Coronary allograft vasculopathy in post-heart transplant patients: pathogenesis and role of cardiac computed tomography in diagnosis-a comprehensive review.

Coronary allograft vasculopathy, often known as cardiac allograft vasculopathy (CAV), is a substantial source of morbidity and mortality in people who have had heart transplants. Early detection and monitoring of CAV are crucial for improving outcomes in this population. Although cardiac computed tomography (CT) has emerged as a possible method for finding and evaluating CAV, invasive coronary angiography has long been thought of as the gold standard for recognizing CAV. This study focuses on the utility of cardiac CT for CAV diagnosis and treatment in the post-heart transplant population. It provides an overview of recent studies on the application of cardiac CT in CAV and highlights the advantages and disadvantages of this imaging modality. The potential application of cardiac CT for CAV risk assessment and care is also examined in the study. Overall, the data point to a potential role for cardiac CT in the detection and treatment of CAV in post-heart transplant patients. It enables evaluation of the whole coronary tree and low-radiation, high-resolution imaging of the coronary arteries. Hence, further study is required to determine how best to employ cardiac CT in treating CAV in this group.

Adult Partial Anomalous Pulmonary Venous Return Repair and Superior Vena Cava Syndrome: A Delayed Complication of the Warden Procedure.

The Warden procedure is one of the most common techniques for surgical correction of partial anomalous pulmonary venous return (PAPVR), involving transection and reanastomosis of the superior vena cava (SVC) to the right atrial appendage and baffling of the anomalous pulmonary veins through the atrial septal defect. While the procedure is typically well-tolerated in pediatric patients, adult patients requiring surgical correction of PAPVR are uncommon. The authors report a case of a 33-year-old woman who developed SVC syndrome as a delayed complication of the Warden procedure. Keywords: Cardiac, Congenital, Complications © RSNA, 2022.

A high-resolution 3D atlas of the spectrum of tuberculous and COVID-19 lung lesions.

Our current understanding of the spectrum of TB and COVID-19 lesions in the human lung is limited by a reliance on low-resolution imaging platforms that cannot provide accurate 3D representations of lesion types within the context of the whole lung. To characterize TB and COVID-19 lesions in 3D, we applied micro/nanocomputed tomography to surgically resected, postmortem, and paraffin-embedded human lung tissue. We define a spectrum of TB pathologies, including cavitary lesions, calcium deposits outside and inside necrotic granulomas and mycetomas, and vascular rearrangement. We identified an unusual spatial arrangement of vasculature within an entire COVID-19 lobe, and 3D segmentation of blood vessels revealed microangiopathy associated with hemorrhage. Notably, segmentation of pathological anomalies reveals hidden pathological structures that might otherwise be disregarded, demonstrating a powerful method to visualize pathologies in 3D in TB lung tissue and whole COVID-19 lobes. These findings provide unexpected new insight into the spatial organization of the spectrum of TB and COVID-19 lesions within the framework of the entire lung.

Three dimensional changes of maxillary arch in Unilateral cleft lip and palate patients following comprehensive orthodontic treatment on digital study models.

OBJECTIVE: To compare the effects of comprehensive orthodontic treatment on palatal area, volume, inter-canine and inter-molar width in patients with Unilateral Cleft Lip and Palate (UCLP) using scanned models of the maxillary arch. DESIGN: Retrospective cohort study. SETTING: Tertiary setting. PATIENTS: Two hundred and ten plaster study models of 70 patients with Unilateral Cleft Lip and Palate (Study group SG) and Control Group (n = 70) were scanned using Maestro 3D Dental scanner. The study groupwas further divided into subgroups; Subgroup I: treated with orthodontic treatment only (non-surgical), Subgroup II: patientsmanaged with combined orthodontics and orthognathic surgery (either maxillary advancement or maxillary distraction), Subgroup A: age >14 years and Subgroup B: age <14 years. INTERVENTIONS: Comprehensive orthodontic and Orthosurgical treatment. MAIN OUTCOME MEASURES: Pre- and post-treatment scanned maxillary models of the study group were compared for palatal area and volumeand intercanine and intermolar width. The palatal dimensions of post-treatment scanned models were also compared to that of the control group. RESULTS: The Palatal area and volume, intercanine and intermolar width were significantly higher in the post-treatment as compared to pre-treatment study models (P < 0.01). The measurements ofthe maxillary arch were significantly higher in the control group compared to the post-treatment measurements of the study group. The increase in palatal area and volume was greater in Subgroup I and A compared to Subgroup II and B patients, respectively. CONCLUSION: The 3-Dimensional palatal dimensions in UCLP group improved after orthodontic treatment but were still not comparable to the normal subjects. The patients with age >14 years showed more improvement in the maxillary arch.

ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update.

Dyspnea is the symptom of perceived breathing discomfort and is commonly encountered in a variety of clinical settings. Cardiac etiologies of dyspnea are an important consideration; among these, valvular heart disease (Variant 1), arrhythmia (Variant 2), and pericardial disease (Variant 3) are reviewed in this document. Imaging plays an important role in the clinical assessment of these suspected abnormalities, with usually appropriate procedures including resting transthoracic echocardiography in all three variants, radiography for Variants 1 and 3, MRI heart function and morphology in Variants 2 and 3, and CT heart function and morphology with intravenous contrast for Variant 3. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Cardiac mass evaluation with cardiac computed tomography: A review.

Cardiac masses are rare and include both benign and malignant neoplasms as well as pseudo-tumors. The goal of imaging in patients with suspected cardiac mass is to: (1) confirm presence of a mass; (2) determine the mass' location in the heart; (3) characterize the mass to determine if it is benign or malignant; and (4) evaluate its relationship and effect on adjacent structures. Echocardiography is often the first to detect and assess cardiac structures as it is widely available, non-invasive, and can be done bedside. Echo can also determine if the myocardium or pericardium is involved. Cardiac Magnetic Resonance Imaging (MRI) is often the second modality of choice to evaluate a cardiac mass. Cardiac Computed Tomography (CCT) is an excellent alternative modality with high spatial and temporal resolution, which is widely available, fast, and can be performed in patients with cardiac hardware. We will discuss the role of computed tomography (CT) in the evaluation of various cardiac masses.

Role of computed tomography in adult congenital heart disease: A review.

Due to advances in cardiac surgery, perioperative care and transcatheter interventions, the majority of infants with congenital heart disease (CHD) now survive and reach adulthood. Transthoracic Echocardiography (TTE) is considered the primary imaging modality in evaluation of patients with CHD. However, in adults it can be limited due to several reasons. Although cardiac magnetic resonance (CMR) is extremely useful in evaluating cardiac morphology and function, it is not widely available, takes a long time to obtain images, and cannot be done in severely ill patients or patients that have claustrophobia. Due to high spatial and temporal resolution, isotropic imaging fast imaging and wide availability, multidetector computed tomography (MDCT) has emerged as an excellent alternative modality in the evaluation of adult congenital heart disease (ACHD). It can be performed on patients with hardware and those with claustrophobia, due to shorter image acquisition time. In this article, the commonly encountered congenital heart disorders in adults are reviewed, whether incidentally discovered on a computed tomography (CT), on a CT done to evaluate sequela of unknown CHD, or known treated CHD. To appropriately perform and evaluate CT imaging for postoperative correction or palliation congenital heart disease in adults, the imager should know the detailed cardiac anatomy, details of the operative technique used, and be familiar with the common short and long term post-operative complications.

Non coronary applications of cardiac computed tomography: A review.

Acquired heart diseases including valvular pathologies and conduction abnormalities, along with coronary artery disease make cardiovascular disease one of the major causes of mortality and morbidity worldwide. Advances in cardiac computed tomography (CCT) have led to markedly improved image quality for assessment of several coronary and noncoronary cardiac abnormalities. With the latest versions of CT scanners, image acquisition can be completed within a few seconds, in a single breath hold and with much less radiation exposure, thus making CT an even more attractive diagnostic tool with its high temporal and excellent spatial resolution. Additional advantages are its noninvasive nature, wide availability, fast image acquisition and ability to provide additional data about the cardiac structure, function, valvular motion, and presence or absence of valvular vegetation, mass or intracardiac thrombus. These factors can result in change in management in many valvular pathologies pre- and post-intervention, and in electrophysiological procedures. The goal of this article is to review applications of cardiac CT in non-coronary indications including valvular assessment, pulmonary vein isolation procedure, and left atrial appendage evaluation for its transcatheter occlusion.

Review of pericardial disease on computed tomography.

Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.

Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose.

Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.

Cardiac computed tomographic evaluation of coronary artery calcification: A review.

Vascular calcification is most commonly due to atherosclerosis. It has been well documented that absence of coronary calcification on a chest CT (CCT) is associated with low cardiovascular events and good prognosis. High CT calcium scores often result in a higher incidence of cardiovascular events and worse survival. In asymptomatic patients with an intermediate risk for coronary artery disease, numerous studies have shown Coronary Calcium Scoring (CCS) has prognostic relevance and incremental prognostic value over conventional risk stratification. CT detected calcium score plays important role in patient management. This article will review various CT based coronary artery calcium scoring methods.

Coronary artery anomalies evaluation with cardiac computed tomography: A review.

