Effective Study: Development and Application of a Question-Driven, TimeEffective Cardiac Magnetic Resonance Scanning Protocol

Abstract

BACKGROUND: Long scanning times impede cardiac magnetic resonance (CMR) clinical uptake. A “one-size-fits-all” shortened, focused protocol (eg, only function and late-gadolinium enhancement) reduces scanning time and costs, but provides less information. We developed 2 question-driven CMR and stress-CMR protocols, including tailored advanced tissue characterization, and tested their effectiveness in reducing scanning time while retaining the diagnostic performances of standard protocols. METHODS AND RESULTS: Eighty three consecutive patients with cardiomyopathy or ischemic heart disease underwent the tailored CMR. Each scan consisted of standard cines, late-gadolinium enhancement imaging, native T1-mapping, and extracellular volume. Fat/edema modules, right ventricle cine, and in-line quantitative perfusion mapping were performed as clinically required. Workflow was optimized to avoid gaps. Time target was <30 minutes for a CMR and <35 minutes for a stress-CMR. CMR was considered impactful when its results drove changes in diagnosis or management. Advanced tissue characterization was considered impactful when it changed the confidence level in the diagnosis. The quality of the images was assessed. A control group of 137 patients was identified among scans performed before February 2020. Compared with standard protocols, the average scan duration dropped by >30% (CMR: from 42±8 to 28±6 minutes; stress-CMR: from 50±10 to 34±6 minutes, both P<0.0001). Independent on the protocol, CMR was impactful in ≈60% cases, and advanced tissue characterization was impactful in >45% of cases. Quality grading was similar between the 2 protocols. Tailored protocols did not require additional staff. CONCLUSIONS: Tailored CMR and stress-CMR protocols including advanced tissue characterization are accurate and timeeffective for cardiomyopathies and ischemic heart disease.