Triple Rule Out CT in the Emergency Department: Clinical Risk and Outcomes (Triple Rule Out in the Emergency Department).

Rationale And Objectives: Triple rule out CT protocols (TRO-CT) have been advocated as a single test to simultaneously evaluate major causes of acute chest pain, in particular acute myocardial infarction (MI), acute pulmonary embolism (PE), and acute aortic syndrome. However, it is unclear what patient populations would benefit from a such comprehensive exam and current guidelines recommend tailoring CT protocols to the most likely diagnosis.

Methods: We retrospectively reviewed TRO-CT scans performed from the Emergency Department (ED) at our institution from April 2021 to April 2022.

Coronary Artery Vasculitis and Encasement: Multimodality Imaging Findings and Mimics.

Coronary artery vasculitis (CAV) and coronary artery encasement are rarely diagnosed conditions that are important diagnostic considerations, particularly in patients with acute coronary syndrome without traditional cardiovascular risk factors or systemic illness. refers to inflammation of the blood vessel walls, which can be primary or secondary. This process should be distinguished from neoplastic involvement of the coronary arteries, termed .

NASCI case of the month: extensive ascending aortic graft infection with underlying chronic sternal osteomyelitis-a rare and high-risk complication.

Thoracic aortic graft infections are infrequent yet grave complications of cardiovascular surgery. Risk factors include prolonged operative time, postoperative wound infections, and patient-specific risk factors like diabetes or malnutrition (Van Hemelrijck et al., Vessel Plus 6:47, 2022).

Resection of a Solitary Right Ventricular Metastasis in Oligorecurrent Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC), constituting the predominant manifestation of liver cancer, stands as a formidable medical challenge. The prognosis subsequent to surgical intervention, particularly for individuals presenting with a solitary tumor, relies heavily on the degree of invasiveness. The decision-making process surrounding therapeutic modalities in such cases assumes paramount importance.

Clinical Impact of Cardiac Fibromas.

Cardiac fibromas are rare primary tumors that can cause significant morbidity and mortality. There has not been a large clinical case review since 1994. This study provides an updated analysis of clinical impact, thereby enhancing understanding, increasing awareness, and revealing important factors in the diagnosis and management of cardiac fibromas.

ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update.

Dyspnea is the symptom of perceived breathing discomfort and is commonly encountered in a variety of clinical settings. Cardiac etiologies of dyspnea are an important consideration; among these, valvular heart disease (Variant 1), arrhythmia (Variant 2), and pericardial disease (Variant 3) are reviewed in this document. Imaging plays an important role in the clinical assessment of these suspected abnormalities, with usually appropriate procedures including resting transthoracic echocardiography in all three variants, radiography for Variants 1 and 3, MRI heart function and morphology in Variants 2 and 3, and CT heart function and morphology with intravenous contrast for Variant 3.

Performing chest computed tomography on pediatric patients on extracorporeal membrane oxygenation (ECMO): a stepwise approach.

Chest CT in pediatric patients on extracorporeal membrane oxygenation (ECMO) can be done safely and provide valuable high-quality diagnostic images to help guide patient management. An understanding of the basics of the ECMO circuit, cannula locations, where and how to inject contrast media, and how to time image acquisition is vital for the radiologist. Additionally, understanding the precautions associated with performing these exams is essential to ensure the safety of the child.

CT Fractional Flow Reserve: A Practical Guide to Application, Interpretation, and Problem Solving.

CT fractional flow reserve (FFR) is a physiologic simulation technique that models coronary flow from routine coronary CT angiography (CTA). To evaluate lesion-specific ischemia, FFR is measured 2 cm distal to a stenotic lesion. FFR greater than 0.

Imaging Features of Complications after Coronary Interventions and Surgical Procedures.

Coronary artery interventions and surgical procedures are used in the treatment of coronary artery disease and some congenital heart diseases. Cardiac and noncardiac complications can occur at variable times after these procedures, with the clinical presentation ranging from asymptomatic to devastating symptoms. Invasive coronary angiography is the reference standard modality used in the evaluation of coronary arteries, with intravascular US and optical coherence tomography providing high-resolution information regarding the vessel wall.

Ventriculotomy Decreases Agreement Between Assessment of Right Ventricular Function by Echocardiography and Cardiac Magnetic Resonance Imaging in Patients with Hypoplastic Left Heart Syndrome.

Accurate assessment of the right ventricular (RV) volume and function is important in patients with hypoplastic left heart syndrome (HLHS). We sought to investigate the effect of ventriculotomy on the correlation of RV functional assessments by two-dimensional echocardiography (2DE) to cardiac magnetic resonance (CMR)-derived RV ejection fraction (EF) in patients with HLHS. A retrospective re-analysis of CMR imaging with matched 2DE was performed from the institutional HLHS registry.

