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Contents

  1. Multi-Slice and Dual-Source CT in Cardiac Imaging: Principles - Protocols - Indications - Outlook
  2. MRI and CT in the diagnosis of coronary artery disease: indications and applications
  3. Recommended for you
  4. Coronary CT angiography: Dose reduction strategies

The extent of myocardial death in the setting of myocardial infarction has a substantial impact on the outcome of the patient. Myocardial infarction and its sequelae not only show a major impact on cardiac function and possible subsequent cardiac failure, but also on the risk of inducing severe arrhythmias. MRI of myocardial viability has substantially changed over the last two decades. The evaluation of late gadolinium enhancement LGE techniques has pushed the envelope for the clinical routine assessment of myocardial viability using MR techniques.

Early studies by Kim et al. In early patient studies, the impact of this imaging technique on the prediction of patient outcome after myocardial infarction and revascularisation procedures has been demonstrated [ , ]. LGE imaging offers the ability to assess the transmural extent of residual viability in patients after myocardial infarction. As a major pre-requisite in the use of LGE techniques in myocardial ischaemia, it has to be considered that the extent of myocardial infarction is typically related to coronary artery supply territories and that the development of necrosis starts at the subendocardial level propagating towards the epicardial border over time Fig.

Differentiation of transmural extent of myocardial infarction using late gadolinium enhancement LGE imaging.

Multi-Slice and Dual-Source CT in Cardiac Imaging: Principles - Protocols - Indications - Outlook

While the left image a demonstrates an almost transmural LGE consistent with only minor residual viable tissue, the patient on the right b only suffered from a smaller subendocardial myocardial infarction in the RCA territory. Sequence techniques for assessment of LGE are typically based on inversion recovery IR T1-weighted gradient recalled echo GRE techniques, with additional nulling [optimisation of inversion times TI ] of the normal myocardium [ ]. This approach allows for high differences in signal intensity of viable versus non-viable myocardium. With ongoing technical developments, changes in imaging approaches have been proposed and incorporated into clinical viability imaging.

As segmented data acquisitions in MR rely on constant heart rates and patient cooperation with consistent breath-holding, image quality is substantially reduced in patients with severe arrhythmia or non-cooperative patients. Huber et al. In addition to the elimination of breathing artefacts, this technique can also be used for a substantial shortening of MRI time.

As the image contrast of standard LGE imaging techniques relies on optimal TI settings, this approach is substantially operator-dependent. The use of advanced image calculation and processing techniques, as proposed by Kellman et al. With regard to the volumetric accuracy of myocardial infarction this approach has been shown to demonstrate constant volumes compared with suboptimal TI settings with changing image contrast [ ].

For LGE imaging, the use of higher magnetic field strength also demonstrates benefits with regard to signal levels. CNR levels viable to non-viable myocardium are typically higher at 3 Tesla although the overall image quality is not necessarily affected by this change [ , ]. Regarding the differentiation of acute versus chronic infarction, the sole application of LGE imaging techniques is limited in its diagnostic use.

Further differentiation can be provided by the additional use of T2-weighted oedema imaging. Although several studies evaluated the degree of MO in acute myocardial infarction using early and late gadolinium enhancement imaging, which technique has the better predictive value in terms of LV remodelling remains somewhat controversial [ — ]. MR and CT imaging are emerging as the most promising complementary imaging techniques in the primary diagnosis of CAD and for coronary atherosclerotic disease detection.

For the detection or exclusion of significant CAD, both cardiac CT—including coronary calcium screening and non-invasive coronary angiography—and cardiac MR, applying stress function and stress perfusion imaging, are becoming widely available and are increasingly being applied in clinical routine. Owing to their high negative predictive value, especially in combining two or more of these applications, the presence of CAD can be excluded with a high probability, if patients are selected correctly.

Today, invasive coronary catheterisation cannot fully be replaced by these techniques, and this should not be the primary goal of future investigations. Europe PMC requires Javascript to function effectively. Recent Activity. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Insights Imaging. Published online Nov PMID: Wintersperger 1, 4.

Bernd J. Corresponding author. This article has been cited by other articles in PMC. Abstract In recent years, technical advances and improvements in cardiac computed tomography CT and cardiac magnetic resonance imaging MRI have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease CAD and correct patient selection for these emerging imaging techniques.

Introduction In recent years, technical advances and improvements in cardiac computed tomography CT and cardiac magnetic resonance imaging MRI have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease CAD and correct patient selection for these emerging imaging techniques. CT coronary angiography: luminography and beyond CT coronary angiography: are we there yet?

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MRI and CT in the diagnosis of coronary artery disease: indications and applications

CT for coronary plaque imaging The imaging reference standard for the detection and characterisation of coronary artery plaques in patients is intravascular ultrasound IVUS. CT viability und perfusion Assessment of myocardial viability and myocardial perfusion plays a critical role in the evaluation of patients with CAD as patterns of myocardial perfusion are associated with short- and long-term prognosis and the haemodynamic relevance of a coronary artery stenosis [ 28 , 29 ].

CT viability imaging Acute ischaemic changes in the myocardium after coronary arterial occlusion consist of disruption of cell membrane function and integrity and increased permeability of small vessel walls. General considerations in cardiac MRI As emphasised earlier, CAD represents a relatively simple description of a disease that in fact consists of a complex array of different sub-entities, especially with regard to the extent, impact and effect upon the heart and its individual structures.

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Assessment of coronary artery stenoses and myocardial ischaemia Coronary artery MRI Direct assessment of the coronary arteries and assessment of potential coronary artery stenoses are considered the holy grail of cardiac imaging. The use of gadolinium-based contrast agents GBCA further improve CNR, irrespective of whether extracellular or intravascular compounds have been applied [ 68 , 73 , 74 ]. Myocardial perfusion imaging Besides the direct visualisation of coronary artery stenosis, the indirect assessment of possible underlying stenotic CAD can also be rendered by MRI, using myocardial perfusion imaging.

Stress cine MRI While MR perfusion imaging focuses on the direct detection of ischaemia at the myocardial blood supply level, stress cine imaging provides an indirect approach to visualising the potential impact of hypoperfusion and thus impaired myocardial oxygen supply on wall motion [ ]. Assessment of myocardial viability Total or temporary occlusion of a coronary artery may result in temporary ischaemic damage or myocardial death and necrosis in the downstream coronary artery territory.

Conclusions MR and CT imaging are emerging as the most promising complementary imaging techniques in the primary diagnosis of CAD and for coronary atherosclerotic disease detection. References 1. Multidetector computed tomography for the diagnosis of coronary artery disease: a systematic review.

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Cardiac CT: Current Technology & Principles (Faisal Nabi, MD, FACC) September 11, 2018

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Quantitative magnetic resonance perfusion imaging detects anatomic and physiologic coronary artery disease as measured by coronary angiography and fractional flow reserve. Myocardial first pass perfusion imaging with gadobutrol: impact of parallel imaging algorithms on image quality and signal behavior.

Coronary CT angiography: Dose reduction strategies

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