Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning

Abstract

Background Structured reporting allows a high grade of standardization and thus a safe and unequivocal report communication. In the past years, the radiological societies have started several initiatives to base radiological reports on structured reporting rather than free text reporting.

Methods Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology, in 2018 an interdisciplinary group of Radiologists, Cardiologists, Pediatric Cardiologists and Cardiothoracic surgeons -all experts on the field of cardiovascular MR and CT imaging- met for interdisciplinary consensus meetings at the University Hospital Cologne. The aim of these meetings was to develop and consent templates for structured reporting in cardiac MR and CT of various cardiovascular diseases.

Results Two templates for structured reporting of CMR in ischemia imaging and vitality imaging and two templates for structured reporting of CT imaging for planning Transcatheter Aortic Valve Implantation (TAVI; pre-TAVI-CT) and coronary CT were discussed, consented and transferred to a HTML 5/IHR MRRT compatible format. The templates were made available for free use on the website www.befundung.drg.de.

Conclusion This paper suggests consented templates in German language for the structured reporting of cross-sectional CMR imaging of ischemia and vitality as well as reporting of CT imaging pre-TAVI and coronary CT. The implementation of these templates is aimed at providing a constant level of high reporting quality and increasing the efficiency of report generation as well as a clinically based communication of imaging results.

Key points: 

• Structured reporting offers a constant level of high reporting quality and increases the efficiency of report generation as well as a clinically based communication of imaging results.

• For the first time templates in German language for the structured reporting of CMR imaging of ischemia and vitality and CT imaging pre-TAVI and coronary CT are reported.

• These templates will be made available on the website www.befundung.drg.de and can be commented via [e-mail].

Zitierweise

• Soschynski M, Bunck AC, Beer M et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. Fortschr Röntgenstr 2023; 195: 293 – 296

Key words

structured reporting - cardiac - perfusion - vitality - TAVI - coronary

Introduction

Background of Structured Reporting

Structured reporting includes standardized text modules and categorized diagnoses with uniformly applied nomenclature, which increase the efficiency of report generation and enable consistent quality. It also facilitates cooperation between different institutions and forms the basis for building structured databases and targeted archive queries [1] [2]. The “Radlex Initiative” and the “Radiology Reporting Initiative” of the RSNA, laid the cornerstones for the standardization of terms in radiological reports and a basis was created for the use of structured report templates [3]. The RSNA and ESR findings templates are thematically available at no cost on the open platform www.radreport.org in HTML 5/IHE MRRT format [4]. In addition, international professional societies have published further basic recommendations on report content and report structure specifically for cardiovascular imaging [5] [6] [7] [8] [9]. However, the recommendations mentioned are only available in English and some of them are still in development. A consensus of German-speaking professional societies has not yet been reached. The board of the DRG’s Cardiovascular Diagnostics working group has therefore defined the creation of structured findings as a central project.

Methodology

Development of approved German-language report templates for cardiac cross-sectional diagnostics

In order to develop appropriate diagnostic templates for CT and MR imaging of the heart in the field of cardiac sectional diagnostics, consensus meetings between experts in cardiovascular imaging and structured reporting from the fields of radiology, cardiology, pediatric cardiology, and thoracic, cardiac and vascular surgery were held at the University Hospital of Cologne in 2018 at the invitation of the Heart and Vascular Diagnostics working group of the German Radiological Society. Within this framework, a total of 11 structured reporting templates for the following examination protocols and clinical pictures in the field of cardiac MRI and CT diagnostics were developed and approved: myocarditis, dilated cardiomyopathy, hypertrophic (obstructive) cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC), siderosis, ischemia and vitality diagnostics, tetralogy of Fallot, aortic isthmus stenosis, coronary CT and CT for TAVI planning (briefly pre-TAVI CT transcatheter aortic valve implantation). Technical support for this project will be provided by the Information Technology working group of the DRG. The developed templates will be converted to HTML 5/IHE-MRRT-compliant format and made freely available on the DRG homepage at “www.befundung.drg.de”. The reporting templates on myocarditis, dilated cardiomyopathy, hypertrophic (obstructive) cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC), and siderosis have already been published [10].

Results

Structured report templates for CT diagnostics of the coronary vessels, CT diagnostics prior to TAVI, and MR ischemia and MR vitality diagnostics of the heart

The created publication presented for the first time the four interdisciplinary approved German-language reporting templates for CT coronary diagnostics, CT pre-TAVI, and MR ischemia and MR vitality diagnostics of the heart. The contents take into account the current recommendations of international professional societies on the subject and structure of findings [5] [6] [7] [8] [9].The terminology reflects that used by RadLex in its current German-language version (www.radlex.org).