Negative Impact of the Left Ventricular Remnant Morphology on Systemic Right Ventricular Myocardial Deformation in Hypoplastic Left Heart Syndrome.

Left ventricular (LV) morphology may affect right ventricular (RV) function before and after Fontan palliation in patients with hypoplastic left heart syndrome (HLHS). We sought to assess the potential impact of LV morphology on RV function in patients with HLHS using cardiac magnetic resonance (CMR) imaging. A retrospective analysis of available CMR scans from all patients with HLHS was performed.

Statement from the North American Society for Cardiovascular Imaging on imaging strategies to reduce the scarcity of healthcare resources during the COVID-19 outbreak.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving global pandemic that is predicted to strain healthcare resources at multiple locations throughout North America and the World. As of April 6, 2020, the apex of infection rates is predicted to occur within 1 to 5 weeks at various locations. Widespread reports of personal protective equipment (PPE) shortages, and healthcare worker exposure to disease have become commonplace.

ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome.

Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document.

Electrocardiogram-Gated Computed Tomography with Coronary Angiography for Cardiac Substructure Delineation and Sparing in Patients with Mediastinal Lymphomas Treated with Radiation Therapy.

Purpose: (1) Demonstrate feasibility of electrocardiogram-gated computed tomography with coronary angiography (E-CTA) in treatment planning for mediastinal lymphoma and (2) assess whether inclusion of cardiac substructures in the radiation plan optimization (CSS optimization) results in increased cardiac substructure sparing.

Methods And Materials: Patients with mediastinal lymphomas requiring radiation therapy were prospectively enrolled in an observational study. Patients completed a treatment planning computed tomography scan and E-CTA in the deep inspiration breath hold position.

Computed Tomography Imaging of Cardiac Masses.

Although not considered a first-line modality for assessing cardiac masses, computed tomography (CT) can provide clinically useful information and is underused for this purpose. In addition to characterizing masses with insights about presence of fat or calcification and the perfusion characteristics of a mass, CT produces high-resolution four-dimensional images depicting the mass and its relationship to chambers, valves, and coronaries. This is combined with imaging of the chest, abdomen, or coronaries.

Guiding peripheral arterial disease management with magnetic resonance imaging.

Peripheral arterial disease (PAD) management is exceptionally challenging. Despite advances in diagnostic and therapeutic technologies, long-term vessel patency and limb salvage rates are limited. Patients with PAD frequently require extensive workup with noninvasive tests and imaging to delineate their disease and help guide appropriate management.

Usefulness of Cardiac Magnetic Resonance Imaging in Patients With Acute Spontaneous Coronary Artery Dissection.

Cardiac magnetic resonance (CMR) has significant diagnostic and prognostic utility in myocardial infarction evaluation. However, its application in spontaneous coronary artery dissection (SCAD) is not described. Patients with confirmed SCAD who had CMR performed within 8 days of the index SCAD were reviewed.

Cardiac MR elastography using reduced-FOV, single-shot, spin-echo EPI.

Purpose: To implement a reduced field of view (rFOV) technique for cardiac MR elastography (MRE) and to demonstrate the improvement in image quality of both magnitude images and post-processed MRE stiffness maps compared to the conventional full field of view (full-FOV) acquisition.

Methods: With Institutional Review Board approval, 17 healthy volunteers underwent both full-FOV and rFOV cardiac MRE scans using 140-Hz vibrations. Two cardiac radiologists blindly compared the magnitude images and stiffness maps and graded the images based on several image quality attributes using a 5-point ordinal scale.

Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography.

Background: There is limited understanding of the role of cardiac computed tomography angiography (CCTA) for assessment of patients with spontaneous coronary artery dissection (SCAD).

Methods: In this report we describe the diagnostic utility of CCTA in three young women presenting with signs and symptoms of myocardial ischemia who were eventually diagnosed with SCAD.

Results: None of the women had traditional atherosclerotic risk factors.

Low incidence of left atrial delayed enhancement with MRI in patients with AF: a single-centre experience.

Background: Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. One potential target for ablation is left atrial (LA) scar (LAS) regions that may be the substrate for re-entry within the atria, thereby sustaining AF. Identification of LAS through LA delayed gadolinium enhancement (LADE) with MRI has been proposed.

Improving Efficiency Using Time-Driven Activity-Based Costing Methodology.

Purpose: The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology.

Methods: In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process.