BJR,the international research journal of the British Institute of Radiology, has published a collection of articles on the theme of imaging patients with stable chest pain, guest-edited by leading experts Professor Matthijs Oudkerk and Professor Edwin van Beek.
Millions of people around the world suffer from chest pain. Diagnosing the cause of chest pain and identifying the level of risk are integral to the prevention of serious coronary events and poor patient outcomes. Imaging is central to these efforts and provides vital information to primary care physicians, cardiologists and the variety of doctors who manage patients with stable chest pain.
Following the publication of the SCOT-HEART trial in 2015 (a study to see if coronary artery calcium score and computed tomography coronary angiogram alters the proportion of patients diagnosed with angina due to coronary heart disease), a new era of non-invasive coronary imaging has opened up. ThisBJRspecial feature covers many of the important topics and questions facing the scientists and clinicians working in the field and presents a collection of insightful Review articles and Commentaries from leading international experts.
Professor Edwin van Beek said “This special feature is essential reading for any medical professionals interested in stable chest pain.The articles cover vital topics such as vulnerable plaque, cost-effectiveness for imaging stable ischemic disease,the potential for functional coronary and cardiac CT imaging, the role of machine learning, the role of MRI for the assessment of chest painandthe role of imaging in the evaluation of heart valve disease”.
Professor Matthijs Oudkerk explains “This special feature marks the moment of publication of the first hard evidence that non-invasive coronary CT imaging in patients with chest pain saves lives compared to current medical practice and at the same time is a lot less harmful for the patient, costs less and is more effective. This special feature is not to be missed!”.
You can access the special feature here: https://www.birpublications.org/toc/bjr/93/1113
Images
Figure 1 from https://doi.org/10.1259/bjr.20190881
Figure 1. The top row is an example of an ischemic perfusion defect, where the stress perfusion image shows a clear hypoperfused area (red arrows), whereas the LGE image shows no defect. The bottom row shows an infarct-related perfusion defect, where on both, stress perfusion (slightly hypoenhanced tissue, red arrows) and LGE image (strongly hyperenhanced tissue) a defect is shown (red arrows). This example of an infarct patient also demonstrates the superiority of LGE to delineate scar in comparison to the perfusion approach. In scar, the extracellular Gd-chelate contrast medium distributes in a large extracellular (fibrotic) compartment during first-pass, which increases the signal in the fibrotic tissue explaining its reduced sensitivity to detect hypoperfusion in scar. This reduced sensitivity to detect hypoperfusion is not observed in viable myocardium (with small extracellular compartment). LGE, late gadolinium enhancement.
Figure 4 from https://doi.org/10.1259/bjr.20190740
Figure 4. 18F-GP1 arterial uptake in right popliteal artery. 18F-GP1 PET-CT images of a patient who had recently undergone right common femoral artery endarterectomy and right popliteal artery angioplasty. Anterior maximum intensity projection and axial images taken 120 min after 18F-GP1 injection show focal increased uptake in the right popliteal artery (a, b); arrows), which corresponds to a thrombotic lesion after angioplasty (c). Additional 18F-GP1 uptake is seen in the dissected right distal external iliac artery (d, e); dotted arrows) and right common femoral artery (a, f); arrow heads) where endarterectomy was performed 3 days prior to the PET-CT (g, arrow head). Images courtesy of Chae et al.40 PET, positron emission tomography.
Figure 5 from https://doi.org/10.1259/bjr.20190797
Figure 5. Examples of coronary plaques with significant uptake on 3 h PET and low tracer activity of 1 h post injection imaging. Short axis images of proximal left anterior descending, proximal circumflex (A) and distal right coronary artery (B) plaques (arrows) which had a TBR <1.0 on 1 h PET (left column) and showed uptake exceeding the 1.25 TBR threshold at 3 h. This research was originally published in JNM. Kwiecinski J, Berman DS, Lee SE, Dey D, Cadet S, Lassen ML, Germano G, Jansen MA, Dweck MR, Newby DE, Chang HJ, Yun M, Slomka PJ. Three-Hour Delayed Imaging Improves Assessment of Coronary 18F-Sodium Fluoride PET. J Nucl Med. 2019 Apr;6025 :530–535. doi: 10.2967/jnumed.118.217885. PET, positron emission tomography; SUV, standardized uptake value; TBR, target to background ratio.
You can read this press release with full colour images included here.
Notes to Editors
AboutBJR
BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences.
Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of CT "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896.
About The British Institute of Radiology
The British Institute of Radiology is an international membership organisation for everyone working in imaging, radiation oncology and the underlying sciences.
Our aims are to:
- support the work of our members and their colleagues to achieve professional excellence
- provide continuing professional development for our multidisciplinary community
- publish cutting-edge research for our authors and readers across the world
- influence and connect with the wider professional sector.
Registered Charity No: 215869
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