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Cardiology Secrets > CARDIAC COMPUTED TOMOGRAPHY > Flashcards

CARDIAC COMPUTED TOMOGRAPHY Flashcards

1
Q

What are the contraindications for cardiac computed tomography?

A

An inability to remain still, hold one’s breath, or follow instructions; anaphylactic reaction to intravenous iodinated contrast; hemodynamic instability; very high heart rate; atrial fibrillation with variable R-R interval; severe renal dysfunction (except when on dialysis).

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2
Q

What is the difference between prospective triggering and retrospective gating?

A

Prospective triggering acquires images of the heart in a predetermined phase of the cardiac cycle, while retrospective gating acquires images throughout the cardiac cycle.

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3
Q

When might retrospective gating be used rather than prospective triggering?

A

When cardiac or valvular function measurements are needed; in patients with irregular heart rhythms or high heart rate; for preinterventional evaluation for structural heart diseases.

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4
Q

Is it possible to scan the entire heart in a single heartbeat?

A

Yes, using modern CT scanners like wide-array/volume scanners or high-pitch spiral scanning.

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5
Q

What is the radiation dose of a standard cardiac computed tomography examination?

A

Ranges from less than 1 mSv to as high as 30 mSv, with a median dose in the US between 1 and 10 mSv.

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6
Q

What is blooming and how can it be reduced?

A

Blooming is an artifact from high attenuation materials bleeding into adjacent structures; it can be reduced by increasing tube voltage, using sharp/stent kernels, thinner slices, adjusting windowing, or using iterative reconstruction.

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7
Q

Is premedication with beta-blockers and nitroglycerin necessary for coronary CTA?

A

Yes, it is necessary to obtain CT images of diagnostic quality.

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8
Q

What is a coronary calcium score?

A

A specialized cardiac CT examination that quantifies the amount of coronary calcium, also known as the Agatston score.

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9
Q

Is calcium scoring appropriate in a patient of low coronary heart disease risk but with a family history of premature coronary heart disease?

A

Yes, it is appropriate to evaluate for subclinical coronary atherosclerosis in this population.

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10
Q

In which patients is coronary computed tomography angiography appropriate?

A

In patients with nonacute symptoms potentially representing ischemic equivalents and low or intermediate pretest probability of CAD.

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11
Q

What is CAD-RADS classification?

A

A standardized reporting system classifying CAD based on the highest grade coronary artery lesion detected on coronary CTA, ranging from CAD-RADS 0 to CAD-RADS 5.

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12
Q

Is coronary computed tomography angiography an appropriate first test for a patient with nonacute chest pain and intermediate pretest probability of coronary artery disease?

A

Yes, it is appropriate for patients unable to exercise with low or intermediate probability of CAD.

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13
Q

Is coronary computed tomography angiography an appropriate test for a patient with low to intermediate pretest probability of coronary artery disease presenting with acute chest pain?

A

Yes, it is appropriate for evaluation in this scenario.

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14
Q

Is coronary computed tomography angiography useful for detecting in-stent restenosis in patients with stents less than 3 mm in diameter?

A

No, stents less than 3 mm in diameter are not appropriate for evaluation by coronary CTA.

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15
Q

Fill in the blank: The ability of a scanner to ‘freeze’ cardiac motion depends on the gantry’s _______ and the patient’s heart rate.

A

rotation speed

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16
Q

True or False: The use of higher pitch in CT scanning increases radiation and contrast doses.

A

False

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17
Q

What is the purpose of coronary computed tomography angiography (CTA) in patients with prior coronary artery bypass grafts (CABGs)?

A

Coronary CTA is indicated for symptomatic patients with prior CABGs to evaluate for graft patency and complications such as thrombosis, malposition, aneurysms, and pseudoaneurysms.

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18
Q

What is the Coronary Artery Disease Reporting and Data System (CAD-RADS) classification for 0% to 25% stenosis?

A

CAD-RADS 0 indicates absence of CAD.

19
Q

What is the CAD-RADS classification for 50% to 69% stenosis?

A

CAD-RADS 3 indicates potentially obstructive CAD.

20
Q

What is the appropriate use of cardiac computed tomography in evaluating coronary anomalies?

