Advanced Imaging Techniques in Cardiology

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Questions and Answers

What is a key benefit of MRPA compared to other imaging methods?

Provides detailed assessment of collateral blood flow

Does not require ionizing radiation or iodinated contrast (correct)

Offers shorter acquisition time than CTPA

Requires contrast medium for accurate results

Which imaging technique is indicated as superior in terms of ease of use and high spatial resolution?

MRPA

DSPA

MRI

CTPA (correct)

What condition can be suggested by the presence of a mosaic perfusion pattern in imaging?

Hypertrophy of right ventricular wall only

Stenosed vessels causing reduced perfusion (correct)

Increased perfusion in all lung areas

Normal lung function indicating no vascular abnormalities

What characteristic features are associated with RV hypertrophy due to increased pulmonary pressures?

Free wall thickness greater than 4 mm Signup and view all the answers

What aspect of CTPA allows for a better understanding of collateral vessels?

Simultaneous opacification of pulmonary circulation Signup and view all the answers

What is a potential appearance of areas with reduced perfusion on CT?

Low attenuation with small vascular calibre Signup and view all the answers

In the context of CTPEH, what can slightly enlarged thoracic lymph nodes indicate?

Potential vascular transformation and sclerosis Signup and view all the answers

What technique allows MR imaging to quantify systemic to pulmonary collateral flow?

Volume rendering technique Signup and view all the answers

What is indicated by a RV diameter to LV diameter ratio greater than 1:1?

RV dilation Signup and view all the answers

What feature characterizes right heart strain in imaging studies?

Straightening and right-to-left bowing of the interventricular septum Signup and view all the answers

Which characteristic pattern is associated with small airway disease?

Patchy mosaic pattern Signup and view all the answers

How is a wedge unmatched perfusion defect demonstrated in cases of pulmonary embolism?

Through V/Q scans Signup and view all the answers

What is a common diagnostic approach for acute thromboembolic disease?

Pretest probability assessment, D-dimer, and imaging Signup and view all the answers

What is often initially overlooked in patients with a history of acute emboli?

Chronic thromboembolic disease Signup and view all the answers

What imaging modality plays a key role in diagnosing both acute and chronic thromboembolic disease?

Computed tomographic pulmonary angiography (CTPA) Signup and view all the answers

What pattern of perfusion is typically observed in patients with chronic thromboembolic disease?

Segmental perfusion defects Signup and view all the answers

What is challenging about diagnosing CTEPH compared to acute pulmonary embolism?

Its features are more subtle and difficult to diagnose Signup and view all the answers

What advancement in imaging technology has been highlighted in relation to diagnosing pulmonary embolism?

Dual-energy computed tomography pulmonary angiography (CTPA) Signup and view all the answers

What is a suggested need for further studies regarding dual-energy CTPA?

To determine its routine use in clinical practice Signup and view all the answers

Why is it important to understand the imaging features of CTED and CTEPH?

They often require different diagnostic approaches than acute PE Signup and view all the answers

What type of embolism is primarily recognized by imaging features that allow prompt treatment?

Acute pulmonary embolism Signup and view all the answers

What role do the referenced guidelines play concerning pulmonary embolism?

They provide standards for diagnosis and management Signup and view all the answers

What aspect of CTEPH diagnosis contributes to its difficulty?

Subtlety of its imaging features Signup and view all the answers

What is a significant outcome of chronic thromboembolic pulmonary hypertension after an initial pulmonary embolism?

Higher incidence of pulmonary hypertension Signup and view all the answers

Which imaging method is noted for its diagnostic accuracy in evaluating pulmonary embolism?

Contrast-enhanced magnetic resonance angiography Signup and view all the answers

What is one challenge associated with dual-energy CT for pulmonary hypertension imaging?

Difficulty in interpreting results Signup and view all the answers

What aspect does magnetic resonance imaging assess in patients with pulmonary hypertension?

Pulmonary vessel condition Signup and view all the answers

Which approach is suggested for managing suspected acute pulmonary embolism?

Use of CT angiography Signup and view all the answers

What long-term effect was observed in patients with pulmonary thromboembolism according to several studies?

Significant reduction in exercise tolerance Signup and view all the answers

Which imaging sequence is evaluated for its performance related to pulmonary embolism?

Gadolinium-enhanced MR angiographic sequences Signup and view all the answers

What is one of the primary goals of the Fleischner Society regarding acute pulmonary embolism?

Advocating for CT angiography utilization Signup and view all the answers

What is one of the CT signs of right ventricular dysfunction in acute pulmonary embolism?

Flattening of the interventricular septum Signup and view all the answers

Which imaging technique is emphasized for assessing pulmonary embolism?

Computed Tomography (CT) Signup and view all the answers

What is the purpose of the prospective investigation of pulmonary embolism diagnosis (PIOPED)?

