In-vivo-validation of a cardiovascular risk prediction tool: the arriba-pro study.

BACKGROUND: Calculation of individual risk is the cornerstone of effective cardiovascular prevention. arriba is a software to estimate the individual risk to suffer a cardiovascular event in 10 years. Prognosis and the absolute effects of pharmacological and lifestyle interventions help the patient make a well-informed decision. The risk calculation algorithm currently used in arriba is based on the Framingham risk algorithm calibrated to the German setting. The objective of this study is to evaluate and adapt the algorithm for the target population in primary care in Germany. METHODS/DESIGN: arriba-pro will be conducted within the primary care scheme provided by a large health care insurer in Baden-Württemberg, Germany. Patients who are counseled with arriba by their general practitioners (GPs) will be included in the arriba-pro cohort. Exposure data from the consultation with arriba such as demographic data and risk factors will be recorded automatically by the practice software and transferred to the study centre. Information on relevant prescription drugs (effect modifiers) and cardiovascular events (outcomes) will be derived from administrative sources. DISCUSSION: The study is unique in simulating a therapy naïve cohort, matching exactly research and application setting, using a robust administrative data base, and, finally, including patients with known cardiovascular disease who have been excluded from previous studies. TRIAL REGISTRATION: The study is registered with Deutsches Register Klinischer Studien (DRKS00004633).

Atherosclerotic disease: whole-body cardiovascular imaging with MR system with 32 receiver channels and total-body surface coil technology--initial clinical results.

In this prospective study, the feasibility of a comprehensive cardiovascular imaging protocol with a dedicated whole-body 1.5-T magnetic resonance (MR) imager with 32 receiver channels in 34 patients with peripheral arterial occlusive disease was evaluated. Informed consent and institutional review board approval were obtained. Three-dimensional MR angiographic data sets were acquired with adapted injection protocol. Cardiac functional imaging and delayed-enhancement imaging were performed, as were fluid-attenuated inversion-recovery imaging of the brain and time-of-flight MR angiography of the intracranial blood vessels. Sensitivity and specificity for depiction of significant vascular stenosis (> 70%) were 96%, with conventional digital subtraction angiography as the standard. Substantial microangiopathic tissue alterations (n = 4) and/or cerebral infarction (n = 4) were diagnosed in seven patients. In seven patients, subendocardial or transmural delayed enhancement was detected in corresponding regions, indicating prior myocardial infarction. Previously unknown findings diagnosed with MR imaging required midterm follow-up or therapy in 24 patients, whereas change of therapy or immediate treatment was necessary in three. For patients suspected of having systemic atherosclerotic disease, comprehensive risk assessment is feasible within 30 minutes.

Whole-body MR angiography using a novel 32-receiving-channel MR system with surface coil technology: first clinical experience.

PURPOSE: To demonstrate the feasibility of detecting atherosclerotic vascular disease using an innovative magnetic resonance angiography (MRA) protocol in combination with a dedicated whole-body MR scanner with new surface coil technology. MATERIALS AND METHODS: A total of 10 volunteers and eight patients with peripheral arterial occlusive disease (PAOD) were examined at 1.5 T. Conventional digital subtraction angiography (DSA) of the symptomatic region was available as a reference standard in all eight patients. Depending on subjects' size, four to five three-dimensional data sets were acquired using an adapted injection protocol. Images were assessed independently by two readers for vascular pathology. Additionally, signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were measured. RESULTS: Whole-body MRA yielded excellent sensitivity and specificity of more than 95% for both readers with high interobserver agreement (k = 0.93). Surface coil signal reception rendered a high SNR (mean 151.28 +/- 54.04) and CNR (mean 120.75 +/- 46.47). Despite lower SNR and CNR of the cranial and cervical vessels, a two-step injection protocol exhibited less venous superposition and therefore proved to be superior compared to single-bolus injection. CONCLUSION: Our approach provides accurate noninvasive high-resolution imaging of systemic atherosclerotic disease, covering the arterial vasculature from intracranial arteries to distal runoff vessels. The recently introduced MR scanner and coil technology is feasible to significantly increase the performance of whole-body MRA.

Fast whole-body assessment of metastatic disease using a novel magnetic resonance imaging system: initial experiences.

OBJECTIVE: The objective of this study was to investigate the clinical use of a novel whole-body magnetic resonance imaging (MRI) system for comprehensive assessment of tumor spread in clinical routine. MATERIAL AND METHODS: Sixty-five patients with different tumors with known metastatic disease and 6 healthy volunteers were included. High-resolution MRI from head to toe was performed using multiple phased-array surface coil elements, 24 independent receiver channels, and an integrated parallel acquisition technique (iPAT). A total room time of less than 60 minutes was required. Whole-body MRI and conventional spiral computed tomography (CT) were independently evaluated and compared in terms of feasibility, location/number of detected metastases, and therapeutic relevance. RESULTS: Whole-body MRI was successfully performed in 68 of 71 subjects. Compared with CT, more metastases were detected by MRI in 11 of 63 patients (17%), particularly in brain, liver, spleen, lymph nodes, bone marrow, muscle, and subcutaneous fat tissue. According to these findings, therapy had to be modified in 6 of 63 patients (10%). CONCLUSIONS: High-resolution whole-body MRI is feasible in clinical routine within 1 single examination and offers great potential for fast assessment of individual tumor spread and total tumor burden.