radiology 101 for the cardiovascular team member 101 cv lecture.pdf · radiology 101 for the...
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Radiology 101 for the Cardiovascular Team Member Saurabh Agarwal, MD Assistant Professor of Radiology Division of Cardiac and Thoracic Radiology Medical Director, RIH/TMH 3D Imaging Laboratory Brown University, Alpert Medical School
Learning Objectives
• Recognize basic cardiovascular pathology on CXR • Understand common indications for cardiac CT and MRI • Discuss basic patterns of myocardial late gadolinium enhancement on
cardiac MRI
Rhode Island Chapter of the ACC
Right aortic arch with aberrant LSCA
Rhode Island Chapter of the ACC
Retroesophageal diverticulum “Kommerell”
• Vascular ring • Dysphagia
C/o Scott Collins, RT
Pulmonary artery pseudoaneurysm
Rhode Island Chapter of the ACC
• Contained rupture of pulmonary artery
• Trauma, iatrogenic, infection (TB)
• Cough and hemoptysis • Life-threatening
• High suspicion • Often missed (50%) • Look at enhancement
• Delayed images • Don’t biopsy!
Coronary CT • Coronary CT
• Low-intermediate risk for CAD • Coronary anomalies • Pre-surgical planning • CABG/stent patency • Problem solving
• Acute chest pain in the ED
• ROMICAT II, ACRIN-PA, SCOT-HEART
Rhode Island Chapter of the ACC
Gated Cardiac CT
• Cardiac CT • Cardiac masses
• Location and anatomic extent • Pericardial disease • Aorta • Pre-procedure planning
• TAVR • Pulmonary vein isolation • Redo sternotomy
Rhode Island Chapter of the ACC
Cardiac MRI
• Cardiac MRI • Cardiac function • CAD/viability* • Cardiomyopathies/Arrhythmias* • Cardiac masses* • Quantifying fibrosis* • Right ventricle/ARVD • Pericardium/constriction • Valvular disease • Congenital heart disease
Rhode Island Chapter of the ACC
*Currently requires gadolinium
Ischemic vs Nonischemic Cardiomyopathy
• Subendocardial: • Ischemic vs non-ischemic
cardiomyopathy
• Midwall and Subepicardial: • Nonischemic cardiomyopathy
Rhode Island Chapter of the ACC
0102030405060708090
ImprovedContractility (%)
Kim RJ et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. NEJM 2000.
57-year-old woman with labile HTN and chest pressure/pain with exertion and rest
Rhode Island Chapter of the ACC
Conclusions
• Many different cardiovascular processes are evident on CXR
• Several indications for cardiac CT and MRI • Distribution of LGE can help distinguish between
ischemic and nonischemic cardiomyopathy and guide differential diagnoses
Rhode Island Chapter of the ACC
Zelda Fitzgerald (1900 – 1948)
“Nobody has ever measured, not even poets, how much the heart can hold.”
Not until…
Questions: [email protected]