Cardiac CT in Radiology

Introduction

Cardiac CT (computed tomography) is a non-invasive imaging technique used to assess the structure and function of the heart. It is particularly useful for detecting coronary artery disease, evaluating heart valves, and assessing congenital heart conditions.

How Does Cardiac CT Work?

A Cardiac CT scan uses X-rays to create detailed images of the heart. Unlike regular X-rays, which provide only a two-dimensional view, CT scans generate cross-sectional images, allowing doctors to see the heart's anatomy in greater detail.

Indications for Cardiac CT

Cardiac CT is commonly used for: - Coronary artery evaluation: Identifies blockages or calcification in the coronary arteries (Coronary CT Angiography – CCTA). - Calcium scoring: Measures calcium deposits in coronary arteries, a predictor of heart disease risk. - Congenital heart disease evaluation: Helps visualize structural abnormalities of the heart. - Preoperative cardiac assessment: Useful before heart surgery or interventions like transcatheter aortic valve replacement (TAVR). - Assessment of cardiac masses: Helps detect tumors or thrombi in the heart.

Risks and Benefits

Benefits:

• Non-invasive procedure with no need for catheterization.
• Quick and highly detailed imaging to detect early heart disease.
• Lower risk compared to invasive coronary angiography.

Risks:

• Radiation exposure: Though minimal, repeated scans could increase risk over time.
• Allergic reaction to contrast dye: Some patients may react to the contrast agent used in CT angiography.
• Kidney effects from contrast dye: Not recommended for patients with advanced kidney disease.

How to Prepare for a Cardiac CT Scan?

• Fasting: Avoid eating or drinking for a few hours before the procedure.
• Avoid caffeine: Caffeine can affect heart rate and may interfere with the scan.
• Medication adjustment: Beta-blockers may be given to slow the heart rate for better imaging.
• Inform your doctor of any allergies or kidney problems before the scan.

Conclusion

Cardiac CT is a valuable imaging tool for diagnosing and managing heart disease. By providing detailed structural information, it aids in early detection, guiding appropriate treatment and improving patient outcomes.

Source recommendations

1. American College of Radiology (ACR) Appropriateness Criteria for Cardiac Imaging

1. https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria
2. https://acsearch.acr.org/list
3. https://pubmed.ncbi.nlm.nih.gov/17010819/
4. https://acsearch.acr.org/docs/3128014/Narrative/
5. https://pubmed.ncbi.nlm.nih.gov/23500216/

2. American Heart Association Guidelines on Cardiovascular Imaging

1. https://www.ahajournals.org/journal/circimaging
2. https://professional.heart.org/en/professional-membership/scientific-councils/cvri
3. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/magnetic-resonance-imaging-mri
4. https://professional.heart.org/en/
5. https://education.heart.org/productdetails/circulation-cardiovascular-imaging-webinar-series-usefulness-advanced-non-invasive-imaging-to-guide-structural-heart-disease-intervention-learning-from-real-cases

3. European Society of Cardiology Guidelines on Cardiovascular Imaging

1. https://www.escardio.org/Sub-specialty-communities/European-Association-of-Cardiovascular-Imaging-(EACVI)
2. https://academic.oup.com/ehjcimaging
3. https://www.escardio.org/Guidelines/Scientific-Documents/Recommendations-and-position-papers
4. https://academic.oup.com/ehjcimaging/article/16/9/919/2399830
5. https://www.escardio.org/Guidelines/Recommended-Reading/Cardiovascular-Imaging