It is important that the medical profession play a central role in critically evaluating the use of diagnostic procedures and therapies introduced and tested for detection, management, or prevention of disease. Rigorous, expert analysis of the available data documenting absolute and relative

/pdf/acc-aha-2008-guidelines-for-the-management-of-adults-with-4oqjti8ewr.pdf

ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: Executive summary - A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease)

https://www.hefssa.org/images/uploads/acc_aha_guidelines_for_adults_with_chd.pdf

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Martine Remy-Jardin, MD, PhD Massimo Pistolesi, MD Lawrence R. Goodman, MD Warren B. Gefter, MD Alexander Gottschalk, MD John R. Mayo, MD H. Dirk Sostman, MD During the past decade, the contribution of computed tomographic (CT) angiography in the diagnosis of pulmonary embolism (PE) has dramatically increased as a consequence of major advances in CT technology. The question now no longer concerns demonstrating its clinical value but optimizing its use in various categories of patients. Since the introduction of multidetector CT with high spatial and temporal resolution, CT angiography has become the method of choice for imaging the pulmonary vasculature when PE is suspected in routine clinical practice. This change in the imaging algorithm has had numerous practical consequences. The widespread availability of a noninvasive and accurate means of evaluating the pulmonary circulation has led to the recognition that acute PE has a lower prevalence than it was thought to have in the past among patients clinically suspected of having the disease. Because CT images contain additional diagnostic information in the majority of patients who are suspected of having acute PE and may therefore lead to diagnosis of alternative causes for the patient’s symptoms, the increased use of CT has improved patient care by minimizing diagnostic delays that may be incurred when alternative imaging tests are used. The current possibility of performing electrocardiographically (ECG)-gated examinations of the entire thorax has further reinforced the role of CT angiography in this clinical setting, adding coronary artery disease to the list of alternative diagnoses detectable with the aid of this tool and enabling the use of CT angiography to provide prognostic information from the same data set as that used to help diagnose acute PE. However, the increasingly frequent use of CT has raised concerns about the overall radiation exposure to the population scanned and has imposed on the radiology community a need to optimize scanning protocols. This, in turn, makes it necessary to stratify more precisely the population being scanned according to the likelihood of PE being present (pretest probability), with the aim of reducing the number of unnecessary CT pulmonary angiograms being obtained in patients who are unlikely to have PE. Furthermore, although the number of indeterminate studies has dramatically decreased over time because of improved CT technology, clinicians may still face diagnostic dilemmas when the CT angiographic results are either inconclusive or discordant with the pretest probability. Because of changes in strategy over the past few years and the numerous issues still being debated, the Fleischner Society has deemed it useful to propose a consensus update on the role of CT angiography in the diagnostic approach to PE in 2007.

Management of Suspected Acute Pulmonary Embolism in the Era of CT Angiography: A Statement from the Fleischner Society

Objectives
To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters.

https://repub.eur.nl/pub/63796/art-3A10.1007-2Fs00330-011-2345-6.pdf

Left and right ventricle assessment with Cardiac CT: Validation study vs. Cardiac MR

OBJECTIVE. The aim of this study was to compare ECG-gated 64-MDCT with MRI for the assessment of global right ventricular (RV) function from coronary CT angiography data.SUBJECTS AND METHODS. Thirty-eight patients (25 men, 13 women; mean age ± SD, 55.0 ± 8.8 years) with suspected coronary artery disease underwent contrast-enhanced 64-MDCT (64 × 0.6 mm, 120 kV, 770 mAseff) and 1.5-T MRI (balanced fast-field echo; TR/TE, 3.3/1.6; flip angle, 60°; 50 phases). Double oblique short-axis MDCT and MR images were used for further analysis. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were computed from manually drawn endocardial contours of the right ventricle. For statistical analysis, repeated-measures analysis of variance and Pearson's correlation coefficients were calculated. Bland-Altman plots were computed.RESULTS. In general, RV volumes calculated from 64-MDCT agreed well with those calculated from MRI. The mean EF (± SD) calculated from MDCT and MRI...

/pdf/assessment-of-global-right-ventricular-function-on-64-mdct-2b66lskos0.pdf

Assessment of Global Right Ventricular Function on 64-MDCT Compared with MRI

The purpose of this study was to determine right ventricular (RV) function from 16-detector-row CT by using two different software tools in comparison with MRI. Nineteen patients underwent cardiac CT. (1) With semiautomated contour detection software end-diastolic and end-systolic RV volumes were determined from short-axis CT reformations (MPR) created at every 10% of the RR-interval. (2) End-systolic and end-diastolic axial images were transformed to 3D to determine the volumes by using a threshold-supported reconstruction algorithm. Steady-state free-precession cine-MRI of the heart was done in short-axis orientation. RV function could not be analyzed in one patient because of sternal wire artifacts in MRI. Mean end-diastolic (155.4+/-54.6 ml) and end-systolic (79.1+/-37.0 ml) RV volumes determined with MPR correlated well with MRI [151.9+/-53.7 ml (r=0.98) and 75.0+/-36.0 ml (r=0.96), respectively (P<0.001)]. RV stroke volume (76.2+/-20.2 ml for MPR-CT, 76.9+/-20.7 ml for MRI, r=0.93) showed a good correlation and RV ejection fraction (50.8+/-8.4% for MPR-CT, 51.9+/-7.4% for MRI, r=0.74) only a moderate one. Threshold supported 3D reconstructions revealed insufficient correlations with MRI (r=0.31-0.59). MPR-based semiautomated analysis of cardiac 16 detector-row CT allows for RV functional analysis. The results correlate well with MRI findings. Threshold value-supported 3D reconstructions did not show satisfying results because of inhomogeneities of RV contrast enhancement.

