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Current imaging strategies in cardio-oncology
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Mirela Tuzovic, Melkon Hacobian, Eric H. Yang
CT scanners obtain high-spatial resolution images providing accurate assessment of LVEF, valve structure, and the pericardium. CT scans are also able to identify the risk and presence of CAD by quantifying coronary calcification and visualizing the coronary artery lumen. Although the accuracy of CT is comparable to echocardiography, CT is not used as first line imaging for assessing cardiac function and structure for cardiotoxicity detection. Coronary CT angiography may have a role in patients who develop symptoms on particular chemotherapeutic agents that are linked to coronary ischemia/thrombosis, such as 5-fluorouracil, capecitabine, paclitaxel, cisplatin, or VEGF inhibitors (2–3), as cancer patients may be too high risk to undergo invasive coronary angiography.
A clinical approach and comprehensive review of percutaneous revascularization of coronary chronic total occlusion
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Subrata Kar, Debabrata Mukherjee, David E. Kandzari
In CTO interventions, characterization of the plaque (e.g. extent of calcification and CTO origin) and visualization of the distal vessel must be optimized. In most instances, invasive angiography with contralateral injection of contrast into the artery supplying collaterals to the distal vessel (Figure 35.4) may provide the necessary information. If there is any doubt regarding the location of the true lumen or the anatomical course of the occluded vessel segment, a coronary computed tomography (CT) angiogram with three-dimensional (3D) reconstruction may be particularly useful (Figure 35.5). Furthermore, in selected cases, coronary CT angiography may improve patient selection for CTO recanalization, decrease the time and contrast media needed for the procedure, decrease complications, and ultimately, improve procedural outcome.32
Coronary angiogram evaluation
Published in Pim J de Feyter, Gabriel P Krestin, Filippo Cademartiri, Carlos van Mieghem, Bob Meijboom, Nico Mollet, Koen Nieman, Denise Vrouenraets, Computed Tomography of the Coronary Arteries, 2008
Pim J de Feyter, Gabriel P Krestin, Filippo Cademartiri, Carlos van Mieghem, Bob Meijboom, Nico Mollet, Koen Nieman, Denise Vrouenraets
There is more than one way to assess a CT coronary angiogram. Depending on the indication, scanning equipment, image quality, and available post-processing software, as well as personal experience and preferences, various approaches can be taken. This chapter describes the evaluation process as it is performed in Rotterdam as well as alternative approaches. It functions as an initial guide for those new to coronary CT angiography.
Is CT-derived fractional flow reserve superior to ischemia testing?
Published in Expert Review of Cardiovascular Therapy, 2022
B. L. Nørgaard, N. P. Sand, J. M. Jensen
The other principle of noninvasive testing is direct visualization of the coronaries by coronary CT angiography (CTA). CTA is increasingly used in the first-line diagnostic workup of patients with suspected stable CAD [1,2]. Recent trials demonstrate that first-line CTA clarified the diagnosis of CAD more accurately than NIT, leading to improvements in the use of evidence-based preventive therapies [3,4]. Moreover, anatomical information determined by CTA is a stronger predictor of outcomes than functional data by NIT [3–6]. Since coronary atherosclerosis is a main contributor to the ischemic burden, it is not surprising that the prognostic value of NIT is attenuated when adjusted for CAD [6]. On the other hand, CTA has modest diagnostic specificity due to, e.g., calcification-induced artifacts, and CTA is a poor discriminator of lesion-specific ischemia as assessed by fractional flow reserve (FFR), which is the gold standard for revascularization decision-making [1,2,7–9]. Accordingly, when compared to conventional NIT, CTA may be associated with increased downstream ICA, revascularization rates, and costs particularly in higher risk populations in whom anatomical stenosis is more likely to occur [1–3]. Diagnostic strategies to more accurately identify patients, who do not require any further testing, are needed to offset the potentially higher ICA utilization after CTA. Therefore, guidelines recommend second-line functional testing if CTA shows CAD of uncertain functional significance [1]. As an alternative to NIT in this setting, several CT derived functional assessment tools have been introduced [2,7–10].
Multidetector computed tomography in transcatheter aortic valve replacement: an update on technological developments and clinical applications
Published in Expert Review of Cardiovascular Therapy, 2020
Moshrik Abd Alamir, Salik Nazir, Anas Alani, Ilana Golub, Ian C Gilchrist, Faisal Aslam, Puneet Dhawan, Khalid Changal, Carson Ostra, Ronak Soni, Ahmad Elzanaty, Matthew Budoff
Whether coronary CT angiography is adequate for evaluation of coronary artery disease and bypass grafts or routine invasive coronary angiography is required pre-TAVR has been a subject of debate. In cases of low risk patients and good quality of images, the operators may feel confident to proceed without further invasive coronary angiography. With the increasing number of TAVR being performed in younger and lower risk patients and the increasing use of pre-TAVR CT, there is an increased prevalence of incidental non-cardiac and non-vascular findings. In a small study of 152 patients with pre-TAVR CT, it was found that 27% of TAVR patients had a clinically significant non-cardiac findings requiring either a referral or a procedure [58] Therefore, SCCT has strongly recommended that the CT imaging should be reviewed for the non-cardiac and non-vascular findings and reported accordingly [8].
The effect of hemodynamic parameters in patient-based coronary artery models with serial stenoses: normal and hypertension cases
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
K. E. Hoque, M. Ferdows, S. Sawall, E. E. Tzirtzilakis
Coronary CT angiography was performed on a dual-source CT (DSCT) scanner (SOMATOM Force, Siemens Healthineers, Germany). The scanning parameters were as follows: (i) tube voltage 100 kV, (ii) tube current 450 mAs. Detector collimation 0.75 × 192 × 0.6 mm. Time per gantry revolution 0.25 ms resulting in a temporal resolution of 66 ms. The CTA was performed using prospective ECG-gating. A bolus tracking technique was used for CTA scans and the triggering threshold was set to a CT-value of 100–140 HU in the ascending aorta. The scan was obtained with intravenous injection of 40–60 ml IOHEXOL (350 mg I/mL, IOPAMEDOL 350) at a flow rate of 4–5 ml/s followed by 30 ml saline chaser at the same flow rate. The CTA scan was acquired from 2 cm below the level of the tracheal bifurcation to 1–2 cm below the level of the diaphragm. Image data were routinely automatically reconstructed in best diastolic and best systolic position in the R-R interval with a slice thickness of 0.75 mm, slice increment of 0.75 mm and a medium to smooth convolution kernel B26f. The Field of view (FOV) was 170 mm with a matrix size 256 × 256.