3.4 Cardiac MRI and CT in cardiology for evaluation

Cardiology#invstigation

1. Cardiac MRI and CT

Dr Venugopal K. MD DM
Professor &HOD Cardiology
Pushpagiri Institute of Medical Sciences
Tiruvalla

2. Feature

lonising radiation
Optimal window
Availability

Cost

Portability

Great Vessel imaging

Soft Tissue evaluation

Fat, blood, water,
distinction

Multiplanar imaging

Initial patient
evaluation

Duration
Claustrophobia

Prosthetic materials

MRI

No

No
Variable
Expensive
No

Excellent

Excellent

Excellent

Yes

Lilimited

30- 60 mts
Not possible

With Caution

CT

Yes

No
Wide
Cheaper
No

Excellent

Good

Fair

No

Yes

Few mts
Possible

Possible

3. Cautions with MRI

Contraindications

Ferro magnetic aneurysm clips

Metallic fragments in eyes or other vital areas
Pacemakers (MRI incompatible)

ICDS

Prosthetic valves (SE Ball and cage Valves)
Insulin pumps

Neural stimulators

Sternal wires , Stents not contraindicated

Gadolinium Nephrogenic systemic fibrosis
Not advised in pts with GFR <30 ml /m2

4. Cardiac Magnetic Resonance (CMR) allows the simultaneous
visualization of both cardiac function and anatomy.

Quantify coronary blood flow in coronary artery disease

Accurately measure left and right ventricular volumes, ventricular
wall thickness, mass, and diameters of the great vessels

Characterize myocardial viability
Quantify myocardial infarction size
Measure blood flow in the myocardium as well as the great vessels

CMR is considered the “gold” standard for noninvasively
characterizing cardiac function and viability, having 3D capabilities
and a high spatial resolution.

5. Imaging sequences are gated using a 3-lead ECG.
Typically, ventricular cines are imaged with 12-25 phases
spanning the cardiac cycle.

Ventricular cines in either the cardiac short-axis or long-
axis can provide an accurate estimation of the following
functional parameters:

Ejection fraction (EF)
Systolic wall thickening
Wall motion

6. + Delayed contrast enhancement using gadolinium
is the preferred method to identify a scarred
region caused by a chronic myocardial infarction.

« Signal enhancement in scarred regions will occur
approximately 5 minutes after the initial contrast
bolus.

* Scarred regions will retain the contrast agent as
cell death and tissue edema (which occur after an
infarction and subsequent scarring) alter the
wash-in and wash-out kinetics of the extracellular
contrast agent.

7. + CMR flow imaging has been useful in the
diagnosis of valvular regurgitation, aortic
stenosis, and has even been used for
angiography.

8. Indications

Coronary artery disease

A. Assessment of global ventricular function and
mass

B. Detection of CAD

i. Regional LV function at rest and during
dobutamine stress

ii. Assessment of myocardial perfusion
(adenosine stress)

iii. Coronary MRA (anomalies)

C. Acute and chronic myocardial infarction
i. Detection and assessment
ii. Myocardial viability

9. + Cardiomyopathies

. A. Hypertrophic cardiomyopathy

. B. Dilated cardiomyopathy

. C. Arrhythmogenic Right Ventricular
Cardiomyopathy

. D. Restrictive cardiomyopathies

. i. Sarcoid

. ii. Amyloid

. iii. Eosinophilic

. E. Myocarditis

10. Cardiac and pericardiac masses
A. Primary cardiac
B. Pericardiac (including pericardial)
C. Thrombus
Pericardial disease
A. Pericardial effusion
B. Constrictive pericarditis

11. Valvular heart disease
A. Quantification of regurgitation
Congenital heart disease (CHD)
A. Assessment of shunt size
B. Anomalous pulmonary venous return
C. Ebstein's anomaly
D. Pulmonary regurgitation
E. Atrial septal defect
Diseases of the aorta and great vessels
A. Aortic aneurysm
B. Aortic dissection
C. Intramural hematoma

13. Ischemic

Idiopathic DCM —
Basal mid-wall

HCM - patchy, intraseptal

14. Subendocardial infarct

15. Transmural infarct

16. ARVD, DELAYED ENHANCEMENT

30-80% of (advanced) cases have LV, as well as RV enhancement /

19. Amyloidosis

21. Thickened Pericardium in Constrictive
pericarditis

24. Hypertrophic cardiomyopathy

26. Apical HCM

27. RVEMF with Right atrial Thrombus

28. Delayed contrast enhancement Delayed contrast enhancement
Showing RV apical hyper With TI (inversion time) 600 to
enhancement identify thrombus

Thrombus seen as black

30. IWMI

31. NON viable territory

Viable territory

35. Post icr rv enlargement

36. Pulmonary atresia, MAPCA

37. Classical BT shunt

ı = =.
y = à
'

38. Septal bounce

39. Image size: 448 x 448
View size 1199 x 1199
WL: 770 WW: 1066

Zoom: 268% Angle

Uncompresses

10229464 ( 36y, 31y)
154_cor_highres ~ RADIAL

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41. Cardiac CT

44. Calcium Score

0

1-10
11-100
101-400
Over 400

Presence of CAD

No evidence of CAD
Minimal evidence of CAD
Mild evidence of CAD
Moderate evidence of CAD
Extensive evidence of CAD

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59. THANK YOU