Coronary artery anomalies involve either their origin, course, or termination of the vessel. Coronary artery anomalies are congenital and relatively few develop symptoms, which can include potentially serious effects like arrhythmia, chest pain, syncope, myocardial infarction, or sudden death. Conventional coronary angiography has been used extensively in the past few decades for evaluation of coronary anomalies. With recent advancements in the software and hardware, noninvasive nature, and excellent temporal and spatial resolution; coronary computed tomographic angiography (CTA) is now the mainstay in the diagnosis of coronary arterial anomalies. Many studies have shown better performance of cardiac CTA compared to invasive angiography in detection of anomalous coronary arteries.

An Updated Comparison of Conventional Coronary Angiography With Cardiac Magnetic Resonance Imaging to Diagnose the Origin and Proximal Course of Anomalous Coronary Arteries.

BACKGROUND: Anomalous coronary arteries (ACAs) may present increased risk for adverse cardiac events. We sought to evaluate the accuracy of conventional coronary angiography (CCA), as it is currently used in clinical practice, compared with expert interpretation and cardiac magnetic resonance imaging (CMR) in determining the site of origin and proximal course of ACAs. METHODS: Fifty consecutive patients without concomitant congenital heart disease, who were referred for CMR to diagnose the course of an ACA, were retrospectively evaluated. Original CCA reports were reviewed. Angiography images were available in all patients and were interpreted by 2 experts blinded to the prior interpretation and CMR results. The accuracy of interpretation in each group was then compared to the current gold standard of CMR. RESULTS: Identification of the site of origin (ie, aortic sinus) by referring angiographers was similar to that of expert angiographers (sensitivity, 89% vs 98%, respectively; P=.10). However, referring angiographers were less likely to correctly identify the proximal course as compared with expert angiographers (sensitivity, 27% vs 98%, respectively; P<.001). CONCLUSIONS: As it is used in current practice, CCA does not provide sufficient diagnostic accuracy for identifying the proximal course of an ACA. Review by expert angiographers added sensitivity, improving the accuracy to nearly 100%. Expert consultation may be nearly as accurate as advanced imaging, and should be considered in cases of ACA in which there is diagnostic uncertainty.

ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded).

Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities. For variants 2 and 5, resting transthoracic echocardiography and MRI heart function and morphology without and with contrast are the usually appropriate imaging modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Assessment of orthodontic treatment outcome using Peer Assessment Rating (PAR) index among patients with non-syndromic unilateral cleft lip and palate.

OBJECTIVE: To evaluate the orthodontic treatment outcome among patients with non-syndromic unilateral cleft lip and palate using the Peer Assessment Rating (PAR) index. MATERIALS AND METHODS: The retrospective study comprised a sample of 80 patients with unilateral cleft lip and palate (39 males and 41 females) with complete pretreatment and posttreatment orthodontic records. The patients were divided into two groups according to the treatment modalities. Group 1 (n = 55), nonsurgical (consisted of patients treated with comprehensive orthodontics) and Group 2 (n = 25), surgical (with presurgical orthodontics followed by maxillary advancement orthognathic surgery). PAR score was evaluated on pretreatment and posttreatment study models for both groups. RESULTS: The mean percentage change for the weighted PAR score of Group 1 and Group 2 was 76.79 ± 20.27% and 82.37 ± 11.38%, respectively. Out of the total sample of 80 cases; 62 (77.5%) cases were "greatly improved," 16 (20%) cases were "improved," and 2 (2.5%) showed "worse/no improvement." Nearly 72.5% of cases in Group 1 and 88% in Group 2 were greatly improved. CONCLUSIONS: The reduction in PAR score in both groups was satisfactory as more than 70% of the patients were in the greatly improved category. The results of the PAR index revealed a high occlusal outcome of orthodontic treatment rendered by the department for patients with unilateral cleft lip and palate.

ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome.

Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR Appropriateness Criteria® Chronic Chest Pain-Noncardiac Etiology Unlikely-Low to Intermediate Probability of Coronary Artery Disease.

Chronic chest pain (CCP) of a cardiac etiology is a common clinical problem. The diagnosis and classification of the case of chest pain has rapidly evolved providing the clinician with multiple cardiac imaging strategies. Though scintigraphy and rest echocardiography remain as appropriate imaging tools in the diagnostic evaluation, new technology is available. Current evidence supports the use of alternative imaging tests such as coronary computed tomography angiography (CCTA), cardiac MRI (CMRI), or Rb-82 PET/CT. Since multiple imaging modalities are available to the clinician, the most appropriate noninvasive imaging strategy will be based upon the patient's clinical presentation and clinical status. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.