A

Cardiac CT is excellent for evaluating coronary anomalies and assessing adult congenital heart disease.

21
Q

True or False: Cardiac computed tomography can differentiate between acute and chronic myocardial infarction.

A

True

22
Q

What findings are typically observed in cardiac CT for patients with chronic myocardial infarction?

A

Wall thinning, fatty metaplasia, or calcification may develop.

23
Q

What is the role of cardiac computed tomography in patients presenting for noncoronary cardiac surgery?

A

Coronary CTA is useful for assessing coronary arteries for obstructive disease in young and middle-aged patients.

24
Q

Fill in the blank: Cardiac CT is appropriate for patients with _______ pretest probability of CAD and new-onset heart failure.

A

low or intermediate

25
Q

What is the significance of high-risk features found on cardiac CT angiography?

A

High-risk features correlate with future events.

26
Q

What is the most common anatomic variant of the pulmonary veins?

A

A separate ostium for the right middle pulmonary vein.

27
Q

What is the role of cardiac CT in the evaluation of patients for transcatheter aortic valve replacement (TAVR)?

A

CT provides important measurements for planning the procedure, including dimensions of the aortic annulus and root.

28
Q

What is the diagnostic accuracy of plaque characterization by cardiac computed tomography?

A

CT is excellent for detecting calcified plaques but modestly accurate for noncalcified plaques.

29
Q

What is the purpose of pulmonary vein mapping before pulmonary vein ablation?

A

To detect variant anatomy and assist in catheter selection.

30
Q

What is the role of cardiac CT in assessing patients with suspected Turner syndrome?

A

Cardiac CT is a reasonable first modality for assessing congenital anomalies associated with Turner syndrome.

31
Q

What does a CAD-RADS 4B classification indicate?

A

Left main disease (>50%) or three-vessel severe stenosis (≥70%).

32
Q

What is evaluated using cardiac CT in patients being considered for transcatheter mitral valve replacement?

A

The complex mitral valve anatomy is essential for planning.

33
Q

What noncoronary structures should be included in a cardiac CT examination report?

A

All significant findings noted in the acquired dataset.

34
Q

How can fractional flow reserve (FFR) be obtained noninvasively?

A

By using data from cardiac CTA to generate advanced 3D models and perform computational fluid dynamic analysis.

35
Q

True or False: Cardiac CT is not useful for evaluating cardiac masses.

A

False

36
Q

What is the purpose of CTA of the access vessels before transcatheter procedures?

A

To measure the minimal luminal diameters and evaluate their suitability for accommodating large sheaths used in prosthesis delivery systems

Also measures vascular calcification and tortuosity.

37
Q

What aspects of the aorta are evaluated during CTA?

A

Kinking, dissection, and thrombi

These evaluations are crucial for ensuring safe access during procedures.

38
Q

What is the role of cardiac CT before transcatheter mitral valve replacement?

A

Understanding complex mitral valve anatomy for planning percutaneous procedures

Provides measurements like mitral annulus size and neo-left ventricular outflow tract area.

39
Q

What specific measurements does cardiac CT provide for planning mitral valve procedures?

A

Mitral annulus size, neo-left ventricular outflow tract area, basal septal thickness, anterior mitral leaflet length

These measurements are essential for different procedural approaches.

40
Q

How does cardiac CT assist in predicting fluoroscopic projections?

A

By providing projections oriented orthogonal to the mitral annulus plane

This aids in the accurate placement of devices during procedures.

41
Q

What is the role of cardiac CT in patients with suspected or confirmed coronavirus disease?

A

To replace TEE or invasive angiography to exclude thrombus and evaluate prosthetic valves

Also helps diagnose endocarditis and its complications.

42
Q

In what scenarios can cardiac CT be used to evaluate patients with acute chest pain?

A

To rule out CAD and workup other possible causes of myocardial injury

Relevant when troponin levels are elevated or in patients with stable chest pain but high suspicion.

43
Q

True or False: Cardiac CT can replace invasive procedures to prevent the spread of COVID-19.

A

True

It helps in minimizing patient exposure to invasive techniques.

Cardiology Secrets (26 decks)

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