Assessment of right ventricular function by 16-detector-row CT: comparison with magnetic resonance imaging.

PURPOSE To determine global and regional left ventricular (LV) function from retrospectively gated multidetector row computed tomography (CT) by using two different semiautomated analysis tools and to correlate the results with those of magnetic resonance imaging (MRI). MATERIALS AND METHODS Nineteen patients (5 females, 14 males, mean age 69 years) underwent 16-slice spiral-CT (MS-CT) with standard technique without administration of beta-blockers for a decrease in the cardiac rate. Ten series of images were reconstructed at every 10 % of the RR-interval. With commercially available software capable of semiautomated contour detection, end-diastolic and end-systolic LV volumes (EDV and ESV) were determined from short-axis multiplanar CT reformations (MPR). Axial images of the end-systolic and end-diastolic cardiac phase were transformed to 3D volumes (3D) to determine EDV and ESV by using a threshold-supported reconstruction algorithm dependent on the contrast enhancement of the left ventricle. Steady-state free-precession cine MR images were acquired in short-axis orientation on the same day in all but one patient. Regional wall motion was assessed qualitatively in 17 left ventricular segments and classified as normo-, hypo-, a- or dyskinetic. Bland-Altman analysis was performed to calculate limits of agreement and systematic errors between CT and MRI. RESULTS For MPR/3D, mean end-diastolic (144.4/142.8 mL +/- 67.5/67.1) and end-systolic (66.4/68.7 mL +/- 52.1/49.9) LV volumes as determined with MS-CT correlated well with MRI measurements (147.6 mL +/- 67.6 [ r = 0.98/0.96] and 73.3 mL +/- 55.5 [ r = 0.98/0.98], respectively [ p <.001]). LV stroke volume (77.6/74.1 +/- 19.2/23.4 mL for CT vs. 74.4 mL +/- 18.4 for MRI, r = 0.92/0.74) and LV ejection fraction (58.6/55.9 % +/- 13.5/13.7 for CT vs. 55.6 % +/- 13.5 for MRI, r = 0.95/0.91) also showed good correlation (p <.001). Regional wall motion analysis revealed agreement between CT and MRI in 316/323 (97.8 %) myocardial segments. CONCLUSION Semiautomated analysis of 16-detector row CT data sets enables global and regional volumetric and functional analysis. The CT results correlate well with MRI findings for short axis MPR and for 3D volume reconstructions, with a higher statistical spread for the 3D method. The underestimation of end-systolic and end-diastolic volumes with CT may be caused by partial volume averaging due to the lower temporal resolution as compared with MRI.

Möglichkeiten der 16-Schicht-CT bei der linksventrikulären Funktionsbestimmung: Beurteilung zweier unterschiedlicher Software-Tools zur quantitativen Funktionsanalyse sowie qualitative Bewertung von Wandbewegungsstörungen im Vergleich zur Magnetresonanztomographie

The limited lifetime and the correlation between graft occlusion and recurring symptoms underline the need for repeated imaging of coronary artery bypass grafts. CT and MRI allow for non-invasive imaging of coronary bypasses with high accuracies concerning the patency of these vessels. Multidetector CT seems to be the CT technique of choice, especially after the introduction of 16 slice CT scanners for morphologic assessment of coronary artery bypass grafts. Compared with MRI, CT is a robust technique for assessment of cardiac anastomoses, native coronary arteries, and for the detection of graft stenoses. MRI, however, is able to deliver functional information about the grafts and the recipient coronary arteries by determining the coronary flow reserve. Furthermore, it can be integrated in a multiparametric MR examination protocol. The follow-up of asymptomatic patients can primarily be done by these non-invasive techniques as nearly every third patient reveals an asymptomatic bypass occlusion 5 years after operation. Furthermore, patients with atypical complaints after the operation may undergo non-invasive imaging as long as documented patency of the bypass averts coronary angiography. Patients with recurrent angina pectoris and/or myocardial ischemia discovered by other cardiologic tests have to undergo coronary angiography.

[Non-invasive assessment of coronary artery bypass grafts -- an update].

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Assessment of right ventricular function by 16-detector-row CT: comparison with magnetic resonance imaging.

Möglichkeiten der 16-Schicht-CT bei der linksventrikulären Funktionsbestimmung: Beurteilung zweier unterschiedlicher Software-Tools zur quantitativen Funktionsanalyse sowie qualitative Bewertung von Wandbewegungsstörungen im Vergleich zur Magnetresonanztomographie

[Non-invasive assessment of coronary artery bypass grafts -- an update].