feature articlewritten for Northwestern Memorial Hospital published in Lifetime of Health Cardiac magnetic resonance imaging: Fifty-four year old Patrick Johnson, a life coach who makes his living helping others manage crises, didn’t know there was anything wrong with his heart. The Chicago resident sometimes had difficulty catching his breath, but thought it was a natural part of aging. “When I did something that caused rapid exertion, I’d have to pause and catch my breath, but only for a minute. I just thought I was getting older,” he says. On the advice of a friend, Mr. Johnson called the Northwestern Memorial Hospital Physician Referral Service to find a doctor for an annual exam. “I was looking for a new primary care physician,” he says. “I told them my preferences, including personality.” He was referred to Jane Vogelmann, M.D., an internist at Northwestern Memorial and clinical instructor of Medicine at Northwestern University’s Feinberg School of Medicine, and scheduled an appointment for an office visit. “Dr. Vogelmann is very friendly and attentive. The referral staff did a great job addressing my preferences,” says Mr. Johnson. During a routine physical examination last September, Dr. Vogelmann diagnosed Mr. Johnson with a pronounced heart murmur. She did an EKG, or electrocardiogram, and referred him to Tom Holly, M.D., medical director of Nuclear Cardiology and co-director of Cardiac MRI at Northwestern Memorial and assistant professor of Medicine at Northwestern University’s Feinberg School of Medicine. Dr. Holly told Mr. Johnson that feeling winded is not a normal part of aging, but rather a symptom of a bigger problem. Using cardiac magnetic resonance imaging (cardiac MRI), Dr. Holly and Scott Pereles, M.D., a radiologist and associate director of Cardiac MRI at Northwestern Memorial and assistant professor of Radiology at the Feinberg School, diagnosed asymmetric septal hypertrophy, which means that one wall of Mr. Johnson’s heart is abnormally thick. This condition can cause several problems, the most serious being potentially life-threatening, abnormal heart rhythms. In other words, Mr. Johnson was at risk for sudden cardiac arrest, commonly called sudden death. “The thicker the septum, or wall, the more likely a person is to develop these abnormal rhythms. So it’s important to measure the septal thickness,” says Dr. Holly. “Scarring of the heart muscle also may affect heart rhythms, and the cardiac MRI is the best way to detect this scarring.” According to the American Heart Association, cardiovascular disease is currently the No. 1 cause of death in America, responsible for more than 40 percent of the 2.4 million deaths each year. Cardiovascular disease currently affects 61.8 million men and women in America. This includes diseases of the heart, high blood pressure, congestive heart failure, congenital heart defects, hardening of the arteries and stroke. Cardiac arrest occurs when the heart stops beating due to illness or injury. When the heart stops abruptly and unexpectedly, it’s called sudden cardiac arrest. Sudden cardiac arrest most often results from an irregular heart rhythm that causes the heart to stop pumping blood. Death can occur within minutes if proper medical care is not administered, including cardiopulmonary resuscitation and electric shock (defibrillation). Cardiac magnetic resonance imaging While MRI technology itself is 20 years old, only in the past few years has technology improved to the point where accurate images of moving tissue can be taken. “This technology is important because MRI can see the walls, blood clots, heart function – which you can’t always see with other tests,” says Dr. Holly. “When a patient’s heart isn’t functioning very well and you are considering bypass surgery or angioplasty, MRI helps you know if surgery is the right option because it allows you to actually see how the heart is functioning.” Cardiac MRI is growing in importance because of its enormous potential to monitor atherosclerosis and because it allows physicians to see things that other tests do not show clearly. For example, current tools such as angiography show how much narrowing has occurred in blood vessels, but MRI can provide a view of the vessel wall itself. MRI is superior to CT scans for distinguishing among various soft tissues. Bone and gas do not provide barriers to visualization in MRI, making it superior to ultrasound as well. MRI technology has made dynamic vascular studies possible, allowing physicians to see blood flow and organ perfusion, which can be very difficult with other techniques. “I typically order a cardiac MRI for a patient when I need a clear picture of the heart’s viability. I’m not satisfied with what the other tests can show in this area,” says Lorraine Bangayan, M.D., a cardiologist at Northwestern Memorial and clinical instructor of Medicine at the Feinberg School. “We are fortunate that our institution supports cardiac MRI. Many facilities aren’t that advanced.” Cardiologists estimate that in about 30 percent of patients with heart disease, conventional methods for imaging the heart fall short in providing accurate information on which to guide treatment. Many cardiologists believe that cardiac MRI can help this significant population. In Mr. Johnson’s case, Dr. Holly prescribed medication in an aggressive effort to keep his blood pressure under control. Based on his test findings, Mr. Johnson also may be considered for an implantable cardioverter defibrillator. This high-tech, surgically implanted device monitors the heart rhythm and shocks the heart back to normal rhythm if it starts to beat too rapidly. Mr. Johnson says he feels lucky the test showed his heart was in trouble. “I had no idea I needed help,” he says. The cardiac MRI experience “The technicians made sure I was comfortable,” says Mr. Johnson.
