Cardiovascular CT for assessment of pericardial/myocardial disease processes

Pericardial and myocardial diseases represent an important cause of morbidity and mortality. Although echocardiography remains the initial standard diagnostic tool for identifying these diseases it has limited detail for the morphological and functional analysis of the pericardium and myocardium. Cardiac CT (CCT) and MR (CMR) are the primary modalities of choice when comprehensive functional assessment of the heart is required. These imaging techniques provide advanced information on anatomy and cardiac function to optimize diagnosis and treatment. However, as CMR is relatively more costly and time consuming, it is often only used when diagnosis is not clear. Due to the volumetric nature of image acquisition, cardiac CT provides an accurate and reproducible method for assessing both myocardial and pericardial morphology and function. The excellent spatial resolution and contrast to noise ratio of CT allows for the detection of mural thrombi in patients with severely reduced left ventricular function. CCT can easily help identify pericardial diseases such as inflammation, effusion, pericardial cyst, benign or malignant masses, as well as pericardial calcification in the case of constrictive pericarditis. CCT is also proficient in diagnosing the functional assessment of the heart. As most of cardiomyopathies have functional compromise, CCT is best suited for cardiomyopathies in terms of functional analysis. With the advancement of CT technology, radiation exposure is minimal, and with continued improvement in post-processing software, it is able to produce a variety of highquality images in multiple reformats with historically low radiation and contrast dose. The new General Electric (GE) Revolution CT scanner has made it possible to image the heart with abnormal rate and rhythm without compromising image quality. It is especially useful for patients who have contraindications to beta-blockers or who have atrial fibrillation.