The 25th Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions saw 1524 registered participants from more than 50 countries attending the meeting virtually. Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters. The sessions were designed so as to showcase the multifaceted role of cardiovascular magnetic resonance (CMR) in identifying and prognosticating various myocardial pathologies. Additionally, various social networking sessions as well as fun activities were organized. The major areas of focus for the future are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using artificial intelligence and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow.
Keywords: Cardiovascular magnetic resonance; Valvular heart disease; Non-ischemic cardiomyopathy; Rapid cardiac magnetic resonance; Artificial intelligence; 4D flow; Congenital heart disease; 3D printing; Early career
Cardiovascular magnetic resonance (CMR) is an integral part of cardiovascular medicine. With the unprecedented advances in CMR, this field has attracted the rapidly growing interest of the clinical and scientific communities throughout the world [[
In addition to the main meeting, three large pre-conferences were held—the Physicians and Peds/Congenital Heart Disease (CHD) preconference and the SCMR/International Society of Magnetic Resonance in Medicine (ISMRM) workshop. The meeting organization was led by Dr. Michael Salerno and a balance of cardiologists, radiologists, scientists, technologists, and others comprising the SCMR Program Committee. Special effort was made to ensure that the faculty represented a balance of male and female radiologists, cardiologists, scientists, and allied health professionals.
Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters (Fig. 1). The opening plenary session "The past, present and the future of SCMR" recorded the highest attendance. The second plenary, "CMR: Delivering Value", discussed value from the perspective of different stakeholders including physicians, hospital administrators, and a patient who underwent CMR as part of her care. In this session, the American College of Cardiology (ACC) president Dr. Dipti Itchhaporia also shared her views on how CMR can offer value to various stake holders. For the 3rd Plenary, "Towards the 10-min CMR Exam", various approaches including real time, 3D all-in-one, and artificial intelligence (AI) for rapid imaging were discussed. Dr. Harlan Krumholz presented the keynote lecture where he discussed how CMR plays a pivotal role in the era of precision medicine. The two outstanding Gold Medal lectures (2021 recipients) for this year were delivered by Drs. Matthias Stuber and Matthias Friedrich. Dr. Stuber shared his exciting and inspiring journey in this field and Dr. Friedrich shared his vision for the future of CMR.
Graph: Fig. 1 Statistics of the Society for Cardiovascular Magnetic Resonance (SCMR) 2022 Annual Scientific Sessions meeting. The pie chart shows the distribution of participants across the continents
In this present manuscript we summarize the highlights from SCMR 2022, organized by different cardiovascular pathologies and CMR techniques.
The established utility of CMR in the diagnosis and management of non-ischemic cardiomyopathy (NICM) was well demonstrated in the variety of sessions focussing mainly upon case-based discussion of the applications of CMR. The talks highlighted the expanding role of CMR in assessing myocardial structure and function, wall motion abnormalities, myocardial mechanics, perfusion, viability, valvular function, advanced myocardial tissue characterization, risk stratification and prognostication of patients with NICM [[
The session on valvular heart disease (VHD) focused on the fundamentals, and provided tips and tricks on VHD assessment by CMR by luminary Dr. Dipan Shah. Substantial focus was given to 4D flow imaging particularly in bicuspid valve patients [[
Early Career sessions at SCMR 2022 focused on three parallel themes. The organizing committee and Early Career Council not only designed the sessions on career advancement and professional development, but also wanted to give early career professionals the opportunity to network with mentors as well as other early career professionals across the globe. For professional growth sessions, the most popular session was "Early Career Challenges and Growth as A CMR Imager and Researcher—Hearing from Mentor–Mentee Duos". Five successful mentor–mentee duos shared their journey from the beginning, and discussed how mentorship can be a key for growth of a mentee. "Launch Your CMR Career—Clinical and Research" sessions focused on finding a clinical and research niche as a multimodality imager, tips on key components of a CMR service, choice of the first scanner in new CMR lab, training of the CMR technologist, collaboration with industry, core lab set up and choice of scanner for early career professionals across the world. Early career professional growth sessions were dedicated on discussion on developing leadership skillsets through different stages of one's career, discussed tips for successful radiology-cardiology collaboration for clinical growth and need for a coach, mentor and sponsors for the academic growth of early career CMR imager. Last but not the least, the early career professional challenges across the world gave us a perspective on common challenges early career professionals face in the field of CMR.
