Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond

Abstract

Purpose of ReviewThe aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states.Recent FindingsCCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics.SummaryCTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.

Dilated left ventricle with multiple outpouchings — a severe congenital ventricular diverticulum or left-dominant arrhythmogenic cardiomyopathy: A case report

“…However, CCTA and CMRI generated more details for differential diagnosis. Previous studies have shown that CCTA, a noninvasive approach, can effectively distinguish outpouchings caused by myocardial infarction and ischemic cardiomyopathy related to occlusion (or lack thereof) of the coronary arteries[ 7 , 8 ]. Furthermore, CMRI has a unique advantage in identifying cardiomyopathy.…”

CT myocardial perfusion imaging complementing coronary CT angiography in a patient with a history of unstable angina: A case report

“…The primary usefulness of cardiac CT, specifically non-invasive CCTA, has been well known among patients with CAD symptoms [5]. CCTA has evolved as an emerging utility of assessment for CAD, which can evaluate the coronary wall and anatomy, thus allowing to differentiate the existence of obstructive and non-obstructive coronary plaques [6].…”

2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography

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