Turner syndrome with aberrant right subclavian artery and partial anomalous pulmonary venous return.

We report the case of a 6 year old girl with Turner syndrome and aberrant right subclavian artery with an incidental finding of PAPVR on contrast-enhanced, high-pitch, 128-slice, electrocardiographic-gated dual source CT. There is value of using high-pitch DSCT in pediatric patients for diagnostic images with minimal radiation exposure.

Usefulness of comprehensive cardiothoracic computed tomography in the evaluation of acute undifferentiated chest discomfort in the emergency department (CAPTURE).

Newer cardiac computed tomographic (CT) technology has permitted comprehensive cardiothoracic evaluations for coronary artery disease, pulmonary embolism, and aortic dissection within a single breath hold, independent of the heart rate. We conducted a randomized diagnostic trial to compare the efficiency of a comprehensive cardiothoracic CT examination in the evaluation of patients presenting to the emergency department with undifferentiated acute chest discomfort or dyspnea. We randomized the emergency department patients clinically scheduled to undergo a dedicated CT protocol to assess coronary artery disease, pulmonary embolism, or aortic dissection to either the planned dedicated CT protocol or a comprehensive cardiothoracic CT protocol.

Risk stratification for sudden cardiac death after septal myectomy.

Background: The importance of risk stratification for sudden cardiac death (SCD) after septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) has not been emphasized previously.

Methods And Results: We report 2 patients with SCD or ventricular tachycardia (VT) after septal myectomy for HOCM in whom risk factors for SCD were identified following surgical myectomy. One received an implantable cardioverter-defibrillator (ICD), which subsequently provided appropriate discharges for VT.

Cardiac CT of non-shunt pathology of the interatrial septum.

The development and anatomy of the interatrial septum is complex. With the increasing use of cardiac CT and its precise delineation of the anatomy, it is important for the cardiac imager to become familiar with the normal anatomic structures that compose the interatrial septum and their variants. Furthermore, it is important to recognize pathologic processes occurring in this region other than atrial septal defects and potential imaging pitfalls.

[Prevalence and clinical significance of incidental cardiac findings in non-ECG-gated chest CT scans].

Background: The purpose of this study was to evaluate the prevalence and clinical significance of incidental cardiac findings in non-ECG-gated chest CT.

Patients And Methods: Non-ECG-gated chest CT examinations of 300 patients were retrospectively analyzed for incidental cardiac findings. Subsequently, these findings were evaluated for their clinical relevance by a cardiologist.

Embryology and developmental defects of the interatrial septum.

Objective: The various types of atrial septal defects (ASDs) can be differentiated on the basis of their imaging appearance on MDCT.

Conclusion: It is fundamental for the cardiac imager to understand the embryologic development of the interatrial septum and the morphogenic differences of ASDs.

Relationship between previous training and experience and results of the certification examination in cardiovascular computed tomography.

Examinees of the first Certifying Examination in Cardiovascular Computed Tomography were surveyed regarding their training and experience in cardiac computed tomography. The results support the current training pathways within the American College of Cardiology/American Heart Association competency criteria that include either experience-based or formal training program in cardiovascular computed tomography. Increased duration in clinical practice, the number of scans clinically interpreted in practice, and level 3 competency were associated with higher passing rates.

Use of 100 kV versus 120 kV in cardiac dual source computed tomography: effect on radiation dose and image quality.

To evaluate the effective radiation dose and image quality resulting from use of 100 vs. 120 kV among patients referred for cardiac dual source CT exam (DSCT). Prospective data was collected on 294 consecutive patients referred for DSCT.

Increased coronary artery calcium score and noncalcified plaque among HIV-infected men: relationship to metabolic syndrome and cardiac risk parameters.

Objective: In this study, the effects of traditional cardiac risk factors on coronary artery calcium (CAC) score and presence of plaque, including noncalcified plaque, measured by computed tomography coronary angiography, were compared among HIV-infected and non-HIV-infected subjects, with respect to the presence of the metabolic syndrome (MS).