Another highly attended session at SCMR 2022 was the Friday plenary session on rapid CMR "Towards the 10 min CMR Exam". The session discussed some of the technical advances that should allow us to further reduce the CMR examination time without compromising image and diagnostic quality. Recently, CMR protocols of 30 min or shorter duration with routine techniques have been described in a SCMR white paper [[
The pediatric and congenital heart disease (CHD) sessions at SCMR 2022 provided attendees with a wide range of offerings: from building blocks to launch a junior career all the way to state-of-the-art talks on cutting edge research. The Pediatric/CHD Pre-conference spanned seven sessions, including use of CMR in patients with implanted cardiac devices, the expanding role of CMR in patients with pulmonary hypertension, and a discussion on the added challenges of 3 T CMR in pediatric patients [[
Women's cardiovascular One of the highlights of SCMR 2022 was focus on quantitative perfusion for evaluation of Ischemia and No Obstructive Coronary Artery disease (INOCA). During the session on women's cardiovascular disease, Dr. Chiara Bucciarelli-Ducci spoke at length about use of quantitative CMR perfusion for diagnosis of microvascular disease (MVD), and how an automated pixel-wise perfusion mapping technique on CMR can be used to detect physiologically significant coronary artery disease (CAD), defined by fractional flow reserve, MVD defined by index of microcirculatory resistance ≥ 25, and to differentiate MVD from multivessel coronary disease [[
CMR in cardio-oncology session highlighted the importance of CMR strain as a tool in early detection of cardiotoxicity, prediction of its prognosis and the role of CMR strain in guiding therapy & management. The need for more literature to correlate different CMR strain techniques and the need to include CMR strain parameters in cardio-oncology trials was emphasized to understand impact of left ventricular (LV) strain on diagnosis and management. The multimodality guidelines for imaging cardiotoxicity, emphasizing the need for early initiation of heart failure therapy leading to better outcomes were discussed at length in these sessions [[
In late 2021, the highly anticipated new Guidelines for the Evaluation and Diagnosis of Chest Pain was published with endorsement by multiple societies including SCMR [[
During the physician's pre-conference course, Dr. Ana Barac, led the delegates through the basics of evaluation of cardiac masses. She highlighted the CMR protocol comprised of ventricular functional analysis, T1 and T2 weighted sequences with and without fat suppression through the mass and surrounding structures, first pass perfusion with slices through the mass lesion, repeat T1 weighted fast spin echo with fat suppression (early after gadolinium-based contrast agent administration), repeat selected balanced steady state free precession cine images post contrast (optional), followed by LGE, including long TI imaging (thrombus vs tumour) and serial imaging (hypoperfused tumour necrotic core vs thrombus) [[
4D flow imaging has been the new kid on the block in the #WhyCMR world in the last few years. In this year's program, a complete dedicated session regarding the present and future of the technique was held. As Dr. Joshua Robinson depicted, 4D flow CMR is moving from being a research tool to answering real-life clinical questions, with a central role in congenital heart disease patients but also increasingly used for the direct assessment of valvular heart disease due to the valve tracking feature provided in various processing softwares. One of the pioneers in the field, Dr. Michael Markl, showed the advantages of the application of compressed sensing, AI and deep learning to 4D flow in order to accelerate the acquisition (5 min), reconstruction (30 times faster with AI) and to automatize segmentation [[
The field of CMR coronary imaging has recently advanced thanks to faster and higher spatial resolution sequences. In the aforementioned Friday plenary "Towards a 10 min CMR Exam", it was shown that comprehensive, non-invasive imaging of coronary atherosclerosis is possible with CMR using a 3D multiparametric sequence in only 10 min [[
A primary focus of this year's meeting was on case-based CMR learning which covered ischemic heart diseases, NICM, cardiac and pericardial masses, CHD and VHD. These cases covered the applications of cine images, mapping, LGE, perfusion imaging, extracellular volume (ECV) quantification and strain imaging in the diagnosis and management of a wide spectrum of both common and rare cardiac pathologies. In addition, there was a competition among the Top 5 Cases of the Week for year 2021 (now "Cases of SCMR") which included tricuspid valve papillary fibroma, endocardial fibroelastosis in congenital pulmonary stenosis, coronary sinus atrial septal defect by 4D flow CMR, role of CMR post-LV assist device explanation and RV outflow obstruction in a patient with pectus carinatum. In addition to the recognition at Scientific Sessions, cases of SCMR for a particular year are collated will be published in Journal of Cardiovascular Magnetic Resonance (JCMR), making this an exciting option to those wanting to submit their interesting CMR cases as brief case reports.
