An Invitation from the Journal of Cardiovascular Magnetic Resonance

The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). Working with our new managing editor, Jennifer Rodriguez, this year we have focused on reducing the time from manuscript submission to first decision. For the last 6 months, we have seen a 50% improvement to a mean of 34 days. We hope to get this under 30 days for the last quarter of the year. Many thanks to our associate editors, reviewers, authors, and readers for making the JCMR the premier CMR publication journal, with a 2020 impact factor of 5.4!

Please join us for our popular monthly JCMR Journal Club—now in its second season—held on the second Wednesday of the month at 11 am ET. At our upcoming 13 October 2021 journal club, JCMR Journal Club Editor Dr. Raymond Kwong will be joined by Dr. Håkan Arheden to discuss their article, “Pulmonary blood volume measured by cardiovascular magnetic resonance—influence of pulmonary transit time methods and left atrial volume.” Please join us!

Do you love SCMR? Of course you do! With the end of the year approaching, now’s the time to renew! We have launched our new membership fees based on GDP, so no matter your location, it's a great time to take advantage of all that SCMR has to offer. Try re-engaging with our website, and enjoy discounts for Scientific Sessions, article submissions, and SCMR Workshops. Apply for your SCMR Letters of Verification or FSCMR for recognition of your dedication to the field! Don't forget to click on the Facebook and Twitter icons to stay updated between newsletters. Click here to renew—and above all, thank you all for your continued enthusiasm and advocacy for CMR!

This month brought another incredibly exciting virtual #ESCcongress. Once again, multiple studies and guidelines confirmed the instrumental value of #whyCMR. We present a focused selection of CMR highlights here:

by Dr. Vass Vassiliou, Professor of Cardiac Medicine

University of East Anglia, UK

The value of MRI (including CMR) for clinical decision making in patients with cardiac implantable electronic devices (pacemakers and defibrillators) is undisputed, and MR-Conditional systems have reduced risk and made workflows easier. Older "non-MR conditional" or MR-unlabeled systems can generally also be scanned provided strict protocols are followed, but few sites provide such services despite CMS coverage. Most patients with older devices will undergo generator change over coming years due to battery depletion, with exchange for an MR-Conditional generator. Unfortunately, the continued presence of old leads means that these "mismatched" systems (MR-Conditional generator attached to non-MR conditional leads) will remain categorised as non-MR conditional, and patients will continue to struggle to access MR imaging.

Bhuva et al. recently published data in European Heart Journal comparing the safety of MRI between patients with non-MR Conditional and MR-Conditional pacing leads across three sites in the UK and the US, including data from over 1,100 scans. The study showed no increased risk in patients with non-MR conditional leads, either in terms of safety events or changes to lead parameters after MRI. The authors highlight that device MR Conditionality should therefore depend on the labelling of the generator, irrespective of the leads connected. This would significantly simplify workflows and expand the number of cardiac patients with pacemakers and defibrillators able to access MRI.

There is still work to do with increasing MRI provision even for patients with MR Conditional devices. The same group from Barts and University College London led by Dr. Charlotte Manisty have also surveyed all hospitals in England, with responses from 95% of sites. The data published in Open Heart shows that despite a four-fold increase in scan provision between 2014 and 2019, only 53% of sites will scan MR-Conditional devices (10% also scan non-MR conditional). This means that patients across large geographical regions in England have no access to hospitals that will offer MRI, and there is no relationship between supply and demand for scans.

Via SCMR we would advocate that all CMR units should provide scans at a minimum for patients with MR-Conditional devices, and given the expanding supportive data, consider scanning non-MR conditional devices. Members should also be prepared to provide mentorship and support for general MRI units who may have less experience with cardiac patients to encourage them to develop services providing non-cardiac scans for patients with pacemakers and defibrillators who should have equity of access to diagnostic imaging.

All applicants must be Regular or Technologist members of SCMR in good standing for the past 3 consecutive years with a distinguished record of CMR science, education, or clinical practice. Applications are reviewed twice per year—the next and final deadline in 2021 will be 1 November. 

Click here for details on FSCMR benefits and the application process.

In support of these agencies’ efforts, SCMR encourages CMR practitioners to use their relevant regional mechanisms for vaccine adverse event reporting (such as VAERS in the U.S.) to report any suspected cases with CMR findings if obtained. Also, the SCMR registry affords a platform for participating members to share images and clinical data with a global community.

