (edema) and T2* (hemorrhage) imaging. How can it help us? 3. T1 mapping in clinical practice and research. 4. CMR and tissue characterization in diabetes; insights from the EMPA-HEART study. Our workshop is diverse and multi-disciplinary. Our panel involves cardiologists, radiologists, community and academic physicians and trainees.