Learning objectives
To highlight the importance ofexaminingthe heart in every thoracic CT examination,even if there is no suspicion of cardiac disease;
To suggest asystematic check-list approachfor the evaluation of every cardiac structure;
To describe cardiac abnormalities detectable innon-ECG- gated CT.
Background
Cardiovascular disease is one of the leading causes of morbidity and mortality.
Improvements in CT technology havereduced scanning times and now provide images of the heart that are much less degraded by cardiac motion artifacts and that allow a more detailed evaluation of the cardiac structures.
Therefore,
although frequently overlooked by radiologists,
many incidental cardiac findings can be obtained from non-ECG-gated CT, which can explain the clinical manifestations or influence the clinical course.
Wesuggest asystematic check-list approachfor the evaluation of every cardiac structure:
√ Coronary...
Imaging findings OR procedure details
CORONARY ARTERY DISEASE
√ Normal origin? (Fig. 1) ⇒ Right coronary artery should arise from the right coronary sinus and left coronary artery from the left coronary sinus (can be hard to assess without ECG-gating).
The left anterior descending artery should originate from the left coronary artery.
Coronary artery calcifications (Fig. 2)
The amount of coronary artery calcification correlates with coronary artery disease,
one of the leading causes of death worldwide.
CT is highly sensitive for the detection of calcifications,
but only a rough estimation...
Conclusion
Cardiac evaluation is often overlooked in non-gated CT.
Many of the cardiac findings mentioned can have an impact in the patient’s prognosis.
Every radiologist should be familiar with these pathologies and report them whenever present.
References
Lim KC,
Chai P,
Teo LS.
Incidental cardiac abnormalities on non- electrocardiogram-gated multi-detector computed tomography imaging of the thorax and abdomen.
Singapore Med J.
2011 Dec; 52(12):906-12.
Lumbreras B,
Donat L,
Hernández-Aguado I.
Incidental findings in imaging diagnostic tests: a systematic review.
Br J Radiol 2010; 83:276-89.
Bruzzi JF,
Rémy-Jardin M,
Delhaye D,
et al.
When,
why,
and how to examine the heart during thoracic CT: Part 1,
Basic Principles.
Am J Roentgenol 2006; 186:324-32.
Bruzzi JF,
Rémy-Jardin M,
Delhaye D,
et al.
When,
why,...
Personal Information
Contact Details:
Dr.
Miguel Correia da Silva
Resident in training.
Department of Radiology,
Centro Hospitalar de São João -Alameda Prof.
Hernâni Monteiro,
4200-319 Porto,
Portugal
Email:
[email protected]
Department of Radiology,
Centro Hospitalar de São João:
CardiacRadiology Section:
Dr.A.
Madureira
Thoracic Radiology Section:
Dr.
M.
Rodrigues
Resident in training:
Dr.
A.T.
Vilares
Dr.
A.
Carvalho
Dr.I.
Portugal