title: Cardiac magnetic resonance in outpatients in Germany--indications, complications and protocol suggestions from a high-volume center.
abstract: BACKGROUND
  Cardiac magnetic resonance (CMR) has developed into a routine examination in many centers in cardiology. However, there is little knowledge about its applicability in outpatients as a diagnostic tool for cardiovascular diseases. We report about the experiences in a high-volume cardiac imaging center and in a "mobile setting" in Germany and provide routinely used examination protocols.
  
  
  METHODS
  8976 patients referred for CMR from cardiologists, internal medicine practices and from general practitioners and 2200 patients examined in a "mobile" system by outpatient cardiologists were included in the study. Indications were as follows: 7672 (69%) examinations for myocardial ischemia and viability, 1313 (12%) for cardiac and pericardial inflammatory disease and cardiac mass, 976 (9%) for detection and quantification of heart valve disease and 466 (4%) for congenital heart disease. 697 (6%) were referred for other indication. Two independent readers performed image analysis of the 8976 patients in our center.
  
  
  RESULTS
  Image quality was rated "excellent" in 90.6%, "good" in 8%, "fair" in 1.2% and "poor" in 0.2%. 0.0002% of all examinations were not assessable due to low image quality. Minor complications (temporarily, asymptomatic AV-blockade; mild chest pain and/or dyspnea; nausea) could be observed in 12% and resolved within few minutes. One patient experienced a grand mal seizure due to hyperventilation. 0.9% examinations had to be terminated untimely due to claustrophobia.
  
  
  CONCLUSIONS
  CMR in outpatients is a widely used imaging modality in cardiology in Germany. A large variety of clinical questions may be answered by CMR with excellent image quality and without major complication. With user-adapted protocols, a rapid diagnosis is achieved even in outpatients in a "mobile" setting. Hence, CMR will increase its applicability as a routine imaging tool.
authors.affiliation: MRT-Praxis am Sankt Gertrauden Krankenhaus, Berlin, Germany. bernhardt@cardiovasc-mri.com
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Engels
authors.forename: Bernd
authors.initials: B
authors.lastname: Knuf
authors.forename: Oliver
authors.initials: O
authors.lastname: Strohm
mesh_terms: D002985:Clinical Protocols; D005178:Faculty; D005260:Female; D005858:Germany; D006276:Health Facility Size; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies