September 24, 2020
SCMR2021 is Going Virtual!
The health and safety of our members, speakers, industry partners and Annual Scientific Sessions attendees is our top priority. SCMR leadership and staff have been monitoring the conditions and evaluating several possible scenarios for the SCMR 24th Annual Scientific Sessions in San Diego, California, USA. 

After careful consideration, and in conjunction with the projections surrounding the COVID-19 pandemic, we have made the decision to transition to a fully virtual global experience.

The theme of the meeting is Precision. Predictive. Personal. This theme has taken on a new and unexpected meaning as we examined how to maintain and enhance the many unique features of our Scientific Session into our #SCMR2021.

Continuing our path of expanding our international reach through educational opportunities and with our new membership scheme, we are excited to bring our #SCMR2021 global with regionally timed events throughout 2021. 

Parallel to this decision, we are going to keep the Abstract Submission date open until October 29, providing you extended time to be a part of this global experience. Take advantage and Submit Now.

SCMR Virtual Scientific Sessions 2021 will kick off our educational year from February 18-20 with Live and Pre-Recorded educational offerings, including lecture sessions by world leaders in the field of CMR, oral abstract and poster presentations of the latest science, as well as state-of-the art reviews of best practices in cardiac imaging.

The #SCMR2021 will offer diverse and interactive session formats including didactic, debates, rapid fire cases, how-to, and poster presentations. Intertwined will be networking and product/educational showcases from our industry partners. 

Registration will open in October 2020. 2021 SCMR Membership is required to qualify for the discounted SCMR member rate for the SCMR Virtual Scientific Sessions 2021. If you do not renew your membership or join the SCMR for 2021, you will be charged the non-member rate. For membership questions, please contact [email protected]

We hope that you stay safe and healthy during these times and we look forward to sharing more information with you in the coming weeks.

Sincerely,
James Carr, MD, FSCMR
SCMR President
SCMR Membership Committee Update
Hello SCMRers!

These are exciting times in the Membership Committee amid expected challenges in our changing world. Prior to COVID-19 descending upon us we assembled at SCMR’s yearly meeting and set about achieving some great goals for the upcoming year and reviewing some from 2019, including recruiting new members to the committee from more diverse areas of the society over 2019-20 – welcome Dave Annese, Maria Boutsikou, Julio Garcia, Omar Khalique, Natalie Long and John Wilson. As well we want to convey a deep appreciation to the significant contributions from Santosh Uppu, Malenka Bissell, Dipan Shah, and especially Harold Litt, whose involvement stretches to the early days of the Society.

The pandemic can’t keep us down regarding membership, people still love magnets! Compared to 2019 we have increased membership by 2% for a total of 3000+ members including 171 new members from March to August in the midst of the pandemic. Many of the membership benefits and offerings have drawn in both new and old and we have been working to highlight webinars, seminars, renewal promotions as well as increase local community involvement and social media activity. Please also check out the SCMR website for a rich variety of resources and continuously curated content available to members- in particular, the free COVID-19 toolkit.

Importantly, we have also restructured the membership categories and fee structure to reflect an awareness of our global community. So no matter your location or GDP, now’s the time to renew! Click here to renew and enjoy continued discounts for Scientific Sessions, article submissions, SCMR Workshops, SCMR Letters of Verification, online learning portal and resource downloads as well as access to application for FSCMR for recognition of dedication to the field of CMR and a significant level of involvement, dedication, and accomplishments consistent with the overall mission of the Society.

Above all thank you all for your continued enthusiasm and advocacy for CMR! Cheers!

Anthony Merlocco
Chair, SCMR Membership Committee
CMR News
Statement from SCMR on the Role of CMR in Asymptomatic Patients with History of COVID-19 Infection
The current clinical indications for cardiovascular imaging in the evaluation of COVID-19 complications have been summarized in a recent American College of Cardiology guidance document, to which SCMR contributed. The indications for CMR in this context include accurate assessment of chamber size and function, detection of ischemia, myocardial infarction, myocarditis and stress cardiomyopathy. Referrals for imaging tests in the setting of COVID-19 should be guided by their potential impact on patient management. 
 
