APPLICATION OF

MULTI-SLICE CT & MRI

IN CARDIAC DISEASES

BY Dr. AMAL. S
Dr. ANDINET.D
IMAGING MODALITIES OF THE HEART
. CXR
. Echocardiography
. Radionuclide scintigraphy
. Digital subtraction angiography
. Coronary angiography
. Cardiac catheterization with
venticulography . CT . MRI
A shift to less & non invasive methods more
recently.
CT OF THE HEART
. Important modality with excellent spatial
resolution ( 0.1 – 0.5 mm ).
. Image planes not in the major axes of the
heart.
. Some scanners have Couches or gantries
that tilt .
 e
. Small contrast medium (1.5 – 2.5 ml/kg)
makes it a powerful imaging modality --- a
very good contrast with adjacent fat and
soft tissues.
. Data can be stored in digital form for later
manipulation.
 INDICATIONS
. Aortic aneurysms
. Aortic dissections
. Pulmonary thrombosis
. Intra-cardiac masses and thrombi
. Pericardial thickening, fluid,& calcification
. Functional studies
. CAH
. 3 types of CT scanners
1- Conventional CT –
. A full complement of contiguous angular
x-ray data must be obtained over s
scanning circle of 0 – 360 degrees.
. Spatial resolution is 0.1 – 0.5 mm.
. Acquisition time is 2 – 5 seconds /section
--- motion artifacts.
. Adequate to evaluate pericardial
diseases, intra-cardiac tumors, &
calcifications.
. Very good static images of cardiac
anatomy & pericardium.
2- Helical CT
. Image acquisition is in less than 1 sec.
. Advantage is data can be obtained as a
single volumetric data set .
-- Later manipulation of data in to required
section thickness.
-- Three – dimensional reconstruction.
3 – EBCT
.Is capable of evaluating both the static
and functional status of the heart.
. A very fast scanner ( 17 images/sec ).
. Comparison of multiple images
throughout the cardiac cycle from the
same section ---MOVIE MODE---
functional analysis.
. Multiple images at the same section and
phase of a cardiac cycle separated by one
or two cardiac cycles show contrast bolus
as it enters, peaks, and washes out that
area of interest--- FLOW MODE.
 DISADVANTAGES OF CT
. Conventional CT ---long scan times
(2-5 sec.)---image degradation due to
cardiac & resp. movements.
. Contrast administration.
. High ionizing radiation exposure.
 MRI OF THE HEART
. Combines many of the capabilities of the
other imaging modalities in to one.
. Produces highly detailed images of
internal & external structures of the heart
without the of contrast material.
. Rapidly progressing modality.
. Multi-planar capability.
 INDICATIONS
. Congenital heart diseases.
. Aortic & PA diseases.
. Pericardial diseases.
. Ventricular & valvular functions.
. CMP
. Cardiac masses.
 MRI PULSE SEQUENCES
. SPIN-ECHO ( SE )
. The main stay for cardiac MRI.
. Primarily to acquire static anatomical
images.
. 90 degree initiation RF pulse followed by
180 degree refocusing pulse.
. Moving blood ---signal void --- dark-blood
appearance on both T1W & T2W.
. ‘ Dark blood ‘ --- excellent natural contrast
with the adjacent cardiac tissue
---eliminates the need for contrast
administration
. GRADIENT RECALLED ECHO ( GRE )
. Fast field echo images.
. Uses short TR, narrow flip angle ( < 90 )
and gradient refocused pulse.
. Short TR values and non slice selective
RF excitation pulses allow flowing blood to
carry constant influx of magnetized
protons in the imaging volume ---
.” Bright blood “ appearance.
. Multiple images of the same section---at
equal intervals--- throughout the cardiac
cycle.
. Electronically looped in a dynamic display
--- functional images of the heart, valves,
& vessels ---CINE MRI.
. In stenotic or regurgitant valves---very
fast flowing turbulent blood---loses its
coherence---depicted as wedge-shaped
dark area in the white blood background in
GRE image.
 HASTE
. A dark blood sequence
. Turbo SE seq. to allow a rapid static
imaging with in a breath hold period.
. Ultra-fast – acquires each image slice in a
single heart beat.
. Image – a combination of relative T1 &T2
effects. Primarily T1 & T2 effect ---
blurring at the edges.
ECG &RESPIRATORY GATING
. Motions ( cardiac & respiratory ) degrade
image quality in MRI.
. Freezing the beating of the heart & moving
thoracic vasculature is critical to avoid
blurring --- by gating to the cardiac cycle
--- using MRI compatible ECG sensing
device ---
 ---synchronizes the phase-encoding steps
in the image data acquisition with a
specific segment of the cardiac cycle.
IMAGE ORIENTATION
. Axial, coronal, & saggital
. Long axis
. Short axis
 ANATOMIC EVALUATION
. In typical SE MRI ‘black blood”
appearance.
. Myocardium, valves, & vessel wall --- in the
range of intermediate densities.
. Blood flowing below critical velocity
( 2.5 – 3cm/sec ) --- intra cardiac or
intravascular signal.
 PHYSIOLOGIC
. Chamber volume, function
. Wall motion abnormalities
. Myocardial perfusion
. Blood flow abnormalities
Ventricular function-measurments maade at level of pappilary muscles
 LIMITATIONS OF MRI
. 1- CONTRAINDICATIONS
. Very ill patients with basic support &
monitoring systems attached to them.
. Pace makers, aneurysmal clips etc.
. 2- LENGTH OF EXAMINATION
. 30 – 60 minutes
. Claustrophobia, agitation &
apprehension
 CAD
. Most common cause of mortality in
developed nations.
. Clinical presentation ---
. Stable or unstable angina
. AMI
. CHF
. Arrhythmia . Sudden death
. Coronary atheromas are strongly
associated with coronary calcification.
. Ca. score = attenuation . Area of coverage
. No agreement on correlation with the
degree of stenosis.
THANK YOU
 REFERENCES
1- Taveras & Ferrucci – Rad on CD
2- Grainger & Allison – Dxtic radiology
3- Sutton – Txt. Of rad. & imaging
4- Brant – Fundamentals of dxtic rad
5- www.emedicine.com
6- www.clevelandclinic.Com