- “In patients scheduled to undergo noncoronary cardiovascular surgery, coronary CT angiograms are of diagnostic image quality in 81% of cases.”
Ruling Out Coronary Artery Disease with Noninvasive Coronary Multidetector CT Angiography before Noncoronary Cardiovascular Surgery
Catalan P et al.
Radiology 2011; 258:426-434 - “ The presence of severe coronary artery calcification is the only independent predictor of nondiagnostic coronary CT angiography: an Agaston score of about 600 shows the best predictive accuracy for performing diagnostic coronary CT angiography.”
Ruling Out Coronary Artery Disease with Noninvasive Coronary Multidetector CT Angiography before Noncoronary Cardiovascular Surgery
Catalan P et al.
Radiology 2011; 258:426-434
- “ In nonselected patients scheduled to undergo noncoronary cardiovascular surgery, preoperative coronary CT angiography was diagnostic in 81% of cases. Preoperative ICA could be safely avoided in patients without significant CAD by using coronary CT angiography. The Agaston score, but not the presence of atrial fibrillation, was an independent predictor of nondiagnostic coronary VT angiography.”
Ruling Out Coronary Artery Disease with Noninvasive Coronary Multidetector CT Angiography before Noncoronary Cardiovascular Surgery
Catalan P et al.
Radiology 2011; 258:426-434
"A small focus of discrete myocardial thinning along the apical/diaphragmatic surface of the left ventricle is a normal anatomic feature. The thinning is sometimes such that no wall can be seen there over a span of up to several millimeters."
Left Ventricular Apical Thinning as Normal Anatomy
Johnson KM et al.
J Comput Assist Tomogr 2009;33: 334-337
"Myocardial density was visually classified as normal or hypodense and was verified by a ratio of infarct HU/normal HU of <.75 within a constant rgion of interest. Hypodense areas were classified as either subendocardial (,50% of the myocardial thickness) or transmural (>50% of the myocardial thickness)."
Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction
J Cardiovasc Comput Tomogr (2009) 3, 272-278
Hecht HS, Bhatti T
"Areas of hypoenhancement represent territories of depressed blood flow, but they are nonspecific in their etiologies. Decreased perfusion may be secondary to a critical coronary artery stenosis or occlusion, microvascular obstruction , or myocardial scar."
Evaluation of myocardial viability by multidetector CT
Mendoza DD, Weigold WG
J Cardiovasc Comput Tomogr (2009) 3, Supplement 1, S2-S12
"In addition to detailing coronary anatomy, cardiac chamber sizes, LV EF, and wall motion abnormalities, MDCT permits reliable myocardial viability assessment. Thus, MDCT, is a powerful, comprehensive noninvasive method for the evaluation of the heart."
Evaluation of myocardial viability by multidetector CT
Mendoza DD, Weigold WG
J Cardiovasc Comput Tomogr (2009) 3, Supplement 1, S2-S12
"Of the atrial diverticula, 88% were superior and anterior, 9% were right lateral superior, and 3% were inferior. Of accessory appendages, 34% were inferior posterior, 32% were left inferior and 18% were superior anterior,14% were inferior posterior and 2% were right inferior posterior."
Cardiac CT Assessment of Left Atrial Accessory Appendages and Diverticula
Abbara S et al
AJR 2009; 193:807-812
"Left atrial diverticula and accessory appendages are commonly found on cardiac gated CT."
Cardiac CT Assessment of Left Atrial Accessory Appendages and Diverticula
Abbara S et al
AJR 2009; 193:807-812
"In conclusion, high resolution cardiac CT represents a unique tool to assess subtle anatomic cardiac variants. Our data show that left atrial accessory appendages and diverticula can be found in more than one fifth of subjects undergoing cardiac CTA and are more common in men."