All report templates are preceded by the sections Technique, Patient Baseline Profile, and Image Quality, followed by the specific reporting text modules.

Coronary artery CT reporting includes Calcium Scoring and CT Coronary Angiography sections. The latter includes coronary anatomy, characterization of coronary plaques, and grading of coronary stenoses using the SCCT Grading Scale [5], as well as overall grading of findings according to the Coronary Artery Disease – Reporting and Data System (CAD-RADS 2.0) [5] [6].

The reporting template for CT pre-TAVI includes measurement of the aortic root (annulus, sinus valsalvae, coronary artery distances, C-arm angulation), relevant findings of the aortic root (calcific spurs in the LVOT, quantification of aortic valve calcification, cuspidity, coronary abnormalities), and assessment of the aortic, iliofemoral, and subclavian access routes.

The report template for MR viability diagnostics includes sections on morphology and functional analysis of the left and, if applicable, the right ventricle, atrial size, valvular pathologies if examined, and tissue characterization. Their central part is the assessment of late gadolinium enhancement (LGE), presence of microvascular obstruction and hemorrhage, and, if examined, assessment of myocardial edema and results of mapping techniques.

In addition to MR vital signs, the MR ischemia diagnostic report template includes assessment of adenosine stress and resting perfusion. This includes the presence, localization, and extent of decreased perfusion at rest and under stress. Heart rate at rest and under stress and the presence of splenic switch-off are documented in the findings as indicators of the effect of a vasodilator.

The online publication explains the findings templates in detail. The individual finding components of the text templates are discussed step-by-step and their inclusion is explained in the context of existing references. Depending on the issue and necessity, technical aspects, performance of image evaluation, interpretation of certain findings as well as their clinical significance are also discussed. The reader should thus be able to obtain comprehensive background information on the application of the diagnostic templates.

Summary

This publication proposes for the first time interdisciplinary approved, German-language, structured reporting templates are proposed for CT diagnostics of the coronary vessels, CT diagnostics prior to TAVI, and MR ischemia and MR vitality diagnostics of the heart. The report templates developed should help to guarantee a consistently high report quality, make report preparation more efficient and enable report communication oriented to the clinical issue. The templates have been embedded in an HTML 5/IHE-MRRT compliant format by the DRG’s working group for Information Technology (AGIT) and are made available for free use at www.befundung.drg.de.

Conflict of Interest

The authors declare that they have no conflict of interest.

• Reference

• 1 Schwartz LH, Panicek DM, Berk AR. et al. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260: 174-181
• 2 Bosmans JM, Weyler JJ, De Schepper AM. et al. The radiology report as seen by radiologists and referring clinicians: results of the COVER and ROVER surveys. Radiology 2011; 25+9: 184-195
• 3 Morgan TA, Helibrun ME, Kahn CE. Reporting Initiative of the Radiological Society of North America: Progress and New Directions. Radiology 2014; 273: 642-645
• 4 IHE Radiology Technical Committee. IHE Radiology Technical Framework Supplement – Management of Radiology Report Templates (MRRT), Rev. 1.7 – Trial Implementation [Internet]. Verfügbar unter: https://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_Suppl_MRRT.pdf
• 5 Cury RC, Leipsic J, Abbara S. et al. CAD-RADS™ 2.0–2022 Coronary Artery Disease – Reporting and Data System: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). J Am Coll Radiol 2022; 19 (11) 1185-1212
• 6 Leipsic J, Abbara S, Achenbach S. et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. Journal of Cardiovascular Computed Tomography 2014; 8 (05) 342-358
• 7 Blanke P, Weir-McCall JR, Achenbach S. et al. Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR): An Expert Consensus Document of the Society of Cardiovascular Computed Tomography. JACC Cardiovasc Imaging 2019; 12: 1-24
• 8 Francone M, Budde RPJ, Bremerich J. et al. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 2019; 1-24 DOI: 10.1007/s00330-019-06357-8.
• 9 Hundley WG, Bluemke DA, Bogaert JG. et al. Society for Cardiovascular Magnetic Resonance guidelines for reporting cardiovascular magnetic resonance examinations. J Cardiovasc Magn Reson 2009; 11: 5
• 10 Bunck AC, Baeßler B, Ritter C. et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Cardiomyopathies (Myocarditis, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular cardiomyopathy and Siderosis). RöFo – Fortschr Röntgenstr 2020; 192: 27 - 37

Publication History

Received: 15 June 2022

Accepted: 29 October 2022

Article published online:
16 February 2023