Recent small and single-center studies have suggested that CMR may detect abnormalities in asymptomatic patients who have had COVID-19 infection. This has led to a debate about the role of imaging, in particular CMR, as a screening tool. The clinical significance of these research findings remains uncertain and further long-term studies are needed to assess their impact. In accordance with the ACC guidance document and in view of the current limited evidence, SCMR does not support the routine use of any imaging tests, including CMR, in asymptomatic patients with a known history of COVID-19 infection.  
 
Several ongoing larger and multicenter studies will provide information on the mechanisms for development of cardiovascular complications in COVID-19 patients and the best way to detect them. SCMR will continue to review the emerging evidence and, in collaboration with other societies, provide updated guidance to the community on the appropriate use of cardiovascular imaging to improve outcomes for those affected by COVID-19.
Recommended CMR Protocols in Patients with Active or Convalescent Phase COVID-19 Infection
As the literature increasingly reveals cardiac involvement in COVID-19 there is a clinical role for CMR to play during the acute or symptomatic convalescent phase in some patients. SCMR has just released a guidance document with the recommended CMR imaging protocol to use for this group of patients. View the article in the Journal of Cardiovascular Magnetic Resonance hereAlso remember that you can help capture the use of CMR in COVID-19 around the globe by completing a short online survey (a combined SCMR and EACVI project) which takes only a few minutes.


Expected CMR-indications in patients within active or convalescent phase of COVID-19
Recommended CMR-protocols in adult patients with active/ post COVID-19
The British Society of CMR Survey Results: UK National and Regional Trends in Cardiovascular Magnetic Resonance Usage


At ESC 2020 Dr Niall Keenan presented the results of the third UK survey of CMR Units on behalf of the British Society of CMR (BSCMR). The survey was performed in 2019 collecting data on scanners, staffing, waiting times and scan volumes for the two previous years (2017 and 2018) as well as other questions such as provision for patients with implantable cardiac devices. The response rate was 100% of units, so the survey gives a comprehensive view of the state of CMR in the UK pre COVID-19.
The UK performed a total of 102,886 scans in 2017, and 117,967 in 2018 representing a 1-year 14.7% increase and a 10-year increase of 573% compared to 2008 data (20,597). By head of population in 2018 there were 1,776 CMR scans per million people, with significant variation nationally and regionally, e.g. 4,256 per million in London vs. 396 per million in Wales. The mean number of scans per unit was 1,404 (range 98-10,000) with wide variation in referral to diagnostic times (mean 45.7 days, range 5-180). There were 358 consultants reporting CMR (234 (65%) cardiologists and 124 (35%) radiologists). 81% of units had a CMR service for patients with pacemakers and defibrillators.

The conclusion was that the 10-year growth has been remarkable, and CMR volumes in the UK are high by international standards, but there are wide disparities in terms of use, access and wait times which need addressed to make CMR provision equitable across the UK.
CMR in MINOCA/ ESC Guidelines
by Chiara Bucciarelli-Ducci

The European Society of Cardiology meeting closed its virtual doors a few weeks ago announcing important new trials in cardiovascular medicine and presenting new guideline documents.

The new 2020 ESC guidelines on NSTEACS was much awaited. Among the new key recommendations, it included a whole new section on myocardial infarction with nonobstructive coronary arteries (MINOCA). The new guideline states that CMR is now a Class IB recommendation for every patient with MINOCA without an obvious underlining cause. This is testament to the pivotal role that CMR plays in the work up of these patients – specifically, the ability to identify an underlying cause in >85%, leading to the most appropriate treatment.

