Advanced Cardiac Imaging

Question 1

Echocardiography

Answer 1

Advantages

• mobile
• cheap cost
• good temporal and spatial resolution to evaluate: function and valves
• **gold standard for assessment of the heart valves

Disadvantages:

• limited by available acoustic windows
• limitations in tissue characterization
• RV evaluation is limited because it’s behind the sternum
• apex and lateral wall can be hard to see
• stress evaluation has good specificity but limited sensitivity

Question 2

Cardiac MRI

Answer 2

Advantages:

• no geometric limitations
• reproducibility
• **gold standard for assessment of cardiac volumes and function. Also stands alone in tissue characterization
• tissue characterization
• good temporal and spatial resolution
• good sensitivity and specificity for stress evaluation

Disadvantages:

• not portable
• limited evaluation of valves
• claustrophobia
• only MRI safe hardware
• technical expertise

Question 3

Cardiac Catheterization

Answer 3

Advantages:

• excellent spatial and temporal resolution
• lumenography to evaluate stenosis
• gold standard for the assessment of coronary artery stenosis*
• intracardiac and intraluminal pressures
• function
• flow across stenosis: fractional flow reserve

Disadvantages:

• invasive
• radiation
• limited views for function evaluation
• no tissue characterization
• can’t evaluate the total disease burden within vasculature

Question 4

Cardiac CT

Answer 4

Advantages:

• lumenography
• burden of disease
• excellent tool to assess burden of disease and course of arteries*
• anomalous coronary arteries
• can assess function (rarely used for it though)
• good temporal and spatial resolution

Disadvantages:

• Ca interferes with evaluation of the lumen
• radiation
• dye load
• “one shot test”

Question 5

Nuclear Imaging

Answer 5

Advantages:

• no geometric assumptions
• can be used for metabolic as well as perfusion imaging of the heart
• commonly used to assess for ischemic heart disease and offers some added advantage of molecular imaging as different radionuclides can be used*
• SPECT: high sensitivity of CAD
• can assess myocardial function

Disadvantages:

• radiation
• poor spatial resolution
• SPECT: low specificity for CAD susceptible to attenuated artifact