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EDUCATION EXHIBIT |
Department of Radiology, University of Arkansas for Medical Sciences, Department of Radiology, Arkansas Children’s Hospital, Little Rock, Arkansas
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All of these advances in noninvasive cardiovascular imaging have come at a time when cardiovascular disease remains the leading cause of mortality in the United States (1). Forty-one percent of all deaths in the United States are attributed to cardiovascular disease. Over 60 million Americans have at least one form of cardiovascular disease. About 40,000 babies a year are born with congenital heart disease. The need for accurate diagnostic cardiovascular imaging has never been greater.
The comfort level of general radiologists with cardiac imaging has ironically diminished as the tools for performing high-quality noninvasive imaging have evolved. Echocardiography and cardiac angiography have become the domain of the cardiologist. Conventional radiography plays only a minor role, with echocardiography frequently being the first imaging test used to evaluate patients with suspected heart disease. Radiology training in cardiac imaging has until recently been neglected. The lack of exposure to cardiovascular imaging in daily work frequently leaves general radiologists "out of the loop" in caring for patients with cardiovascular disease.
The divide between general radiologists and the relatively small number of elite radiologists advancing the field of cardiovascular imaging has grown so wide that one wonders how the general radiologist can hope to narrow the gap. In the preceding article, Haramati et al (2) begin to build a bridge across the chasm. The authors do not use the most advanced techniques available for cardiovascular imaging. Instead, they use equipment and basic techniques that are likely to be available to a larger number of general radiologists. Even restricted to electrocardiographically gated spin-echo T1-weighted imaging and single–detector row helical CT, the authors show that practical information necessary for patient care can be obtained. The authors chose to study lesions that are vascular rather than intracardiac. Most of the anomalies studied are common: coarctation of the aorta, vascular rings, and pulmonary artery abnormalities associated with tetralogy of Fallot. Heterotaxy syndromes are less common, but the venoatrial relationships lend themselves to cross-sectional imaging. In each category, the authors were able to not merely duplicate the results of echocardiography but add valuable information needed for surgical management without the need for invasive angiography. The detection of additional diagnoses such as Takayasu arteritis in a patient with coarctation or a mimicker of a vascular ring adds value to the CT and MR imaging examinations.
A general radiologist reading this article should be encouraged that cardiovascular evaluation with helical CT and MR imaging can be part of a standard radiology practice. The simple techniques used by Haramati et al can be used as a foundation to begin practicing modern cardiovascular imaging. The general radiologist may then develop the confidence to use more advanced cardiovascular imaging techniques such as gradient-echo cine imaging, contrast-enhanced MR angiography, and flow analysis. In time, the chasm between subspecialist and generalist can be bridged.
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Department of Radiology, Albert Einstein College of Medicine, Department of Radiology, Montefiore Medical Center, Bronx, New York
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Adoption of cutting-edge imaging techniques by our general radiology community, such as MR angiography, flow analysis, diffusion imaging, and MR arthrography, has successfully been embraced. It is our impression that this adoption was dependent on several factors. The anatomy and pathologic conditions evaluated with these techniques already captured the interest of general and subspecialist radiologists. Radiologists had been directly involved in the diagnosis and management of these diseases. Radiology training, scientific journals, and society meetings had all emphasized these areas.
Cardiac imaging, especially of congenital heart disease, may have been "orphaned" in radiology circles because the anatomy and pathophysiology were not embraced by general or subspecialty radiologists. Currently, improved understanding of developmental embryology and advances in cardiac surgery have dramatically altered the natural history of congenital heart disease.
We applaud the efforts of the Radiological Society of North America and other professional organizations to provide the necessary educational materials and tools to allow the knowledge of cardiac anatomy, pathologic conditions, and pathophysiology to become as commonplace in radiology circles as the knowledge of vascular disease, glenoid labral abnormalities, and biliary malformations. The European Society of Cardiac Radiology defined the following as one of their goals: to expand and offer our knowledge, competence, and expertise for the benefit of cardiac patients (1). Intellectual cross-fertilization, collaborative efforts with our clinical colleagues, and outcomes research programs are vital to improving our understanding of this important field (2).
It is our belief that high-quality imaging of cardiac disorders will improve patient care when general and subspecialty radiologists understand the anatomy, pathologic features, and pathophysiology of cardiac disease.
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This article has been cited by other articles:
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  R. M. Steiner Invited Commentary RadioGraphics, July 1, 2002; 22(4): 905 - 906. [Full Text] [PDF]
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