Every year, there are exciting advances in the development of new CMR sequences. One of the more prominent topics presented this year was related to the ongoing advances in CMR fingerprinting. This involves the development of multi-dimensional, multi-parametric quantitative CMR sequences, which incorporate different types of tissue characterization/function into a single acquisition. This includes a combination of T1 mapping, T2 mapping, T2*, fat fraction, T1rho, cine imaging in 2D or 3D with perhaps free breathing/self-gated acquisition to improve CMR efficiency [[
The hot topic of incorporation of AI into the practice of CMR was discussed in detail at SCMR 2022. Machine learning AI can improve CMR performance with more data over time. AI permeates not only the image reconstruction allowing free breathing ungated image acquisition to produce useful images for clinical assessment, but also post-processing quantification such as cardiac chamber volume calculation and myocardial perfusion. There is now investigation into using machine learning to identify cardiac diseases and provide prognostic information. Radiomics is the ability to extract data from images that is not readily identified by the naked eye, but can be derived from machine learning algorithms. There are ongoing projects which investigate the assessment of cine images with myocardial deformation analysis to identify cardiac pathology, texture analysis of cine images to determine areas of scar without the use of contrast, and the use of cine images to obtain displacement encoding with stimulated echo (DENSE) type strain data [[
There have been 20 years of development in interventional CMR. Dr. Robert Lederman discussed various barriers have prevented the wide spread use of the technology, and the technologic advances that has occurred. The development of low field (0.55 T) CMR may help with reduced specific absorption rate (SAR) limitations and heating and easier development of CMR safe interventional equipment. The current work has been assessing how to use hemodynamic data with catheterization and CMR volumetric data to create pressure–volume loops to enhance the understanding of pathophysiology of disease states. These concepts were elucidated by the esteemed panel at this year's meeting.
Dr. Orlando Simonetti reviewed the various methods of performing exercise CMR and the utility of the test. This can include supine bicycles/steppers, hand grip exercise equipment and hydraulic driven treadmills. Exercise CMR can be used to assess a patient's cardiac function during exercise, and may have particular value in the setting of unexplained dyspnea. Exercise CMR has been used to assess obstructive CAD, dilated cardiomyopathy, and heart failure with preserved ejection fraction. Future directions in this area include the determination of systemic metabolic oxygen consumption with CMR oximetry and real-time flow imaging and post-processing to see stroke volume and cardiac output changes during exercise [[
As the 25th SCMR annual scientific sessions were presented virtually, the Technologist Track consisted of 18 pre-recorded presentations which formed 6 unique and interesting sessions. All the presentations were available as on demand videos which could be viewed by the delegates at any time during the 4 days of the conference. This made it exceedingly convenient no matter where in the world, and at whatever time the delegates wished to view the videos. The technologist track benefited greatly from the 6 live breakout Zoom sessions where two moderators and the presenters could discuss at length the topics of their pre-recorded videos, and answer questions submitted into the chat box by the live audience. Each session was well attended and discussions on topics such as CMR physics, safety, and pediatric imaging were enjoyed. A particularly interesting discussion took place in the Advances in CMR session, which included the previous President and Gold Member winner Prof Matthias Stuber. The fascinating discussion focused on the evolving role of the technologist in the setting of potential reductions in imaging time and increasing amounts of post processing and data evaluation over the coming years because of ongoing technological innovations in sequence design and the expanding use of AI in image acquisition.
The early career reception held on Wednesday evening was a great platform for the exchange of ideas between the early career CMR imagers. More than 70 early career members from more than 15 countries met virtually at this event. The speed mentoring session for the early career and the fellows in training allowed the early career and fellows in training to meet with various CMR leaders. The Women in CMR reception held on Thursday saw the incredible women power of SCMR tuning in to have an interesting discussion on work-life balance, time management, self-care, importance of family and priorities in different spheres of life. Similar to last year, the SCMR video initiative included a few videos released on social media in which an early career member interviewed one member from the SCMR leadership on a particular session or topic of interest. Events like yoga and Peloton ride were necessary virtual getaways from the busy conference schedule and drew many fitness enthusiasts. The SCMR kudo board allowed delegates to scribble their thoughts and previous memories and have a virtual chat with each other. The Gathertown virtual party was a nice alternative to the in-person afterparty of the SCMR. The SCMR quiz conducted by the incredible quizmasters Drs. Mark Westwood, Patricia Bandettini and John-Paul Carpenter registered one of the highest attendances and a complete amalgam of fun and education (Fig. 2).
