CARDIOVASCULAR INVESTIGATIONS Ñ 461,1

1-PLAIN FILMS
2-ULTRASOUND 4 echo .

3-ISOTOPE SCANNING
4-CT
5-MRI
6-ANGIOGRAPHY

Hand mit Ringen (Hand with Rings): print of Wilhelm Röntgen's first "medical" X-ray,
of his wife's hand, taken on 22 December 1895 and presented to Ludwig Zehnder of
the Physik Institut, University of Freiburg, on 1 January 1896
☐ Krogh
X is the first I heart
* -

ray in cardio
modality imaging the .
& the
body in
general .

*
why X-ray ?

Ava liable
1-
widely .

2- Cost effective

3- give important into include

↳ size of heat ,
Chambers
,
calcification in valuer ,
stats ol the main vessels

stats the ( pkudeltusim hyperemia )

hrg lung congestion • . .
, , ,

(2) US

mainly used
echocardiography
* as

*
highly available

* But it
requires a psltessimd physician (
operator dependant )

#
Disadvantage #
*
not reproducible .

view
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 ③

ISOTOPE SCAN
cardiac
a imaging
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scarring &

meta
③ Thyroid &
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The radio pharma used radio (Iodine )
mc in
isotope scan is
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one I tie me used radio pharma .

& HMPAO Braini-n.org ing - used in cardiac

imaging .

Function I
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& Diphosphonale Bone
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vied in
lung ventilation Function (
MAGS Renal
Imaging & Brai -
ISOTPE SCAN
• Rest isotope scan using thallium ( Ti201) injection.
• Dual-isotope imaging is a hybrid protocol that
combines a resting thallium injection and
subsequent scan with the injection of either
Tc-99m sestamibi or tetrofosmin during stress.
• Adenosine stress test if patient cant physically do
exercise (Pharmaceutical stress is used to increase
blood flow to the heart muscle) .
 -

:
PETS.CI

Detector

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an
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Detect ischemia

2- Detect Abnormalities 1 Cardiac muscle .

from
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is¥a
decreased BI necrosis d muscles
-
Supply
-
-

4- Was the 1st method to evaluate the EF ( ejection Faction) ol the heart .
& Component &

the heat chambers .

 seotimI(
Cross -

Sagittal

-
Time -

Stress 99mTc-tetrofosmin/rest 201Tl images in a patient with a low likelihood of CAD.

The first and third rows are stress short-axis slices from apex to base. The second and
fourth rows are matching rest slices. The fifth and sixth rows are the stress and rest
vertical-long-axis slices, while the seventh and eighth rows are the stress and rest
horizontal-long-axis slices.
 is done Pest Stress Phases
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study in & . . .

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more common

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C.C. 6¥ s, §
① Conventional
Angiography ÷ @i
① It's not operator dependant
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an

Hii
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② CT MRI -

⇐←
-

→
③ MRI
-

② Determine the
viability l the muscles

(indirect indicator I vessels status )

-
coronary

ZÉg A ,
- Ischemia
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11--66

Infarction si -66 IN
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ischemic pt _
Angioplasty or
stenting
infarction be done
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ischemia n' ↳ 61
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Coronary CT
↳ need
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, .

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detector Ñ ¥31 % I
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• Patient cooperation. To be
developed able to catch his breath
,
but the CT devices can pick the
image
← anti during one heart beat

• Stable heart rate , heart rate around 60p/m.

.

IF Mi is & 8,5

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Cardiac Ct assess:
• Coronary vessels.
myocardium µ -
ji ,

) ( congenital Anomaly Stenosis occlusion

, , ,
bridging
-
.
.
. .

• Aorta . ( Direction , Dilation )

Aneurysm +

• Functional ( thrombus , EF , contractility,….) →

Ref CT isn't operator
-
dependant
-

• Muscles viability ( dual source/spectra CT).

( calcification →
thickening )
• Valve ,

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 Usage , limitation :
to
• Mainly used for low- intermediate risk patients . Advantages
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• Not indicated for high risk paints except in some

advanced centers.
• In case of heavy coronary vessels calcification , it
has low resolution. even in LL
-
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dense

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←

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,
calcification → white
←

% 4-

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%
-
rate is limitation for some type of CT scanners. "
CT Contrast

s #
→ white

IN

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• Used to assess complex cardiac congenital

( MRI )

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Is It 15 shot +
 TJ Calcification § :-D ( Ca score )
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si I 48 CI A ← as
-

[ Pca ]
Ca score score -
F Risko

Grozny
Risk si mi a
Ñ , Greg AJ d c

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• Used for risk stratification for coronary , valve and
aortic calcification.
• low , intermediate risk patients. 111
• Not used in case of previous bypass surgery or
coronary stenting. distinguished soitwoÉbeacwa_e
①

②
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surgical
d
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the
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bypass surgery

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heart rate and arrhythmia.

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to resolution ICT Jl 4

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The result of the test is usually given as a number called an
Agatston score. The score reflects the total area of calcium
6 deposits and the density of the calcium. -
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↳

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&

clinical 0 low
+
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score → coronary or .