Twitter-based #WhyCMR journal watch 📚⌚—join the online discussion!

1.    Rapid CMR in <15 mins? Anatomy, cine, & LGE in 2 breath-holds 🏃‍♀️⏳⏩💨

2.    High CMR diagnostic accuracy for cardiac tumor assessment 🥔🥦

3.    Obesity cardiomyopathy—a distinct entity? 🍔💔⚖

4.    Early CMR assessment for MINOCA is high-yield 🐙💚💙❤

5.    Acute carbon monoxide poisoning causes myocardial injury & fibrosis 🚬🔥🧯👩‍🚒

6.    Pacemaker? Defibrillator? Non-conditional? Pah…no problem! 🧲⚓

7.    Are you MAD or pseudo-MAD—what is really disjunction? 😡😠

8.    Ischemia is strong predictor of MACE in HFpEF 💔 📈

9.    CMR abnormalities in 21% 6 months after hospitalized COVID-19 💔 🦠

On 21 July 2021, experts Chiara Bucciarelli-Ducci, MD, and Colin Berry, MD, presented the Siemens Healthineers webinar Novel Insights into MINOCA and INOCA: Resolving Diagnostic Dilemmas and discussed the potential of diagnostic imaging for risk assessment and prognosis in MINOCA and INOCA patients. This webinar highlighted the added value of CMR, CT, and Angio imaging in both acute and chronic ischemia without obstructive coronary arteries. The recording of this innovative session is now available on the SCMR Online Learning Portal.

The British Society of Cardiovascular Magnetic Resonance (BSCMR) is the UK’s national representative body for CMR. Formed in 2006 by a group of national leaders and enthusiasts in CMR, BSCMR aims to promote the clinical use and practice of high-quality, cutting-edge CMR and to strive for high-quality diagnostic CMR services across the UK.

As with all major medical societies, BSCMR is looking at how to evolve and adapt to the new world after the pandemic. Along with the online webinars, its annual meeting will be held on 12 October 2021 as a full hybrid offering, both online and in person, at the Royal College of Physicians, London (Register here). After the last 18 months, we look forward to taking part in rebuilding the global CMR community to which many of our members proudly belong.

by Dr. Mark Westwood, BSCMR President

The standard inversion-recovery (IR) sequence with the inversion time (TI) set for myocardium nulling used for LGE imaging has its limitations. Due to the often bright signal of the blood pool, blood may appear equally enhanced as adjacent subendocardial scar regions. During the last 15 years, various novel dark-blood LGE approaches have been proposed to increase scar-to-blood contrast and improve subendocardial scar conspicuity. Most of these methods use additional magnetization preparation mechanisms to either suppress the blood pool signal partly (gray-blood techniques) or null the signal completely (black-blood techniques). These mechanisms include T₂ preparation, magnetization transfer, and spin-locking in concert with the standard inversion pulse, and utilization of multiple inversion pulses. Similar effects, however, have also been achieved without using any additional magnetization preparation. As each approach utilizes a different contrast mechanism, a great variety in contrast between the normal myocardium, blood pool, and areas of enhancement can be achieved nowadays. For a mainstream adoption of dark-blood LGE methods, however, clinical availability and ease of use are crucial.

Our latest review article aims to provide a comprehensive overview of the various dark-blood LGE methods. For each method, the employed contrast mechanism and corresponding magnetization preparation scheme are illustrated, followed by a discussion on the findings in phantom, preclinical, and clinical studies. Finally, various aspects relevant for LGE imaging are discussed, conclusions on the current evidence and limitations are drawn, and new avenues for future research are mentioned.

by Robert J. Holtackers, MR Physicist,

Cardiovascular Research Institute Maastricht (CARIM)

bSSFP showing image distortion artefact.      

Using a gradient echo sequence will reduce the artefact, but also image contrast.      

The SCMR web site hosts “Case of the Week” - a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. Recently we have published the case archive from 2019 in JCMR as a means of further enhancing the education of those interested in CMR and as a means of archiving this incredible resource from our members on PubMed. 

Last month's CMR Picture Puzzle answer:

Please use this link for a filtered PubMed list of all CMR-related manuscripts for September 2021—more than 400 in total!