Letter from the Guest Editor

Article Outline

• Copyright

This issue of Seminars in Ultrasound, CT, and MRI is part two of a focus on imaging of the chest. In this issue, the focus is noninvasive imaging of the heart. Cardiovascular disease remains the number one cause of death both in the United States and worldwide. Cardiovascular disease is the primary cause of death in women as well as men in the U.S., accounting for 38% of all deaths in 2002. The total cost in the U.S. for cardiovascular disease was nearly $400 billion dollars in 2005. The role of CT and MRI in heart disease is changing dramatically. This issue will focus on some of the reasons for this impending revolution in noninvasive imaging for cardiac disease.

Dr. Michael Jerosch-Herold and colleagues present the use of MRI for the evaluation of myocardial ischemia using perfusion techniques. Dr. Jerosch-Herold is a pioneer in the development of rapid scan techniques and analytic methods for perfusion assessment. Perfusion assessment of the heart typically requires a stress agent, but the examinations are nevertheless rapid and can be incorporated into a busy clinical schedule.

Dr. Kathleen Wu and colleagues present the use of MRI for the evaluation of myocardial viability. Dr. Wu was the first investigator to demonstrate the importance of microvascular obstruction by MRI in acute infarction as the key parameter predicting patient prognosis after an infarction. MRI is currently the gold standard for myocardial viability assessment, with greater spatial resolution than nuclear methods as well as a shorter and more accurate examination. MRI viability assessment for patients after myocardial infarction provides key diagnostic information after acute and chronic infarction.

Dr. Christopher Kramer is a senior investigator and innovator in cardiac MRI function and structure assessment, and his group presents an overview of MRI to evaluate cardiomyopathy. MRI is unique in its ability to provide information regarding myocarditis, infiltrative disease or arrhythmogenic conditions of the heart. Dr. Kramer provides a comprehensive overview of the range of MRI applications in these areas.

Multi-detector CT (MDCT) greatly expands the role of the cardiovascular imaging physician. Dr. Mathew Budhoff has a great deal of experience in all aspects of MDCT applications, and has been a pioneer in the use of MDCT to evaluate coronary calcification. His article presents an overview of the use of MDCT and electron beam CT to evaluate coronary artery disease based on calcium assessment, as well as the significance of calcium scoring.

MDCT will be making a further dramatic impact in the evaluation of coronary artery disease using angiographic techniques. Dr. Thomas Gerber is a leader in these applications, and presents the use of MDCT and its potential in the evaluation of coronary CT angiography. Because MDCT is an important and powerful tool for coronary artery disease, both the strengths and limitations of the method need to be understood, and are reviewed in this article.

Dr. Pamela Woodard is an experienced and recognized clinician scientist in the evaluation of cardiovascular disease by noninvasive methods. She and her colleagues present the use of MDCT for noncoronary applications. MDCT has tremendous flexibility and potential for myocardial function, valve assessment or viability amongst other applications. Dr. Woodard reviews these applications as well as traditional strengths of MDCT for noncoronary pathologic conditions.

Noninvasive imaging of the heart using MRI and MDCT has advanced significantly so that MRI and MDCT are now changing the management of cardiovascular disease on a daily basis for both inpatients and outpatients. Given the importance of cardiovascular disease both worldwide and in the U.S. population, physicians performing noninvasive imaging need to understand their impact and potential. The goal of this issue is to help improve understanding cardiac MRI and MDCT in this context.