Cardiac CT can be a more or less frequent examination faced in daily practice also depending on the institution and the CT scanner technology available. With technological advances and improved dose reduction techniques in the last decade, cardiac CT has become increasingly popular.
What is presented below is a “basic approach” for how to organize findings within a radiological report of a cardiac CT without claim for completeness. This does not cover all facets and the workup of every clinical question and every cardiac problem that might be investigated.
Recommendations, given in the Coronary Artery Disease - Reporting and Data System (CAD-RADS) document, created and published in 2016 as a collaborative effort by the Society for Cardiovascular Computed Tomography (SCCT), American College of Radiology (ACR), and North American Society for Cardiovascular Imaging (NASCI) has been taken into consideration by this approach.
On this page:
Indications
Similar to other organ-specific examinations it is important to understand that depending on the indication the acquisition protocol can vary but will include a coronary CTA in most circumstances.
Typical indications of cardiac CT include evaluation of the following:
preoperative assessment in the setting of non-coronary cardiac surgery
-
coronary artery disease (in patients with low to intermediate pretest probability)
acute coronary syndrome without ECG changes and negative troponin
surgical or interventional planning of chronic coronary occlusions
visualization of aortocoronary bypass grafts in symptomatic individuals
visualization of cardiac veins
visualization of pulmonary veins
aortic disease
-
ascending aortic/aortic root aneurysm
aortic valve disease
-
preprocedural planning and postprocedural follow-up of structural heart disease
imaging of cardioembolic disease
Systematic review
The most common indication of cardiac CT consists of the assessment of the coronary arteries and thus a systematic evaluation should be included in every examination even if the respective clinical question for the cardiac CT is different.
A systematic review is essential and should comprise a meticulous inspection of the cardiac chambers, left ventricular outflow tract and coronary arteries including origin, course and variant anatomy as well as the cardiac veins on thin slice axial and multiplanar reformations, if possible also curved reformations.
Morphology
Visual assessment
The visual morphological assessment includes the following 1-8:
cardiac situs, position, cardiac chambers and connections
congenital anomalies (e.g. atrial and ventricular septal defects)
-
cardiac chamber morphology
-
coronary artery morphology
coronary origins
other variant anatomy (shepherd crook)
-
coronary anomalies
absent or hypoplastic coronary artery
anomalous coronary ostium, ectopic origin, split origins, single coronary artery
-
anomalous course
right coronary artery: interarterial, subpulmonic, intraseptal, intra-atrial, retroaortic
anomalous posterior descending artery (PDA) from the left anterior descending artery (LAD)
-
-
stenosis grading in vessels >1.5 mm in diameter
based on luminal diameter stenosis (SCCT classification)
none, minimal, mild, moderate, severe, occlusion
location based on the AHA 15 segment model 2
-
plaque morphology
calcified
vulnerable or high-risk plaque
non-diagnostic segments
-
-
additional coronary findings
diffuse or partial arterial mural thickening
coronary pseudotumor formation
-
stenosis/occlusion
anomaly
-
aortic root and ascending aorta
acute aortic syndrome (e.g. Stanford A aortic dissection)
aortic atheroma/aortic plaques
-
cuspidity
valvular and subvalvular calcifications (absent, mild, moderate, severe)
valvular vegetations
other cardiac findings
-
pericardial disease
extracardiac findings (adjacent mediastinal and pulmonary structures)
Quantitative assessment
Quantitative measurements usually depend on and are tailored to the clinical question. They can include the following measurements 6,7:
left and right ventricular size including diameter
-
semiautomatic stenosis quantification
-
aortic root (at least systolic phase)
aortic root/sinus dimensions (cross-sectional area, circumference, derived diameters)
annulus dimensions (cross-sectional area, circumference, derived diameters)
height of coronary ostia
determination of fluoroscopic viewing angles
-
aortic valve calcification (in patients with a discordant result on echocardiography)
aortic valve area (AVA), regurgitant orifice area (ROA)
left atrial appendage ostium
Cardiac function
A left ventricular functional analysis can be only conducted on a retrospective gated cardiac CT and is more an optional part of the analysis:
contraction pattern: synchronous/dyssynchronous
Quantitative assessment
A quantitative assessment and depending on the clinical question may include the following:
end-diastolic diameter
end-systolic volume index (ESVI) [mL/m2]
stroke volume index (SVI) [mL/m2]
left ventricular mass index [g/m2]*
regional wall motion abnormalities: localization according to the 17 segment model
Cardiac perfusion
A myocardial perfusion analysis can be only conducted after a respective acquisition preferably on a scanner with a wide detector row coverage during pharmacological stress hyperemia similar to SPECT/PET or MRI.
A quantitative myocardial attenuation analysis can then be performed in a semiautomatic fashion and depicted as perfusion maps and correlated to previously detected coronary lesions 7.
Common pathology
-
coronary anomalies
-
ischemic heart disease/myocardial infarction
cardiac vein pathology (cardiac vein stenosis or occlusion)
pulmonary vein pathology (pulmonary vein stenosis or occlusion)
-
pericardial disease
-
transplant rejection
coronary vasculopathy
and many more….
Unable to process the form. Check for errors and try again.