Increasing Traffic on the Cardiac MRI Highway

Meeting: International Society of Magnetic Resonance in Medicine (8th annual meeting).

Topic: Cardiac MRI

Background: Last year’s ISMRM meeting in Philadelphia (May 1999) introduced the world to the coming of age of MRI technology to address cardiac MRI research and clinical applications.

Update: The research base of cardiac MRI (and cardiovascular, as well) has expanded enormously, and now includes a small, significant base of clinical sites using these techniques and applications daily. The on-ramp to the cardiac MRI freeway (push-button systems and software) appears almost complete, and the coming year should provide substantial evidence of the depth and breadth of the market and technology. The interesting questions now are: How big is the market? Who are the buyers? And how many units per hospital? It clearly looks like another billion-dollar market within one to two years to the casual math student, adding to the present $2 billion MRI market.

Last year, hundreds of MRI scientists and physicians packed every cardiac MRI session. This year, it was thousands. Not only is the cath lab a prime target for stealing procedures, but echo labs also have been added to the list, as MRI demonstrates the ability to perform cardiac stress exams. Reimbursement is an issue, but not a show-stopper, as several CPT codes are being widely touted on Web sites as safe and effective for getting paid.

Last year, a single lunch session, sponsored by GE Medical Systems (Waukesha, Wis.) focused on “Advances in Cardiovascular MRI.” This year, all four lunch sessions were focused on cardiac MRI. The talks were oriented both to future developments and real-world technical ins and outs for performing successful cardiac MRI exams on new specialty cardiac MRI scanners from the usual vendors (GE, Siemens, Philips, Hitachi, Marconi). Joining the party this year are the MRI contrast agent companies with agents new and old for cardiac MRI applications (Nycomed, Bracco, Mallinckrodt, Epix). Image review and analysis software for cardiac MRI applications were demonstrated by Vital Images (review) and MEDIS Medical Imaging Systems (cardiac function and flow analysis). Specialty coils also were shown by SurgiVision and ScanMed.

From the societies page: The Society for Cardiovascular Magnetic Resonance (www.scmr.org) has announced its membership passed 400 (December 1999) and continues to host meetings and symposia (both ACC and AHA) that keep everyone up-to-speed on the latest techniques and developments. This international group of devotees represents the leading edge in both science and clinical applications, apart from the broader technical push provided by the ISMRM meeting.

Developing Applications: Morphology, perfusion and function are the big three for cardiac MRI. Detecting ischemia, quantifying ischemia and infarction, assessment of chest pain in the ER, identifying non-viable tissue and remodeling after myocardial infarction are more detailed applications. If many of these applications appear related to real or suspected heart attacks, then you can “PASS GO” and collect your CPT codes, because these applications have huge numbers of patients and money behind them (at least in the U.S.).

Everyone is calling for cooperation between cardiologists and radiologists in this developing market. Does this suggest that we don’t expect them to get along? Expect plenty of cooperation at the scientific and research level, but less at the clinical level where the bucks stop. Cardiologists most likely have the upper hand via patient control and access to capital budgets. While they generally have limited MRI experience, they can hire the technical talent to run an MRI. A possible side effect may be a shortage of qualified MRI physicists, if the market takes off as envisioned by the scanner manufacturers.

No matter how you choose to look at the market potential for cardiac MRI, the future for patients with cardiac disease looks better.

Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].