To determine the effectiveness of CT in diagnosing pulmonary embolism Signup and view all the answers

Which of the following is NOT a benefit of using multislice CT for diagnosing pulmonary embolism?

High radiation exposure Signup and view all the answers

What role does the ventilation/perfusion scan play in diagnosing acute pulmonary embolism?

It assesses blood flow to the lungs Signup and view all the answers

Which study established reference values for normal pulmonary artery dimensions?

Framingham Heart Study Signup and view all the answers

What safety aspect is particularly important when investigating pulmonary embolism using CT?

Management of intravenous contrast media Signup and view all the answers

Which of the following studies evaluated short-term mortality in relation to clot burden in pulmonary embolism?

JACC Cardiovascular Imaging 2011 Signup and view all the answers

What was the primary purpose of the study reported by Grothues et al. in 2004?

To evaluate right ventricular volumes and function using MRI. Signup and view all the answers

What complication associated with pulmonary angiography was highlighted by Hudson et al.?

Contrast-induced nephropathy. Signup and view all the answers

Which CT technique was explored by Lu et al. for pulmonary angiography?

High-pitch computed tomography with iterative reconstruction. Signup and view all the answers

How did Difﬁn et al. contribute to the understanding of pulmonary angiography interpretation?

By evaluating the effect of emboli distribution on interobserver agreement. Signup and view all the answers

What did the study by Qanadli et al. aim to develop?

A quantitative index for arterial obstruction in pulmonary embolism. Signup and view all the answers

Which aspect of pulmonary embolism did Stein et al. review in their study?

Complications and validity of pulmonary angiography. Signup and view all the answers

What was the aim of the systematic review conducted by Vedovati et al.?

To evaluate the prognostic significance of embolic burden in acute pulmonary embolism. Signup and view all the answers

What new score was evaluated by Mastora et al. in relation to acute pulmonary embolism?

A spiral CT angiographic score to evaluate severity. Signup and view all the answers

Study Notes

Acute Pulmonary Embolism (PE)

PE is the third most common acute cardiovascular disease after coronary artery disease and stroke.
PE arises from deep vein thrombosis (DVT) in the lower limb.
Prompt diagnosis is critical for good outcomes.
Non-specialist radiologists can recognise acute emboli using recent imaging advances.
Most acute emboli resolve with anticoagulation, but some become chronic thromboembolic disease (CTED).
CTED can lead to chronic thromboembolic pulmonary hypertension (CTEPH), affecting up to 5% of acute PE survivors.

Chronic Thromboembolic Disease (CTED)

CTED arises when acute emboli fail to fully resolve and become endothelialised.
CTED involves organisation and endothelialisation of thromboembolic material, forming laminated thrombi and vascular occlusions.
The mechanism of transition from acute to chronic PE is not fully understood.
Factors include failed thrombolysis and localized inflammation and endothelial dysfunction.
Patients with CTEPH often initially experience a "honeymoon period" of symptom improvement followed by insidious progressive dyspnea, chest pain, and right heart failure.
A history of acute PE is present in the majority of CTEPH patients.
CTEPH is diagnosed with mean pulmonary artery pressure (mPAP) ≥25 mmHg; pulmonary capillary wedge pressure (PCWP) <15 mmHg; and persistence of organized thrombi for at least three months after effective anticoagulation.

Imaging Techniques

Ventilation-perfusion (VQ) scintigraphy provides data on lung parenchymal perfusion.
CT, MRI, and invasive angiography are angiographic techniques.
MR angiography, time-resolved angiography, and dual-energy CT angiography are combinations of techniques.
CT pulmonary angiography (CTPA) is the preferred method for diagnosing suspected acute PE, due to low cost, wide availability and rapid acquisition.
V/Q scans and SPECT imaging are used in CTEPH diagnosis in preference to CTPA.
Modern CTPAs yield high quality images, but have also raised concerns about over-diagnosis and overtreatment due to increased ability to identify minor emboli.
MRI plays a role in the assessment of pulmonary arterial obstructive disease and RV (right ventricle) function in CTEPH patients.

Treatment

Anticoagulation is the standard treatment for most patients with acute PE.
Systemic thrombolysis and catheter-directed therapy (CDT) are indicated in high risk patients.
Pulmonary endarterectomy (PEA) is the primary treatment for CTEPH, targeting chronic thromboemboli.
Balloon pulmonary angioplasty (BPA) offers less invasive treatment options for selected patients.

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Description

Explore the key advantages and characteristics of various imaging methods used in cardiology, with a focus on MRPA, CTPA, and CTPEH. This quiz addresses specific imaging techniques, their applications, and diagnostic implications in identifying conditions related to pulmonary pressures and cardiac function.