Journal of cardiovascular computed tomography
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A number of congenital anomalies of the aortic arch complex can occur, ranging from asymptomatic normal variations in arch vessel branch pattern to symptomatic vascular rings, stenoses, and arch interruptions with a frequency ranging from 0.5% to 3.0%. A right aortic arch is present in 0.1% of the population and can occur in isolation or be associated with congenital heart disease. Patients may present at any age with signs and symptoms of airway or esophageal compression, heart failure, or abnormal chest imaging studies. This pictorial essay will show the computed tomography and appearances of congenital variations of the right aortic arch and use Edwards' hypothetical embryonic double aortic arch model to explain the cause of some of these variants.
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Septal defects are common congenital cardiac anomalies that may present in adulthood. Although echocardiography and magnetic resonance imaging are most frequently used to assess for and evaluate septal defects, multidetector computed tomography (CT), with its high spatial and temporal resolutions, multiplanar reconstruction capabilities, and wide field of view, is an excellent tool for detection and characterization of septal defects and for identification of associated anomalies of the heart and pulmonary vasculature. Knowledge of the CT appearances of septal defects and their respective associated abnormalities is critical for accurate reporting as well as for providing information for planning of surgical or percutaneous therapy. In this pictorial review, the CT appearances of various atrial and ventricular septal defects and associated shunts are described and illustrated.
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J Cardiovasc Comput Tomogr · Mar 2009
ReviewIs the "triple rule-out" study an appropriate indication for cardiovascular CT?
There is interest in using the fast volume coverage of 64-slice cardiovascular CT angiography (CCTA) in patients presenting with undifferentiated acute chest pain to simultaneously evaluate the coronary arteries, thoracic aorta, and pulmonary arteries during a single breathhold, the so-called "triple rule-out." However, it is not clear whether the triple rule-out study is an appropriate indication for cardiovascular CCTA. Initial studies suggest that performing a triple rule-out protocol to comprehensively evaluate patients with acute chest pain presenting to the emergency department (ED) is feasible and that quantitative parameters of image quality may be comparable to the conventional, dedicated coronary and pulmonary CTA protocols. ⋯ In addition, new scanner technology has also reduced the contrast and radiation doses necessary for such an examination. However, despite these early encouraging results, randomized control trials designed to determine whether this protocol is safe, cost-effective, and improves clinical decision making are necessary before routine implementation of such an examination can be justified.
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J Cardiovasc Comput Tomogr · Jan 2009
ReviewRole of computed tomography in the evaluation of acute chest pain.
Chest pain is common and the initial clinical presentation is often nonspecific. The emergency physician faces the challenge of correctly identifying those patients with a life-threatening cause of chest pain while avoiding unnecessary hospital admissions. Three important life-threatening causes of chest pain are aortic dissection, pulmonary embolism, and acute coronary syndrome. ⋯ Improvements in CT scanner technology now enable in-depth data on the coronary arteries. Although angiographic information is limited in its relation to physiologic lesion significance, coronary CT is used to safely diagnose or exclude coronary disease as a source of chest pain in emergency department patients. "Triple rule-out" protocols designed to simultaneously assess the aorta, pulmonary arteries, and coronary arteries are a compromise between dedicated protocols for each diagnosis. The diagnostic value and appropriate clinical use of these protocols remain to be shown by randomized, controlled, outcomes-based trials.
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J Cardiovasc Comput Tomogr · Mar 2008
ReviewCurrent status and future directions in technical developments of cardiac computed tomography.
Labeled as a dying modality in the late 1980s, the remarkable resurgence of computed tomography (CT) was the commercial availability of the helical CT and the multidetector-row CT (MDCT) scanners. The MDCT scanners in particular were responsible for creating new and promising opportunities for imaging the heart and the vascular system in a noninvasive manner. ⋯ Work in progress on the potential of the dual-energy CT, the 256-slice MDCT, and the flat-panel volume CT, suggest the possibility of new and interesting cardiac applications. This review article describes the present status of CT in noninvasive cardiac imaging and highlights the future directions of the technology.