Cardiovascular imaging

Question 1

Which types of imaging have no radiation?

Answer 1

MRI and US

Question 2

What are the advantages and disadvantages of a CXR?

Answer 2

\+Easy to do
\+ Immediately available
\+ Answers immediately 
- Radiation
-Non specific

Question 3

How large should the heart be on a CXR?

Answer 3

1/3rd of the chest diameter

Cardiothoracic ratio

Question 4

How can you see cardiomegaly on a CXR?

Answer 4

When the heart occupies more than 50% of the thoracic diameter of a PA CXR

Question 5

What are the advantages and disadvantages of catheter angiography?

Answer 5

\+ Excellent coronary artery depiction
\+ Easily access abnormalities 
\+ Assess conorony plaques and stenosis
\+ Assess stents and CABG
- Radiation
- Invasive- femoral/radial artery
- Complications /bleeding
- Contrast allergy/nephropathy`

Question 6

What is an angioplasty?

Answer 6

Stretching the artery with a balloon

Question 7

What are the advantages and disadvantages of an echocardiogram?

Answer 7

+ immediately available
+ Immediate assessment of function of the heart
+ Structural (valvular and chamber abnormalities
+ No radiation and can be repeated
- Operator dependent- requires lots of skill
- Patient dependent- difficult in obese patients
- Limited views => incomplete cardiac assessment

Question 8

What are the advantages and disadvantages of a Cardiac CT +/- IV contrast?

Answer 8

+ Excellent coronary artery depiction
+ Non invasive coronary artery assessment
+ Functional assessment. Can estimate EDV/ESV
+ Chamber assessment
+ Look at the great vessels and lungs
- High radiation dose
- Resolution less than catheter angiography
- Potential for contrast allergy/nephropathy
- Need specialist CT equipment and expertese

Question 9

Do you need contrast to see Ca++ deposits on a Cardiac CT?

Answer 9

No

Question 10

Do you need contrast to see stenosis of the coronary arteries deposits on a Cardiac CT?

Answer 10

Yes- iodine contrast is used

Question 11

What are the advantages and disadvantages of cardiac MRI?

Answer 11

+ No radiation or contrast and can easily repeat
+ Excellent soft tissue resolution (better then CT)
+ Good anatomical assessment
+ Gold standard for structure and function
- Long imaging times
- Claustrophobia
- MRI contraindications (Pacemaker, hip replacement etc)
- Specialist equipment and expertese
- Not good for looking at coronary arteries

Question 12

What is an Enhancement MRI scan used for?

Answer 12

Looking for foci or potential foci of arrythmias

Question 13

What are the 3 standard projections for cardiac MRI?

Answer 13

4 chamber view, 2 chamber view and Short axis (cross section through the ventricles)

Question 14

What can be calculated from MRI?

Answer 14

Cardiac functions (LV muscle mass, EDV, ESV, and ejection fraction)

Question 15

What is a Cine cardiac MRI?

Answer 15

4 chamber view giving a dynamic assessment of flow and turbulence. You can use other views. Video.

Question 16

Most of the time, contrast is not required in MRI but what can be used?

Answer 16

Gadolinium contrast is used

Question 17

What are the functions of nuclear cardiology?

Answer 17

Assess the perfusion of the myocardium

Question 18

What is an isotope myocardial perfusion?

Answer 18

Checking the uptake of a radioactive isotope and stressed using adenosine or dipyridine (vasodilators)

Question 19

Which projections are used in nuclear cardiology?

Answer 19

3 standard projections

Question 20

What is nuclear cardiology used for in practice?

Answer 20

Determining the impact of coronary artery disease on regional myocardial perfusion. Helps to direct surgical or medical management

Question 21

What scan can accurately calculate the ventricular ejection fraction?

Answer 21

Marga scan