He adds with a chuckle, “When they took the images, the noise kind
of surprised me. It sounded like something from ‘Star Wars.’
If you are in the right frame of mind for the noise, it’s a perfectly
comfortable experience.” A multidisciplinary approach to delivering excellence “We have leaders in the field in both cardiology and radiology, which is important because these MRI scans are not interpretable by everyone,” says Keith Horvath, M.D., a cardiothoracic surgeon at Northwestern Memorial and assistant professor of Surgery at the Feinberg School. “There’s a certain level of expertise that’s needed to understand the images. And we are leading the way with this technique.” On average, 20 cardiac MRI scans are ordered each week at Northwestern Memorial. “We’ve looked at hundreds of these scans, and in terms of the kinds of images we can get, ours are the best-looking,” says Dr. Holly. “We get such great results through cooperative efforts between the cardiology and radiology areas. Excellent service means we combine our expertise.” Cardiologists and radiologists often read the scans together and hold interdisciplinary conferences to discuss patient cases for clinical decision-making. The cardiologists and radiologists at Northwestern Memorial also are interested in investigating new technologies and improving science. Their close collaboration helps them accomplish this mission. “We bring different skill sets to the table, and we work together to decide the best way to do things,” says Reed Omary, M.D., M.S., an interventional radiologist at Northwestern Memorial and assistant professor of Radiology at the Feinberg School. “The growth of cardiac MRI requires a team approach among all of these disciplines.” Where research and technology meet “We’re creating the technology here,” says Dr. Pereles. “Most of the major ways people are creating MR images of the heart now were developed here at Northwestern Memorial.” The hospital’s radiology department is an academic practice that includes researchers and technicians dedicated to patient care. “For the past six years, our MRI division has maintained state of the art high-field MR technology for both clinical and research applications. Our research relationship with Siemens Medical Systems has provided us with immediate access to all new hardware and software advancements,” says Eric Russell, M.D., chair of Radiology at Northwestern Memorial and Drs. Frederick J. Bradd and William Kennedy professor at the Feinberg School. Once a new imaging technique has been proven to be useful by the research team, physicians at Northwestern Memorial implement it clinically. “Our site has helped to develop many of the newer techniques now available and used internationally for the highest quality cardiac and vascular MR imaging,” says Dr. Russell. The department’s mission is to work to provide exceptional patient care and service to physicians; conduct internationally recognized research; and educate future leaders in radiology. With support from the Feinberg School, the Radiology Department recently installed the first whole body 3T MR machine in Illinois, which is dedicated to research into functional imaging. “Our goal here is to research ways to use MRI technology to find out the information we need to know in a noninvasive way,” says Debiao Li, Ph.D., an MRI physicist at Northwestern Memorial and associate professor of Radiology at the Feinberg School. The multidisciplinary research team is currently looking at developing the technology to use MRI for the early detection of coronary artery disease, examination of the coronary vessel itself and evaluating oxygen supply to the heart. “Cardiac MRI has the potential to combine a lot of information that other, sometimes more invasive, techniques currently provide – such as echocardiography, nuclear medicine and coronary angiography,” says James Carr, M.D., an interventional radiologist at Northwestern Memorial and assistant professor of Radiology at the Feinberg School. “Our goal eventually is to be able to evaluate all pathology within the heart in a non-invasive manner.” Mr. Johnson is glad he went to Northwestern Memorial, and is relieved to say that his risk for sudden cardiac arrest was found to be significantly less than previously feared. “I like that I’m getting the benefit of cutting edge science here. But in addition to the expertise, I also like the concern I get from the physicians and staff. They care for me, as well as my body.” To obtain a referral to a physician at Northwestern Memorial Hospital, call our Physician Referral Service at 312-926-8400. ### For more information, contact
Jennifer Ecklund-Johnson via e-mail at jen@jenej.com.
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