Cardiac CT angiography: normal and pathological anatomical features—a narrative review

Abstract

The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.

The value of cardiac CT in the diagnosis of unroofed coronary sinus syndrome

“…UCSS is often associated with other malformations, such as atrial septal defect, ventricular septal defect, uniatrial heart, completely abnormal pulmonary venous drainage and tetralogy of Fallot [21]. The excellent temporal (millisecond) and spatial (sub-millimetre) resolution of the CCT undoubtedly ensures the accuracy of the diagnosis of cardiac malformations and the description of the overall intracardiac-vascular-thoracic structures [22,23]. In this cohort, 12 extra malformations were diagnosed by CCT comparied to 5 diagnosed by TTE (41.7%).…”

“…TTE is not ideal for the diagnosis of extracardiac malformation such as PLSVC and anomalous pulmonary venous connection [3,4]. Compared to TTE, cardiac computer tomography (CCT) with superior spatial resolution shows advantages of evaluating the coronary vein system, and exhibiting the abnormalities of intracardiac structure and extracardiac vascularity [5][6][7]. The aim of this study is to present the different features of UCSS by various CCT postprocessing techniques and evaluate the diagnostic advantages of CCT.…”

Cardiac CT in CRT as a Singular Imaging Modality for Diagnosis and Patient-Tailored Management

“…Next to dual-source, wide-detector CT and dual-energy CT, the photon-counting technique has recently been introduced for cardiac imaging [16]. With these hardware systems, advances have been made in spatial resolution (0.25-0.5 mm isotropy) and temporal resolution (up to 66 ms) with rapid image acquisition (240-270 ms gantry rotation) and improved contrast resolution (e.g., by increased tube-power and low kV) as well as in radiation dose reduction [15,17,18]. Essential developments in post-processing methods, such as iterative reconstruction or deep-learning image reconstruction for noise and artifact reduction, multi-energy CT-based virtual reconstructions for monochromatic (monoenergetic) images, and iodine (perfusion) maps have further enhanced image quality [19][20][21][22].…”

Gender Specific Coronary Artery Diameters in CT Coronary Angiogram: A Comparative Study in Female and Male Population

“…Moreover, with ECG-gated synchronized dual-source dualenergy cardiac CT scanners having multiple detectors that yield very nice morphological characteristics (like temporal resolution, contrast resolution), the virtual measurement of coronary arteries complying with heart-rate associated with a great (submillimetric) precision helps in follow up of the temporal evolution of various pathologies. [24] Indians' coronary artery dimensions were being described to be significantly smaller than that of the Western population. This can be attributed to the smaller body habitus, built, and BSA.…”