Dear Cardiac Insider,
Much has been made of the use of initial coronary CT angiography for evaluation of patients with suspected coronary disease, but other approaches, including so-called standard care with invasive angiography serving as the initial imaging test if warranted, remain common throughout the world. A third approach for patients presenting with chest pain is initial perfusion MRI before considering coronary angiography, or fractional flow reserve before angiography.
How do the costs stack up? Researchers presenting at the European Society of Cardiology compared the price tag of initial MR versus sending patients straight to the cath lab, versus fractional flow reserve plus angio. They found some surprises -- and some broad cost variations -- between several European countries and the U.S.
MR is also uniquely qualified for follow-up after acute myocardial infarction, according to a German team. In particular, the presence of left-ventricular thrombi at cardiac MR makes all the difference in recovery, they report here.
Meanwhile, coronary artery calcium scoring with CT remains one the best predictors of coronary events and mortality, and many physicians recommend its routine use in individuals at risk. The test has even been found to boost the predictive value of Framingham and other risk predictors. But the semiautomated scoring test takes time to perform well, and that can be a burden.
Dutch researchers have taken a new tack, building an algorithm that identifies and quantifies coronary artery calcium from CT scans, paving the way for faster deployment of a test that is increasingly important in gauging the likelihood of adverse events. Get the story on automated scoring here.
Performing cardiac MR on patients with pacemakers can be dangerous if the device isn't certified as MR-safe. Unsatisfied with the guidelines issued two years ago by the European Society of Cardiology, German researchers have recently issued guidelines of their own. The subject of MRI-safe and MRI-conditional pacemakers is a complex one, according to the German Radiology Cardiovascular Diagnosis Working Group, which published the new position paper, and deserves more nuanced treatment. Get the rest of the story here.
We invite you to scroll through the links below for the rest of the news in cardiac imaging. You won't miss a beat with the AuntMinnieEurope.com Cardiac Imaging Community.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
