Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases

Abstract

Multimodality imaging is indicated for the evaluation of left ventricular (LV) myocardial diseases. Cardiac magnetic resonance (CMR) allows morphological and functional assessment of the LV along with soft tissue characterization. Technological advances in cardiac computed tomography (CT) have led to the development of techniques for diagnostic acquisition in LV myocardial disease. Cardiac CT facilitates the characterization of LV myocardial disease based on anatomy, function, and enhancement pattern. LV regional and global functional parameters are evaluated using multi-phasic cine CT images. CT myocardial perfusion facilitates the identification of hemodynamically significant coronary artery stenosis. Cardiac CT with delayed enhancement is used to detect myocardial scarring or fibrosis in myocardial infarction and non-ischemic cardiomyopathy, and for the measurement of extracellular volume fraction in non-ischemic cardiomyopathy. In this review, we review imaging techniques and key imaging features of cardiac CT used for the evaluation of myocardial diseases, along with CMR findings.

Cardiac Imaging in Athlete’s Heart: The Role of the Radiologist

“…The knowledge of the normal ranges is essential for the differential diagnosis between AH and cardiomyopathy. Normal values of LVEDV and LVESV were, respectively, 112.9 ± 26.1 mL and 41.7 ± 14.7 mL, the normal value of LV mass was 145.0 ± 29.1, and the normal values of the septal and posterior wall thicknesses were, respectively, 1.08 ± 0.18 cm and 0.91 ± 0.15 cm [ 8 , 28 ].…”

“…Morphological and functional findings are comprehensively assessed using a retrospective ECG-gated helical scanning protocol, which is characterized by continuous data acquisition throughout some consecutive cardiac cycles. This retrospective technique allows the evaluation of any cardiac phase and it is particularly useful in patients with high or irregular heart rhythm and, even if it is associated with relatively high radiation doses, it allows with the same acquisition the evaluation of the coronary artery disease [ 8 , 29 ].…”

“…ECV is a reproducible index and it demonstrated good agreement with the same value calculated with CMR. Indeed, iodine-based contrast medium has similar pharmacokinetic characteristics compared to the paramagnetic contrast agent [ 8 , 30 ].…”

“…ECV is calculated with the formula: ECV = (1 − Htc) × (ΔHU LV m /ΔHU b ), where ΔHU LV m and ΔHU b represent the Hounsfield Unit difference between the pre-contrast and the post-contrast phase, respectively, in the myocardium and in the blood. The post-contrast phase is usually performed 5–7 min after contrast injection [ 8 , 30 ].…”

“…Likewise, cardiac computed tomography (CCT) provides morphological and functional heart evaluation with low radiation dose using the last generation CT scanner. Moreover, the recent technological advances, such as the introduction of dual energy (DE) technology, enabled to extend the CCT application for the myocardial tissue characterization [ 7 , 8 ].…”