This document discusses cardiac imaging modalities such as CT, MRI, echocardiography, and nuclear scintigraphy used by cardiac surgeons. It provides information on how to perform good quality CT and MRI imaging, and what each modality can be used to visualize such as coronary artery anatomy, post-procedure evaluation, congenital heart disease, and cardiac function. The document also covers contraindications of CT and MRI, how to decide between the modalities, and risks of contrast-induced nephropathy.

1. Cardiac CT, MRI Imaging for the
Surgeon
Dr. S.K. Varma. MS, FRCS(Ed), MCh, DNB, FIACS
Chief Cardiothoracic Surgeon
KG Hospital, Coimbatore 641018
www.skvarma.com

2. Cardiac Imaging Modalities
• CXR
• Echo
• CT
• MRI
• Nuclear Scintigraphy
• Cardiac Catheterisation

3. Good CT Imaging
• 64 slice
• ECG gated
• Preferably dual source
• HR 60/min, regular rhythm

4. Coronary Artery Anatomy

5. Coronary Anatomy (3D
Reconstruction)
• Multiple planes
• Multiple views
• Exact course
• Intramyocardial course

6. Anatomy distal to total occlusion

7. Post PCI stent evaluation

8. Post CABG graft evaluation

9. Aortic calcification

10. Distance from sternum (Redo
procedures)

11. Congenital Heart Disease

12. Anatomy of the aortic root

13. Anatomy of Aneurysms

14. Anatomy of Aortic Dissection

15. Anatomy of access vessels (TAVI,
endovascular aortic stenting)

16. To r/o pulmonary embolism

17. Evaluation of Pericardial Disease

18. Cardiac MRI for the Surgeon

19. Good MRI study
• ECG gated
• 1.5 tesla
• Contrast enhanced

20. Myocardial viability

21. Dobutamie/ adenosine stress MRI

22. Cardiac volumes & masses

23. Global/regional contractility

24. Myocardial tissue charecteristics
• Oedema
• Inflammation
• Metabolism
• Fibrosis

25. CT or MRI ? How to decide?
• CT
• Structural evaluation
• Coronary anatomy
• Avoid magnetic fields
• Iodine based contrast
• MRI
• Functional evaluation
• Anatomy of infarct
• Avoid radiation
• Gadolinium based

26. Contraindications to CT
• Avoid radiation (Pregnancy)
• Anaphylaxis to iodine based contrast
• Fast heart rate, irregular rhythm

27. Contraindications to cardiac MRI
• Prosthetic valve
• Pacemaker / AICD
• Coils / stents
• Occluder devices
• Cochlear implants
• Critically ill patients (ventilator, inotrope
dependent)

28. Contrast Induced Nephropathy
• >25% increase in renal function within 48-72
hrs of IV contrast
• Can occur as long as after 7 days after
• Direct cytotoxicity + vasoconstriction on PCT
• Common with hypo-osmolar contast
• Less with iso-osmolar contrast
• Common in elderly, diabetics, CKD,
dehydration

29. Contrast Induced Nephropathy
• Volume of contrast
• Treatment – hydration, forced diuresis, N
Acetyl cystine, NAHCO3, high dose statins

30. Summary

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E Mail: varmask@hotmail.com
Web: www.skvarma.com