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Integrated imaging; the best modality for each patient

By Professor Thor Edvardsen, Scientific Documents Committee Chair

Professor dr. Thor Edvardsen is Professor in Cardiology at the University of Oslo, Chief of the Department of Cardiology at Oslo University Hospital, Rikshospitalet and Center Director of the Center for Cardiological Innovation.



The main goal of the integrated     recommendations is that experts from the different modalities - echocardiography, computed tomography (CT), cardiovascular magnetic resonance (CMR) and nuclear imaging – choose the best modality for each patient. In reality, this comes down to personalized medicine from the start for the patient.

Although echo is the most available (and cheapest) imaging modality in Europe and the rest of the world, some important features are not accessible by echo such as scar tissue, a complete image of the heart – which is particularly important and complicated in congenital heart disease – as well as coronary anatomy and stenosis. Moreover, CMR provides a much better resolution. Therefore it was not surprising to find an overall perspective to change the recommendations.

Integrated imaging: dynamic and interesting

Multimodality recommendations are a fairly new phenomenon with the first being published in 2014: “Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography”. As integrated imaging is so new, the ideas and recommendations keep improving all the time which makes this a very dynamic and interesting field. The benefits of having integrated imaging in daily clinical practice is obvious, not only with regard to the patient who will receive the best and most suitable care, based on his or her specific situation, but by doing so, unnecessary specific imaging studies can also be avoided.

Recommendations ready at hand

By bringing together all experts from different specialties who will co-   author the papers, the best possible context is created in which all sections of imaging are present. Clear recommendations on what is necessary are of utmost importance and to enhance their use, a small but comprehensive booklet has been developed by the EACVI which physicians can keep in their pocket and easily use during their daily practice. The information can also be accessed from the EACVI recommendation mobile app suitable for IOS/Android. In the first three weeks after it became available, it was downloaded more than 300 times which is quite impressive. The scientific committee also tried to incorporate integrated imaging in all educational platforms on the web, as well as in research projects.

What the future brings …

Over the next few years, appro-     priateness criteria for cardiac imaging within Europe will be launched. Although European countries differ substantially, EACVI tries to set up a common European platform for integrated imaging. An ongoing task force is currently working on heart failure as this is a frequent condition with a high mortality rate throughout Europe. They are assessing which kind of imaging modality or combination is necessary for correctly ­diagnosing and evaluating heart ­failure.