Right heart on multidetector CT

Abstract

ABSTRACT. Right ventricular function plays an integral role in the pathogenesis and outcome of many cardiovascular diseases. Imaging the right ventricle has long been a challenge because of its complex geometry. In recent years there has been a tremendous expansion in multidetector row CT (MDCT) and its cardiac applications. By judicious modification of contrast medium protocol, it is possible to achieve good opacification of the right-sided cardiac chambers, thereby paving the way for exploring the overshadowed right heart. This article will describe the key features of right heart anatomy, review MDCT acquisition techniques, elaborate the various morphological and functional information that can be obtained, and illustrate some important clinical conditions associated with an abnormal right heart.

Pathogenic structural heart changes in early tricuspid regurgitation

“…CTA is a validated, accurate method for measuring right heart volumes 15,16 and was used to measure chamber volumes and annulus area using Vital Images (Toshiba, Minato, Tokyo) VITREA software. The tricuspid annulus plane was identified from 3-dimensional multiplanar reformatted CTA data in diastole.…”

Diagnostic Accuracy of Sex-Specific Chest CT Measurements Compared With Cardiac MRI Findings in the Assessment of Cardiac Chamber Enlargement

“…All CT measurements were performed on nonreformatted axial images. For evaluation of RA enlargement (RAE), the CT measurements evaluated were RA transverse and longitudinal diameters [8]. RA transverse diameter was measured as the largest diameter perpendicular to the interatrial septum and parallel to the tricuspid valve plane, excluding the RA appendage and coronary sinus ( Fig.…”

“…For evaluation of RV enlargement (RVE), the maximum RV transverse diameter based on visual evaluation was measured perpendicular to the interventricular septum and parallel to the tricuspid valve plane, from RV septal to RV lateral wall endocardial blood pool border [8,9] (Fig. 2C).…”

Analysis of ventricular function by CT

“…22 To minimize the overall contrast load, a second phase injection using a reduced flow rate or a diluted mixture of contrast at the same flow rate can be administered. 47 Assessment of RV function by cardiac CT has been validated in multiple studies with good accuracy and reproducibility utilizing CMR as the reference standard. 19, 48 A cohort that may frequently benefit from the CT-based assessment of RV volumes and function are the complex adult congenital heart disease patients, such as those after Tetralogy of Fallot repair.…”

“…8 Cardiac CT can assess RV dilatation, reduction of RV ejection fraction, severe segmental dilatation, and regional hypokinesis – all part of the major or minor criteria per the original task force criteria of the diagnosis of ARVC/D (Table 1). 47, 52–54 The 2010 ACC/AHA appropriate use criteria designates cardiac CT as “Appropriate” for the evaluation of suspected right ventricular anomalies such as ARVC/D. 22 One study with the use of major or minor criteria showed moderate to excellent sensitivity and positive predictive value.…”