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high risk ( need

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Plug
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in one
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major vessel

suggests a low chance of developing a heart attack in the

- - -
-

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↳ risk
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future. Sl
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your risk of heart disease. vessels

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→

ji

associated with a relatively high risk of heart attack or other Rigidgot ↳

heart disease over the next three to five years. Cardiac

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consultation
-

• A score greater than 300 is a sign of very high to severe

f-
disease and heart attack risk.
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earlier detection

CAD Risk can

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atherosclerosis t.IE
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> 300 =
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hi
calcification 24

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According to the American College of Cardiology and the American Heart
Association guidelines, a heart scan may not be recommended for the
-

following people: = Ca Score isneeded

not in . - .

• Men under age 40 and women under age 50, because it's
unlikely calcium can be detected at younger ages or
they may
di section
have thrombotic

detection I
de .

→
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⇐ " ↳

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heart attacks at an early age asymptomatic
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heavy smokers or those with diabetes or very high high Pt very

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MYOCRDAIL ENHANCEMENT AND VIABILITY ASSESSMENT

myocardial enhancement

① -
severe stenosis
in Lt main

trunk at the
severe
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o
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 myocardial
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Gray area ( b enhancement )
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#
wrong vessels calcification
stenosis
& . . .

# Functional evaluation

-
color-coded

conventional
angiography
-

¥ ( stenosis )
 Cardiac CT functional assessment
By
-
.
CT
-

3D d chambers
* image
software
end diastole & end systole
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images -

TT sensitivity & specificity

Is H ÷ - - - - -
-
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.

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l ejection traction ) not

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Cardiac CT Cunctind Assess

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t.MY?EIgYneh--- ⇐ •

Functional
- -
Analysis
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11
 By
G-
LV apex thrombus

0
Q
(enh_ance_mt--
detect
Filling 5T¥ I
= b enhancement ( td-sit-sth-n-mus-e.tn " "
 easily detected by Cardiac CT
- -
- -
-
- -

q
Myxoma LT atrium ( most common location)
filling defect in
LA= near to the als_eptI & some calcification * took some enhancement
-
-

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 ① Cardiac Isotope
BE ① Cardiac CT

Cardiac MRI. ① Cardiac MRI

• Patient cooperation ( long study). very expensive+ study

• ECG & respiratory gating . some
requires
sequencer
in MRI Breath hold
-
↳ Is ,
-

• Specialized technician and physician( skill

demanding).
&? stat , Gim # ÷ induction
fibrosis
MRI detect

Cardiac MRI used for: #

-

to Éi # \ Amyloidosis

Deposition dz .
in the muscles
✗
isotope ←É ÷
-

✗ " "" " µ

isotope is
-

SI
contrast
↑ viability i I
go.im ' - ↑

Mdg
-
MRI 777 CT D) CI
MRI

• Muscle viability , masses, thrombus , contractility .

,

• Functional assessment . (contractility )

• Used to assess complex cardiac congenital
anomaly.
\
CT can be used also
54 G. .-

• Coronary vessels. MRI 77 > CT

- - -

{ MRI 11 •

÷
\ :*
standard Cath lab relation to the
# The gold is
-
major vessels

then
CI septa .

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# MRI
-
→ m .

Contrast
viability
is not
needs

required
MRI

in
contrast ( like G)

functional studies
⑥
schematic

diagram

cardiac
imaging .

-
muscle
this
car .
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,

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it ,

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F ischemia
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Another Application be
MRI is
ftp.gafial-lla-ss in
Hypertrophic Ip Paff ←
-

MRI
.

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king
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- ma±
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i. Ñ
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re
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 # Cardiac MRI *
Contrast
- -

-
LV
Apex

#
thinning & muscles endocardial
b
-
-

enhancement
a - -

mu JI Is
I
part
-

/ & upper
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.

the

muscle si §!
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① ¥
 # Time Interval Images
- -

Acvk Phan

=÷,
-
C wit
o

*
Thinning
i
status I
myocardium

*
Enhancement
=

Late gadolinium imaging in horizontal image plane at 1 week (A) and 4 months (B) after
the acute event. At 1 week, presence of diffuse enhancement of the apical part of the
ventricular septum and LV apex (arrowheads, A) with large area of microvascular
obstruction (small arrows, A). Note the presence of some pericardial enhancement over
the laterobasal part of the LV (arrows, A). At 4 month follow-up, the infarct has thinned
and strongly enhances (arrowheads, B). Note the presence of a small mural thrombus in
LV apex (arrows, B)
 "" " "" " "
"
⇐
Contrast is in
req -

LV ventricle apex thrombus

→
CI " - '
I
↳

Thrombus in Apex

g( 0

MRI
←

Gets
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 contrast in CT
Myxoma at RT atrium bulging inside the RT ventricle.
✓

my na

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.

the valve
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Filling feted

sign 1-
Mush JI
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in IT & -12 &

other MRI sequencer

is #↳
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-

Io #

→ 81 t.SI
other applications lo , MRI
=

dz
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deposition muscle
in -
→

→ muscle
dystrophy

ibge functional Assessment

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