Meetings

The group organises between five and six meetings per year, these have been held at each site undertaking CMR on a rotational basis. They are formally accredited by the Royal College of Physicians of London for CPD points, and are open to consultants, trainees, and allied healthcare professionals with an interest in CMR. The meetings are free to attend please get in touch if you are keen to attend.

The planned meetings are noted below.

At each meeting we use the first 90 minutes to look at regional cases that either provide a diagnostic dilemma to utilise the experience in the room, or cases that provide nice examples of conditions that can be studied with CMR. The second half of the meeting is on a more specific topic prepared by the unit consultant and registrars

Recent meeting topics:

March 2020 Meeting: First case presented was a lady with a BMI of 67 who was successfully scanned with focal Septal Hypertrophic Cardiomyopathy (HCM), the discussion centred around contrast dose to use in this situation, and the pitfalls in interpretation of Regadenoson stress in HCM.  A second case of HCM with extremely unusual septal epicardial enhancement was discussed, and a third case with normal wall thickness, but abnormal ECG and very marked RV insertion point enhancement.

Dr James Dundas then presented a unique case of presumed focal pericardial clot presenting with IVC insertion stenosis causing peripheral oedema, the management of which was extensively discussed.

Dr Nic Child then presented a paper on the merits of late gadolinium enhancement degree to predict risk of SCD in HCM (Freitas et al. Journal of Cardiovascular Magnetic Resonance (2019) 21:50). This provoked wide ranging discussion of the use of scores to predict risk in HCM, and LGE was felt to be of value but not presently integrated in the European  in the risk scoring systems for HCM

January 2020 Meeting:Fascinating case of apparent RV takotsubo’s cardiomyopathy, cases of likely infarction with mid wall enhancement. Dr Child and Dr Davison discussed a series of papers looking at the present perceived variation in normal ranges for volumetric analysis. The discrepancy is most marked between the Biobank data (Peterssen et al, JCMR 2017 19 18.) and normal ranges used in most centres derived from small cohorts (Maciera et al, JCMR 2006;8(3):417-26.) This led to extensive discussion around which set of values to use while still maintaining parity with echocardiographic parameters. Further support for the Bio bank data has come form a large European cohort (European Radiology (2018) 28:3996–4005 ) suggesting a similar normal range of EF to Biobank. The consensus suggested that the group should await decision from BSE around alteration of the echo grading then  review normal ranges applied to CMR data.

December 2019 Meeting: Series of cases reviewed including some unusual mitral valve pathologies, and profound case of lipomatous hypertrophy of the intra-atrial septum, and a case of potentially both ischaemic scarring and infiltration.

Dr Crilley presented the results of an extensive audit into the therapeutic usefulness of cardiac MRI in the ? myocarditis indication and found a different diagnosis when considered across age groups of patients, and size of troponin release leading to a discussion around the merits of CMR in this population.

Dr Maredia  presented the initial available results from the Ischemia trial, and the group discussed the impact that trial will have on stress perfusion imaging

Sept 2019 Meeting: The meeting looked at a series of cases, including two primary cardiac malignancies and two cases of cocaine related cardiomyopathy.

Dr McDiarmid gave a fascinating talk on the imaging characteristics of athletic heart, and the complexities in differentiating athletic heart from early dilated cardiomyopathy, looking at advanced methodology including CSPAMM tracking and T1 map derived ECV calculation. One paper on  prolonged training was felt to elegantly demonstrate the cardiac physiological adaptation to high level exercise. (Arbab-Zadeh Circ 2014: 130;215)

July 2019 Meeting: cancelled due to un-avoidable circumstances

April 2019 Meeting:This meeting looked at a series of interesting cases from around the region.  Dr Mahadevan, International Imaging fellow, from Malaysia presented an audit of the T1 map values for the Northumbria service allowing for the sequence and machine parameters, and comparing them to the literature. Dr Child led a  review of the summary document created by the group which he has edited to a single side of A4 succinct summary of indications for CMR to be distributed to regional consultants to assist non CMR colleagues in appropriate requesting of the modality. Dr Ripley presented the Biobank paper (JCMR 2017 19:18) looking at the changes this would cause to normal ranges applied to reports across different sex and age demographics. The paper and its implication for regional services provoked a lively  discussion.

January 2019 Meeting: The meeting covered two classical cases of Andersen Fabry disease with a discussion around the use of T1 maps to assist in the diagnosis. Dr Davison gave an comprehensive talk on the use of CMR to assess intra-cardiac shunts and the potential pitfalls of the approach. Dr Child spoke about the development of pathways for the region and the group has agreed to split the pathways up and present areas for discussion at the next meeting

November 2018 meeting was cancelled due to proximity to the course.

September 2018 James Cook: This meeting looked at some complex cases from the region, and Dr Maredia’s talk covered non compaction as a clinical entity with review of the more recent literature where the diagnosis has become less established, due to the frequency with which the findings are seen in the normal population. Dr Green undertook an excellent summary of the use of CMR to assess valvular heart disease with review of the literature on CMR parameters associated with the need for valve intervention.

June 14th 2018: This meeting focused on the complexity of diagnosing cardiac sarcoid including a fascinating talk on PET CT for diagnosing cardiac sarcoid by Dr Tamar Ali, Consultant Radiologist, and a summary talk by Dr Alexandra Thompson, a newly appointed consultant, on the benefits of using an MDT for these complex and potentially subtle diagnoses.

Cases discussed:CMR in cardiac mitochondrial disease

March 20th 2018: This was a successful and interesting meeting, where several regional cases were reviewed, including a case of Kasawsaki disease presenting in middle age, and an unusual case suggestive of ARVC with RVOT dyskinesis seen during ventricular bigeminy. Dr Rae Davison gave an excellent summary of the evidence underpinning the MRI assessment of atheletes as part of overall risk assessment

Since the initial meetings in 2015 we have covered wide ranging topics including

Comparison of Regadenason vs Adenosine as vasodilator stress in CMR.

CMR findings in Takotsubo cardiomyopathy

CMR in the work up for TAVI

CMR in pulmonary hypertension.

The role of T1 mapping in routine CMR outside research

We have discussed many regional cases including examples of Fabry’s disease, cardiomyopathy associated with Fredrichs ataxia, cardiac mitochondrial disease, mass lesions including primary cardiac masses and secondary lesions such as an invasive thymoma. We have reviewed congenital cases including new presentation of congenitally corrected transposition, and complications after coarct surgery.