Non-invasive Imaging for Management of Cardiovascular Diseases Dr. Muhammad Ayub, FCPS Diplomate Certification Board of Nuclear Cardiology Diplomate Board of Cardiovascular Computed Tomography Department of Cardiovascular Imaging Punjab Institute of Cardiology Lahore
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Non-invasive Imaging for Management of Cardiovascular
Diseases
Dr. Muhammad Ayub, FCPSDiplomate Certification Board of Nuclear Cardiology
Diplomate Board of Cardiovascular Computed Tomography
Department of Cardiovascular Imaging
Punjab Institute of Cardiology Lahore
Trends in Imaging
Cardiovascular Imaging
Comparative spatial resolution
SPECT
PET Echo MRI CT
Resolution
(mm)
7-15 3-10 <1 <1 <1
Function Structure
Atherosclerosis and Imaging Modalities
Accuracy for diagnosis of CAD
Parameters Assessed with Various imaging Modalities
LV Function
Perfusion Coronary Pathology
Viability Valve Function
Radiation Dose
PET + + - + -
10-25 mSvSPECT + + - + -
Echo + + -+
IVUS
+ + -
MSCT + - + _ - 9.3-11.3 mSv
MRI + + _ + + -
Cardiac Cath
+ +TIMI Flow,TIMI Blush
+ - + 3-5 mSv
Applications of Nuclear Cardiology
Coronary Artery Disease Assessment of LV /RV function Cardiomyopathy /Myocarditis Valvular Heart Disease Cardiac Shunts Secondary Hypertension Pulmonary Hypertension Assessment of Cardiac Transplant
Nuclear Studies for Diagnosis of CAD
5.17.4
25.0
33.5 33.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Clinical +Ex Clin+Ex
+Cath
Clin+Ex
+SPECT
All
P=ns
P<.01
P<.01 P=ns
2
Iskandrian AS, et al. J Am Coll Cardiol. 1993;22:665-670. Reproduced with permission. Copyright 1993 by the American College of Cardiology.
N = 316
Incremental Prognostic Value of MPI
NS=not significant
Cardiac CT
Applications of Cardiac CT
Diagnosis of Coronary Artery Disease (intermediate probability)
Suspected Coronary Anomalies Assessment of grafts prior to redo CABG Assessment of complex congenital heart disease
(difficult echo) Suspected Aortic Dissection Suspected Pulmonary Embolism Assessment of Cardiac masses (difficult echo) Assessment of pericardial conditions (difficult
echo) Assessment of pulmonary veins prior to
radiofrequency ablation Assessment of coronary veins prior to
biventricular pacing
CTA Accuracy of MDCT for CAD
CTA Limitations
Rapid (>80 bpm) and irregular HR High calcium scores (>800-1000) Stents Contrast requirements (Cr > 2.0
mg/dl) Small vessels (<1.5 mm) and
collaterals Obese and uncooperative patients RADIATION EXPOSURE
Cardiac MRI
Diagnosis of CADMRI Vs SPECT
88% 90%
71%
91%
52%
88%
52%
87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MRI SSS SRS SDS
Sensitivity
Specificity
MR Assessment of Myocardial Viability
MR Assessment of Myocardial Viability
time
N Myocardium
Gdinjection
infarct
1st pass Delayed enhancement
MRI Pros
No Radiation Less Toxic Gadolinium Contrast
Cons Expensive Claustrophobic Long Acquisition time Operator dependant Technical Artifacts with 3T Problem in patients with metallic prosthesis
Diagnostic Testing According to Clinical Need
Chest pain syndromeIntermediate Likelihood for CAD
Resting ECG abnormal or patient not able to Exercise
CTA MPI
Low to Intermediate Intermediate to High• Stress MPI• Stress Echo• Dobutamine