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Appropriateness and diagnostic yield of cardiac magnetic resonance imaging from a tertiary referral center in the Middle East

Background

Cardiac magnetic resonance imaging (CMR) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program.

Methods

All patients who underwent CMR studies between January 1st 2013 and June 18th 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed by a level III trained cardiologist. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines.

Results

There were a total of 142 patients (mean age [SD] 42.1 [18] years, 24.6% female) that underwent CMR study. Two-third of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value (Table 1). Of the remaining 130 appropriate studies (appropriateness level A8-A9) (Figure 1), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant burden (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation.

Table 1 Details of non-appropriate indications for CMR studies
figure1

Figure 1

Conclusions

Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.

Funding

None.

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Correspondence to Wael AlJaroudi.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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AlJaroudi, W., Ism'eel, H., El-Merhi, F. et al. Appropriateness and diagnostic yield of cardiac magnetic resonance imaging from a tertiary referral center in the Middle East. J Cardiovasc Magn Reson 17, P303 (2015). https://doi.org/10.1186/1532-429X-17-S1-P303

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Keywords

  • Cardiac Magnetic Resonance
  • Diagnostic Yield
  • Cardiac Magnetic Resonance Imaging
  • Tertiary Referral Center
  • Left Ventricular Myocardium