Design And Methods: HIV-infected men recruited for the presence of the MS (HIV + MS, n = 27) were compared with 2 control groups, HIV-infected men recruited without regard to metabolic criteria (HIV, n = 87), and HIV-negative control men (C, n = 40), also recruited without regard to any metabolic criterion.

Results: All 3 groups were similar in age, demographic parameters, and smoking.

Patient preparation and scanning techniques.

Cardiac computed tomographic angiography (CCTA) is a unique diagnostic modality that can provide a comprehensive assessment of cardiac anatomy. Rapid advances in scanner and software technology have resulted in the ability to noninvasively image the coronary arteries. However, careful patient preparation and scanning technique is required to ensure optimal image quality while minimizing radiation dose delivered.

Acute renal infarction secondary to calcific embolus from mitral annular calcification.

We report a case of a 62-year-old man who presented with right groin pain who subsequently was found to have a renal infarct secondary to calcific embolus from mitral annular calcification on CT and angiography. We briefly review the literature and discuss the importance of this entity in clinical practice.

CT angiography of the thoracic aorta.

Patients with thoracic aortic diseases may be completely asymptomatic (as in thoracic aortic aneurysms) or present acutely with severe chest pain (as in acute aortic dissections). Thoracic aortic disease is often occult until a life-threatening complication occurs or the disease is discovered incidentally on imaging. Multidetector-row computed tomography (MDCT) can be used to diagnose various acute and chronic abnormalities of the aorta, including aortic aneurysms, aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, traumatic aortic transection, and congenital malformations.

Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measure left atrial volume.

Left atrial (LA) volume is an important prognostic factor in cardiovascular disease. Multidetector computed tomography (MDCT) is an emerging cardiac imaging modality; however, its accuracy in measuring the LA volume has not been well studied. The aim of our study was to determine the accuracy of MDCT in quantifying the LA volume.

Increased epicardial adipose tissue volume in HIV-infected men and relationships to body composition and metabolic parameters.

Epicardial fat accumulation may have important clinical consequences, yet little is known regarding this depot in HIV patients. We compared epicardial fat volume in 78 HIV-infected men and 32 HIV-negative controls. Epicardial fat volume was higher in HIV-infected patients than that in controls (P = 0.

Comparison of postprocessing techniques for the detection of perfusion defects by cardiac computed tomography in patients presenting with acute ST-segment elevation myocardial infarction.

Background: Despite rapid advances in cardiac computed tomography (CT), a strategy for optimal visualization of perfusion abnormalities on CT has yet to be validated.

Objective: We evaluated the performance of several postprocessing techniques of source data sets to detect and characterize perfusion defects in acute myocardial infarctions with cardiac CT.

Methods: Twenty-one subjects (18 men; 60 +/- 13 years) that were successfully treated with percutaneous coronary intervention for ST-segment myocardial infarction underwent 64-slice cardiac CT and 1.

Appropriateness and utilization of cardiac CT: implications for development of future criteria.

Background: The cardiac CT (CCT) appropriateness criteria (AC) were jointly published by multiple societies to ensure effective utilization of CCT. We sought to determine how these criteria apply to CCT scans performed at a tertiary-care hospital.

Methods And Results: Data were collected from medical records and interviews of 267 consecutive patients referred for CCT.

Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial.

Background: The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain.

Methods And Results: We analyzed 356 patients (mean age, 53+/-12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission.

Intravenous leiomyoma extending into the right ventricle.

We present a case of a retroperitoneal leiomyoma invading the inferior vena cava and extending to the right ventricle. The tumor was visualized with electrocardiographic-gated dual-source computed tomography, showing a low-density, lobulated mass invading the inferior vena cava and prolapsing through the tricuspid valve during diastole. Cardiac computed tomography is useful in assessing the extension and hemodynamic effect of intracardiac masses.

Perceived usefulness of cardiac computed tomography as assessed by referring physicians and its effect on patient management.

Despite the growing use of computed tomographic angiography (CTA), the effect on patient management is less clear. We sought to determine the perceived usefulness of the results provided by CTA and to assess whether and how it influences patient management. Comprehensive prospective data were collected from 184 consecutive patients who presented for clinical CTA for the evaluation of coronary artery disease from March to July 2008.