Graph: Fig. 2 The social media initiative and various events and activities organized during SCMR 2022 Annual Scientific Sessions meeting
Many coveted awards were announced at the closing ceremony. There were two deserving winners for the SCMR Seed Grant award—Dr. Justin Canada and team for their study on non-invasive CMR oximetry with exercise stress CMR and cardiopulmonary exercise test and Dr. Junyu Wang and team for "Deep learning-based rapid Spiral Image Reconstruction". Dr. Warren Manning, JCMR Editor-in Chief, presented the JCMR awards. The Gerald M. Prohost award for the best scientific manuscript for 2021 went to Dr. Theo Pezel and colleagues for their study on the prognostic value of vasodilator stress perfusion CMRafter inconclusive stress testing [[
As always social media and advocacy played a great role in disseminating science across the world. As highlighted by Dr. Michael Salerno in the closing ceremony, the #SCMR22 trended globally during the meeting with over 14 million impressions created worldwide through January 24–February 5, 2022, with 3510 tweets and more than 405 users (Fig. 3). The best tweet award for the most educational tweet during the conference was awarded to Dr. Anudeep Dodeja for covering parametric mapping in myocarditis and cardiomyopathy. Dr. Amro Alsaid and Dr. Jennifer Co-Vu were the runners up for this contest.
Graph: Fig. 3 The social media statistics for #SCMR22. 14 million impressions were created during January 24–February 5, 2022 (Data from symplur.com)
The 25th SCMR Annual Scientific Sessions was a unique blend of state-of-the-art lectures covering both clinical and translational components of CMR, demonstration of various innovations, interesting cases and debates covering almost all the aspects of current day CMR practice. CMR is poised for the paradigm shift towards providing value, with increased recognition in clinical practice guidelines. The path into the future will be to utilize newer computational and quantitative techniques to further improve the value of CMR by enabling more efficient and simplified acquisition, and to improve CMR outreach world-wide towards the ultimate goals of making CMR accessible anywhere. As Prof Jeanette Schulz-Menger rightly said in her opening plenary lecture, CMR is "an enabler of precision medicine". Moving towards the widespread adoption of CMR, the SCMR will align itself with CMR communities in various countries as well as other imaging societies to enable a broader dissemination of CMR into clinical practice worldwide.
With the rapid pace of developments, we expect to see more transformative science in the coming years. The major areas of focus are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using AI and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow. In the coming years, we look forward to more transformative scientific content at the SCMR scientific sessions aligned with the theme "Changing Global Clinical Practice". Indeed, the increasing participation of countries outside of the United States and Europe as well as outreach efforts of the SCMR in developing countries are testaments to SCMR's global mission. It is an exciting and pivotal time for CMR. We look forward to welcoming all of you to the 2023 SCMR Annual Scientific Sessions from January 25–28, 2023 in sunny San Diego, California, USA.
We wish to thank the Social Media Ambassadors for SCMR 22 and #SCMR22 Influencers for their efforts
VO, OK, RK, DL, SWL, BL, TCS, CCP and PP drafted different sections of the manuscript. PP, JCC, CBD, ARP, CCP, SP, MS, SVR: conceptualization, expert guidance on technical aspects, critical revisions of the manuscript. All authors read and approved the final manuscript.
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Review article, not applicable.
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Amit Patel: Research grant from General Electric. Research support from Arterys, Circle CVI, and Neosoft. Omar Khalique has received consulting fees from Edwards Lifesciences and Abbott Structural.
• ACC
- American College of Cardiology
• AI
- Artificial intelligence
• AS
- Aortic stenosis
• CAD
- Coronary artery disease
• CHD
- Congenital heart disease
• CMR
- Cardiovascular magnetic resonance
• CNN
- Convolutional neural networks
- COVID-19
- Coronavirus disease 2019
• CT
- Computed tomography
• ECV
- Extracellular volume
• INOCA
- Ischemia and no obstructive coronary artery disease
• ISMRM
- International Society of Magnetic Resonance in Medicine
• LGE
- Late gadolinium enhancement
• LV
- Left ventricle/left ventricular
• MBF
- Myocardial blood flow
• MINOCA
- Myocardial infarction with no obstructive coronary arteries
• MPR
- Myocardial perfusion reserve
• MVD
- Microvascular dysfunction
• NICM
- Non-ischemic cardiomyopathy
• PET
- Positron emission tomography
• RV
- Right ventricle/right ventricular
• SCMR
- Society for Cardiovascular Magnetic Resonance
• VHD
- Valvular heart disease
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By Vineeta Ojha; Omar K. Khalique; Rishabh Khurana; Daniel Lorenzatti; Steve W. Leung; Benny Lawton; Timothy C. Slesnick; Joao C. Cavalcante; Chiara-Bucciarelli Ducci; Amit R. Patel; Claudia C. Prieto; Sven Plein; Subha V. Raman; Michael Salerno and Purvi Parwani
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