The term MINOCA incorporates a heterogenous group of coronary and noncoronary pathological conditions including small embolic myocardial infarction, infarction with spontaneous recanalization, acute myocarditis, TakoTsubo cardiomyopathy and others. By consensus, the panel of experts proposed that myocarditis and Takotsubo syndrome should be excluded from the MINOCA definition, and have it reserved exclusively to the coronary-based conditions. This decision has created some debate on social media, well summarised in this twitter thread.
CMR in Coronary Artery Disease: From Strength to Strength
The debate between anatomical or functional imaging for coronary artery disease continues – but in reality both approaches have their merits and decisions are best made on an individual patient basis depending on the specific presentation. Meanwhile, two recent papers remind us of the particular strength of stress perfusion CMR imaging in different aspects of CAD assessment. In a large registry study (n = 6389) published in JACC: Cardiovascular Imaging, Marcos-Garces et al demonstrated that revascularisation in patients with a large ischemic burden >5 segments (~>30% ischemic burden) on stress perfusion CMR was associated with lower all-cause mortality. Second, in another multi-center study published in JACC from the SCMR SPINS registry led by Raymond Kwong, Antiochos et al confirmed that presence of MI – whether clinically recognized or not - portended an equally significant risk of death independent of presence of ischemia. Compared with recognized MI patients, those with clinically unrecognized MI were less likely to receive guideline-directed medical therapies and presented an increased risk for heart failure hospitalization. Both of those studies at opposing ends of the CAD spectrum underline the prognostic importance of abnormal findings on stress perfusion CMR + LGE imaging protocols.
New 2021 SCMR Members!
Mobeen Ahmed
Nasih Mohsen Ahmed
Islamiyat Babs Animashaun
Antonio Belda
Adam Canning
Ben Corden
Isabela Bispo Costa
Amit Garg
Adina Haramati
Mohamed Abdelghafar Hussein
Shashank Jain
Donna Jones
Jared Klein
Cédric Lehner
Gavin A Lewis
Juliano Pacheco Lima
Xianglun Mao
Silvan Meier
Smita I Negi
Neil Patel
Rachel Pizano
Marwa Salah
Roy Sanguino Lobo
Jan-Erik Scholtz
Apurva Shah
Fiona Strasserking
Silanath Terpenning
Apostolos Vrettos
Karla Wehrheim
Edward Wooten

Member Success Stories
2018 Clinical Science Seed Grant Recipient

Cardiac Cine Magnetic Resonance Fingerprinting
by Jesse Hamilton

Cardiac MRI exams are often long because many different types of scans must be collected to study different aspects of cardiac anatomy and function. Many cardiac MRI protocols include cine imaging to assess left ventricular (LV) function, as well as quantitative mapping of the MRI relaxation times T1 and T2, which can provide insight into a variety of diseases. However, cine imaging, T1 mapping, and T2 mapping are conventionally performed in separate acquisitions. These scans require multiple repeated breathholds, which can be time-consuming and difficult for patients. In this project, our main goal was to develop a single time-efficient acquisition for jointly performing cine imaging and T1/T2 mapping. We believe that a multi-parametric approach could potentially streamline cardiac MRI exams by providing information about both LV function and myocardial tissue characterization during one rapid scan.
We designed our acquisition using principles based on magnetic resonance fingerprinting (MRF). Our proposed technique, called cine-MRF, acquires highly undersampled spiral k-space data during a breathhold of 11 seconds.

It was a privilege to receive the SCMR Seed Grant, which facilitated this exciting project leading publication; and I enjoyed the opportunity to share our results with the SCMR community during the last annual conference