Cardiac CT Assessment of Left Atrial Accessory Appendages and Diverticula
Abbara S et al
AJR 2009; 193:807-812
- Atrial Septal Defect: Facts
- Most common congenital cardiac defect to present in adulthood
- ASD provides left to right shunt
- Three subtypes with ostium secundum most common (80-90% of ASDs)
- Left Atrial Appendage Thrombi Protocol
- Scan 1: trigger the injection 6 seconds after 100 HU is reached in ascending aorta
- Scan 2: this scan is 30 seconds after first scan is completed
- Injection protocol was 60-90 cc of Iopamidol-370 injected at 5 cc/sec "Two phase cardiac CT angiography can be used to differentiate thrombus from circulatory stasis, which may cause a pseudo-filling defect on early phase CT images."
Left Atrial Appendage Thrombi in Stroke Patients: Detection with Two-Phase Cardiac CT Angiography versus Transesophageal Echocardiography
Hur J et al.
Radiology 2009; 251:683-690
- " Compared with transesophageal echocardiography (TEE), two phase cardiac CT angiography, with a sensitivvity of 100% and a specificty of 98%, is useful for detecting left atrial appendage thrombus."
Left Atrial Appendage Thrombi in Stroke Patients: Detection with Two-Phase Cardiac CT Angiography versus Transesophageal Echocardiography
Hur J et al.
Radiology 2009; 251:683-690
- "Two phase 64-section cardiac CT angiography is a noninvasive sensitive modality for detecting left atrial appendage thrombi and differentiating thrombus from circulatory stasis in stroke patients."
Left Atrial Appendage Thrombi in Stroke Patients: Detection with Two-Phase Cardiac CT Angiography versus Transesophageal Echocardiography
Hur J et al.
Radiology 2009; 251:683-690
- Cardiac Lymphoma: Facts
"Patients with chronic thromboembolic pulmonary hypertension may be asymptomatic for several years before their presentation with symptoms such as recurrent acute or progressive exertional dyspnea, chronic nonproductive cough, atypical chest pain, tachycardia, syncope, and cor pulmonale."
CT Diagnosis of Chronic Pulmonary Thromboembolism
Castaner E et al.
RadioGraphics 2009; 29:31-53
- Cardiac Lymphoma: Facts
- Usually related to extensive systemic involvement
- Primary cardiac lymphoma is rare
- Primary cardiac lymphoma more common in immunosuppresed patients and favors the right side of the heart
- Cardiac Angiosarcoma: Facts
- Most common primary malignant tumor of the heart
- Arises most commonly in the right atrial free wall
- Most other primary cardiac tumors arise from the left atrium
- Cardiac Myxomas: Facts
- Most common benign primary tumor of the heart
- Arises from left atrium near interatrial septum
- Most difficult dx in many cases is an cardiac thrombus
- Atrial Myxoma vs Thrombus: Key Differential Dx Parameters
- CT attenuation of mass
- Size of mass
- Left vs right atrium
- Origin of mass
- Lesion shape
- Lesion mobility
- Occurrence of prolapse "Atrial myxoma and thrombi can be differentiated by their distinguishing features of size, origin, shape, mobility and prolapse. CT is accurate in determining the origin of myxomas but may fail in some cases."
Atrial Myxomas and Thrombi: Comparison of Imaging Features on CT
Scheffel H et al.
AJR 2009; 192:639-645
- Patent Ductus Arteriosus (PDA): Facts
- Isolated Patent Ductus Arteriosus accounts for up to 10-12% of all congenital heart anomalies
- Most incidentally discovered PDAs in adult are asymptomatic
- Diagnosis on CT is based on defining a vessel connecting the main pulmonary artery and the aorta that is patent - Patent Ductus Arteriosus (PDA): CT Findings
- Calcification at the site of the PDA is common
- Communication best seen on MPR and 3D images
- Flow may be from aorta to pulmonary artery or pulmonary artery to aorta - "MDCT represents a novel method of noninvasively assessing patent ductus arteriosus in adults that provides detailed anatomic information."
Morphologic Assessment of Patent Ductus Arteriosus in Adults using Retrospectively ECG-Gated Multidetector CT
Morgan-Hughes GJ et al.
AJR 2003; 181:749-754
