COMPUTED TOMOGRAPHY is a topic covered in the Harrison's Manual of Medicine.

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Provides high-resolution images of cardiac structures (including the pericardium and cardiac masses) and detects coronary calcification in atherosclerosis with high sensitivity. CT angiography (CTA) delineates abnormalities of the great vessels, including aortic aneurysms and dissection, and pulmonary embolism. Multislice spiral CT provides high-resolution images of coronary anatomy. It is most useful in evaluation of suspected coronary anatomic anomalies and to exclude high-grade coronary stenoses in pts with chest pain and intermediate pretest probability of coronary artery disease. Its greatest accuracy is in detection of left main and proximal LAD and circumflex disease. CTA is also helpful in assessing the patency of bypass grafts.

Table 112-2 summarizes key diagnostic features of the noninvasive imaging modalities. Figure 112-3 provides an algorithm for diagnostic imaging assessment of suspected CAD.

TABLE 112-2: SELECTION OF IMAGING TESTS
 EchoNuclearCTMRIa
LV size/function

Initial modality of choice

Low cost, portable

Provides ancillary structural and hemodynamic information

Available from gated SPECT stress imaging

Best resolution

High cost

Best resolution

High cost

Valve disease

Initial modality of choice

Valve motion

Doppler hemodynamics

  

Visualize valve motion

Delineate abnormal flow

Pericardial disease

Pericardial effusion

Doppler hemodynamics

 Pericardial thickeningPericardial thickening
Aortic diseaseTEE rapid diagnosis of acute dissectionc 

Image entire aorta

Aortic aneurysms

Aortic dissection

Image entire aorta

Aortic aneurysms

Chronic dissection

Cardiac massesTTE—large intracardiac masses Extracardiac massesExtracardiac masses
 TEE—smaller intracardiac massesb Myocardial massesMyocardiac masses
aRelative contraindication: pacemakers, metallic objects, claustrophobic.
bWhen not seen on TTE.
Abbreviations: Echo, echocardiography; SPECT, single-photon emission CT; TEE, transesophageal echocardiography; TTE, transthoracic echocardiogram.
FIGURE 112-3

Flow diagram showing selection of initial stress test in a pt with chest pain. LBBB, left bundle branch block; Prev MI-Reg ischemia, previous MI with a need to detect regional ischemia; Nuc, SPECT nuclear imaging study; Pharm, pharmacologic.

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TY - ELEC T1 - COMPUTED TOMOGRAPHY ID - 623664 Y1 - 2017 PB - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623664/all/COMPUTED_TOMOGRAPHY ER -