CMR in Brazil
by Juliano de Lara Fernandes and Carlos Rochitte


CMR in Brazil started in the late 1990s after fellows trained mainly in the US returned home and launched their clinical and training programs. The first training program was launched by the Heart Institute, University of Sao Paulo, and from there innumerous programs followed suit, providing long term, 2-year standardized fellowship positions in advanced cardiovascular imaging. The modality has flourished since then with more than 400 trained physicians and over 70 CMR centers covering a large area of the country.
The main drivers for success are listed below:
  1. High integration between Radiologists and Cardiologists from the beginning with both modalities sharing meetings and constructing a cooperative environment.
  2. Public and private coding available since its conception, allowing for fair reimbursement, with incentives for all stakeholders.
  3. Regular and continuous meetings and long term 2-year training programs, with consistent integration and collaboration with the international CMR community.
  4. Integration of the modality into broader clinical and imaging communities, with CMR practitioners constantly taking roles in important leadership positions outside of the CMR field.
All these points have provided a strong background for the growth of CMR in the country, with new initiatives being driven now to provide full Board Level Certification in the field for all trained physicians, mandatory rotations in CMR for all Cardiology and Radiology fellows and expansion of the use of the exam in public practice.

A practical report from one of the busiest labs in the countries can be found in the accompanying piece below: Dr Paulo Schvartzman reports his experience with over 3600 CMR exams (90% stress perfusion) with a growth rate of > 15% per year.
My Year as the First SCMR Early Career Board Member
by Purvi Parwani

The Early Career (EC) Section Chair was a new SCMR board of trustees (BOT) position announced in 2019 – and I was honored to be the first appointee into this role. The goal is to increase visibility of EC members, address their particular concerns and provide mentoring to become future CMR leaders themselves. I am an EC cardiologist at Loma Linda University and prior to that completed a multimodality imaging fellowship at University of California, San-Francisco. I have witnessed many difficulties posed to those in EC stages while trying to establish successful CMR programs at their own institutes. As I tried to navigate through my own challenges, I understood how important it is to have a voice as an EC representative, not only to establish a path forward for myself but also to leave an easier route for people behind me - the EC BOT position has allowed me to fulfil that role.

Over the year, I have been working on publications that describe the EC challenges of CMR imagers all across the world and also provide the toolkit to help them kickstart their own CMR programs. Further, with the rest of the SCMR social media team, I successfully launched the #WhyCMR campaign on twitter which regularly shares CMR news, showcases the value of CMR and highlights other SCMR initiatives. Being on the SCMR Board has given me valuable insight into the societal operations, finances & challenges - but has also taught me very critical lessons on leadership qualities, effective communication and the crucial role of diversity as well as inclusion in the society. Probably the biggest challenge this year has been working remotely and not having in-person board meetings. As I continue to launch more initiatives to engage EC members before my term ends, I would like to encourage early career radiologist and cardiologist imagers to apply in the future.
SCMR Education Corner
Online Educational Opportunities
Wednesday, September 30 from 11:00 AM - 12:00 PM ET

This webinar will describe the acquisition strategies for T1 mapping and the processing to generate ECV maps. In particular, the MOLLI and SASHA families will be discussed and compared. Furthermore, the webinar will highlight how the choice of acquisition parameters can influence the accuracy and precision of the measurements, and put it into the context of the clinical interpretation.

Presenter: Andreas Sigfridsson, PhD, MR Physicist at the Karolinska Institute, Stockholm, Sweden
JCMR Journal Club

Wednesday, October 14 @ 11:00 am ET

Article to be discussed:

Kocaoglu et. al

Journal Club Editor: Raymond Kwong

Presenting Author: Amol Pednekar
The Fifth Congenital CMR Case Conference (C4)
On Wednesday, September 23 the fifth Congenital CMR Case Conference (C4) developed by the Congenital Steering Board of the SCMR was held. This one hour video conference was packed with interesting, challenging and enlightening congenital cardiac cases with the main theme of “CMR in Pediatric Cardiomyopathy”. Audience participation and moderator discussion was geared towards practical tips from experts, new techniques, and trouble-shooting. The event was hosted by Dr. LaDonna Malone and Dr. Sujatha Buddhe. Guest speakers included Lindsay Griffin, MD of Ann & Robert H. Lurie Children’s Hospital of Chicago who presented “Cardiomyopathy assessment: What’s in your MRI toolbox”; and Lars Grosse-Wortmann, MD of OHSU Doernbecher Children’s Hospital who presented “CMR in HCM risk prediction”. This webinar was recorded and will be available in the SCMR online learning portal in the coming weeks.

