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Tuesday, August 25, 2015

3D Heart-Imaging Technology Means Better Care for Young Patients

Posted By: Advancing Care

As our region’s largest pediatric cardiology center, Maria Fareri Children’s Hospital at Westchester Medical Center has always set the standard for treating children’s heart problems. Recent enhancements to the hospital’s cardiac imaging program have enabled better use of jaw-dropping 3D images of children’s hearts and the surrounding vessels, created painlessly and noninvasively—even in tiny babies with complex congenital heart disorders.

The hospital has long been able to use cardiac magnetic resonance imaging, or CMR (an imaging technique that uses radio waves, magnets and an advanced computer to take pictures of the heart and blood vessels), to get a detailed look at its young patients. “Now, however, we are using CMR much more effectively,” says Supriya Jain, MD, director of the pediatric cardiac MRI program. The CMR images are being compiled to produce multidimensional pictures on screen and are combined with new analysis software that provides more information to the physicians than ever.

Much of this progress is thanks to Dr. Jain herself, who arrived at the hospital in 2011 after completing a cardiac MRI fellowship at the Boston Children’s Hospital. There, she learned cutting-edge MRI techniques, knowledge she has brought to Maria Fareri Children’s Hospital. “Now, we can even understand how certain heart lesions affect heart functioning,” she says. “Before, for example, we could see from MRI images if a heart valve was leaking. Now, we can determine just how much it is leaking, to help us decide whether the leak is large enough to require a surgical procedure to close it.” Another wonderful thing, she adds, is how enhanced 3D images aid in the assessment of holes in the heart: “We can better figure out from the images what type of approach is best to close a hole and thus help to better plan the procedure and reduce risk for the child.”

These new-view images are proving reliable when it comes to examining pulmonary arteries—the arteries that carry blood from the heart to the lungs for vital oxygenation. These are often difficult to clearly image with other noninvasive methods such as echocardiography. 3D MRI has proven to be a great advance in this very important component of circulation.

Indeed, one of the best parts of 3D imaging is that it can help spare children the trauma of unnecessary procedures. “We had a baby who was just 3 or 4 days old who had complex congenital heart disease,” Dr. Jain shares. “The structure of the baby’s aortic arch was very bizarre,” she says, referring to the top part of the main artery that carries away blood from the heart to the body. Though there was no doubt the aortic arch had a strange shape, a larger question needed to be answered: Was it functioning well enough to avoid surgical correction? “We wanted to have a better understanding,” Dr. Jain says. In the past, this would have meant subjecting the baby to a CT (computerized tomography) scan, a test that involves taking multiple X-ray images, then using computer processing to create cross-sectional images of the body area in question or a cardiac catheterization and angiogram.  While this would have produced helpful final results, the X-rays that a CT or a cardiac catheterization require create other risks, like radiation from X-rays. And children, it’s known, are more susceptible than adults to radiation’s effects.

Instead, Dr. Jain and her team were able to use their 3D capabilities. “We went ahead with the CMR and got a beautiful 3D heart image,” she says. The procedure involved no potentially harmful radiation, she adds, and provided an in-depth look at the heart and aortic arch. “We were able to show it to the baby’s heart surgeon [Suvro Sett, MD, Maria Fareri Children’s Hospital’s Chief of Pediatric Cardiac Surgery],” Dr. Jain says. And there was good news: Though the baby needed heart surgery to enlarge pulmonary arteries, the baby’s aortic arch was functioning well enough to be left untouched, and the operation could be shortened considerably.

If CMR has any downside, it’s that very young children usually need to be sedated since patients must lie perfectly still (something for which children aren’t particularly well known). Yet Dr. Jain is pushing the limits even there. “You usually have to use sedation for children up to age 8 or 9,” she says. “But we have been able to image even 6- and 7-year-olds without it. I’ve just gone right there in the scanner with them and held their hand. It’s worked!” Now, using a specially developed protocol, the team is increasibly able to do studies on babies, too, without general anesthesia.

As much as she enjoys sharing past triumphs, Dr. Jain and the cardiology department are more focused on creating an even brighter future for their patients through further advancement of CMR technology. “Right now, we’re involved in multicenter trials to examine the use of CMR data in children with myocarditis, an inflammation of the heart muscles due to a virus or other causes,” Dr. Jain says. “CMR gives you a good anatomical and functional overview of the condition.”  3D imaging has even made the leap from the computer screen to 3D printing at
Maria Fareri Children’s Hospital: With collaborators, the hospital arranged to have an actual 3D model of a patient’s heart made, in order to better understand and treat her complex heart problems.

What could possibly be next? “Video goggles,” Dr. Jain quickly volunteers. “I’d like to get them for some of our older children, so that while they are in the MRI scanner, they can be less nervous, and instead watch a show and be entertained.”

After all, as Dr. Jain knows, a good view can make all the difference.