[Comprehensive cardiac imaging using multidetector CT and magnetic resonance imaging].

Abstract

Recent technical improvements have allowed to non-invasive cardiac imaging by Multidetector CT. (MDCT). In initial work we compared the value of successive generations of MDCT (4, 16, and 64 slice) for non-invasive imaging of coronary arteries vs. non-invasive magnetic resonance coronary angiography using conventional coronary angiography as gold standard. Our work demonstrated progressive improvement of diagnostic accuracy from 4 to 64 slice MDCT technology. The most recent generation of 64 slice MDCT became more performing than MRI. Since cardiac function is the main predictor of outcome in patients with coronary artery disease, we evaluated whether MDCT can also access left ventricular volumes and ejection fraction, and observed excellent correlation of these parameters estimated by MDCT vs MRI. Subsequently we demonstrated that MDCT can also assess aortic stenosis by direct planimetry of the valve. We also found MDCT to be able of evaluating the severity and mechanism of aortic regurgitation and to evaluate function and mechanism of dysfunction of aortic bioprosthesis. We also demonstrated that MDCT can detect myocardial necrosis and fibrosis, and thus assess myocardial viability using similar mechanisms as MRI. Finally, we demonstrated that combined assessment of non-invasive coronary imaging and assessment of myocardial viability may allow assessing the etiology of ischemic vs non-ischemic heart failure, similarly well as the combination of mri and invasive coronary angiography. We also demonstrated that MDCT might allow avoiding performing systematic invasive coronary angiography in patients prior to valve surgery, by selecting only those patients with suspected coronary artery disease to undergo this test. Thus in summary, we performed work, demonstrating the value of MDCT not only for imaging of coronary arteries, but also for assessment of cardiac and valve function and evaluation of myocardial viability. Such comprehensive cardiac imaging by MDCT might be useful for assessment of patients with valve disease and to evaluate etiology of heart failure.