Past C4 events currently available in the SCMR online learning portal include:

SCMR Endorsed Meetings
Athens, Greece
October 3-5, 2020

Duke University School of Medicine
October 5-9, 2020

Kuala Lumpur, Malaysia
November 2-4, 2020

If you'd like your meeting to be endorsed by SCMR, click here for details.
SCMR Case of the Week
Number 20-07: New Murmur in a Patient with Pectus Deformity

A 14-year-old male presented to a pediatric cardiologist following referral for a new murmur heard on sports physical examination and for cardiac evaluation of connective tissue disease due to concern for Marfanoid features. His cardiac history was unremarkable, and there was no family history of connective tissue disease or sudden unexplained death. His medical history was notable for two years of progressive pectus carinatum. He was followed by orthopedics and was recommended for treatment with a brace. Physical exam was notable for a harsh grade III/VI systolic murmur best heard at the mid-left sternal border. Physical exam findings were also notable for a superiorly positioned pectus excavatum and an inferiorly positioned asymmetric pectus carinatum. 

COVID-19 Survey from
SCMR & EACVI
Back in May, the Society for Cardiovascular Magnetic Resonance (SCMR) and the European Association of Cardiovascular Imaging (EACVI) launched an online survey to capture use of CMR is suspected COVID-19 cases around the globe.

We are making a push over the next month to record as much activity as possible before analysis begins- please contribute!

Each submission (one per scan) takes only five minutes and is entirely anonymous.

** Confirmed or high-probability COVID-19 cases can be included (regardless of test result)
** Both acute or recovery phase scans are eligible.
** You can also complete a survey for patients scanned in the past.
** Can easily be completed on your smartphone- just bookmark the page.
Around the Globe
CMR in Brazil: Performing 3600 CMR cases per year and growing
by Paulo Schvartzman
In the south of Brazil, the city of Porto Alegre reflects a well-defined example of how CMR has succeeded in Brazil. Dr. Paulo Schvartzman trained at the Cleveland Clinic with Richard White and Scott Flamm from 1998 to 2001 returning to his home town to develop the then new imaging technique in a private setting. At the start, no one new about CMR, but Dr. Schvartzman repeatedly participated in hospital rounds, as well as every Cardiology conference he could, explaining how this novel technique was useful to investigate cardiac diseases but always focusing on ischemic heart disease given its prevalence.

The message spoken as a mantra was that “CMR can help combine information from Nuclear Medicine and Echo, focusing on cost-effectiveness and speed. We have a technology that can answer your questions about ischemia, viability and LV/RV function in 20 minutes with higher accuracy that the other tests available”. And from that point on, CMR started its continuous increase in number of cases. Beginning with small numbers in 2002 with only 100 cases that year to 3200 cases in 2018 and 3600 cases in 2019, 90% focused on stress induced ischemia. “The numbers increase about 15-20% a year, but we have to focus on cost-effectiveness not only to patients and payers, but also to the hospital. If we can perform a CMR exam at a fair reimbursement value on the same time length as a brain MRI, for example, your hospital will want you to increase the numbers and provide incentives for this. It can be win-win for all sides” states Dr. Schvartzman.
#WhyCMR | Social Media
August 22 to September 21, 2020
#WhyCMR Activity
by Jennifer Co-Vu
Each month our social media committee correspondents update us on the latest #WhyCMR activity stats, most popular tweets or threads. Join the conversation and use the #WhyCMR in your social media posts!
Just for Fun
CMR Picture Puzzle
What well known MRI term is illustrated below? Answer available next month.
Last month's CMR crossword answers:
JCMR Articles
CMR Literature Search
Please use this link for a filtered PubMed list of all CMR-related manuscripts for September 2020 – more than 200 in total!