Comprehensive multidetector CT assessment of apical hypertrophic cardiomyopathy

Cardiac-CT with the newest CT scanners: An incoming screening tool for competitive athletes?

Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose.

Multimodality imaging in apical hypertrophic cardiomyopathy

Apical hypertrophic cardiomyopathy (AHCM) is a relatively rare morphologic variant of HCM in which the hypertrophy of myocardium is localized to the left ventricular apex. Symptoms of AHCM might vary from none to others mimic coronary artery disease including acute coronary syndrome, thus resulting in inappropriate hospitalization. Transthoracic echocardiography is the first-line imaging technique for the diagnosis of hypertrophic cardiomyopathies. However, when the hypertrophy of the myocardium is localized in the ventricular apex might results in missed diagnosis. Aim of this paper is to review the different imaging techniques used for the diagnosis of AHCM and their role in the detection and comprehension of this uncommon disease.

Evaluation of discrete upper septal thickening on 64-slice coronary computed tomographic angiography

PURPOSE

Discrete upper septal thickening (DUST) has been well described in the echocardiology literature. To our knowledge, the computed tomography findings of DUST, however, have not been previously described.

MATERIALS AND METHODS

Five hundred consecutive coronary computed tomography angiograms were evaluated by 2 cardiothoracic radiologists for the presence of DUST.

RESULTS

Of the 500 studies reviewed, 23 cases had features consistent with DUST (23/500 = 5%). The average systolic blood pressure of patients with DUST (150/77 mm Hg) was higher than that of patients without DUST (133/75 mm Hg). Patients with DUST were older (mean 63 y) than patients without DUST (mean 50 y). None of these patients had evidence of abnormal systolic anterior motion of the mitral valve on cine imaging.

CONCLUSIONS

DUST is seen on coronary computed tomography angiograms and has imaging characteristics distinct from significant pathology, such as hypertrophic cardiomyopathy. Recognizing DUST is important because, unlike hypertrophic cardiomyopathy, previous studies have not found an associated adverse prognosis with DUST.

Cardiac multidetector computed tomography: basic physics of image acquisition and clinical applications

Cardiac MDCT is here to stay. And, it is more than just imaging coronary arteries. Understanding the differences in and the benefits of one CT scanner from another will help you to optimize the capabilities of the scanner, but requires a basic understanding of the MDCT imaging physics.

This review provides key information needed to understand the differences in the types of MDCT scanners, from 64 – 320 detectors, flat panels, single and dual source configurations, step and shoot prospective and retrospective gating, and how each factor influences radiation dose, spatial and temporal resolution, and image noise.

Left ventricular apical diseases

There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features.

Hypertrophic cardiomyopathy: assessment with MR imaging and multidetector CT

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease. Its early detection is important because it is the most common cause of sudden cardiac death among young people. However, HCM is often a dilemma for clinicians because it manifests with diverse phenotypic expressions and clinical courses. With the advances in imaging technology, magnetic resonance (MR) imaging and multidetector computed tomography (CT) serve as suitable modalities for detecting and characterizing HCM and obtaining information for appropriate management of cases of HCM, although echocardiography is currently the most widely used modality. This article is an overview of the definition of HCM, its various phenotypes, risk stratification of HCM, and the potential application of cardiac MR imaging and multidetector CT for the assessment of HCM.

Imaging spectrum of sudden athlete cardiac death

Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.