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When, Why, and How to Examine the Heart During Thoracic CT: Part 1, Basic Principles

John F. Bruzzi1,2, Martine Rémy-Jardin1, Damien Delhaye1, Antoine Teisseire1, Chadi Khalil1 and Jacques Rémy1

1 Department of Radiology, Hospital Calmette, Boulevard Pr. J. Leclerq, Lille 59037, France.
2 Present address: Department of Thoracic Imaging, The University of Texas M. D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030-4095.


Figure 1
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  		Fig. 1A —CT scan of heart from 46-year-old man with non-small cell lung cancer. Images were acquired with 16-MDCT scanner with cardiac gating as part of preoperative evaluation of patient's tumor (temporal resolution, 250 msec; diastolic phase, A and B; systolic phase, C and D). Image reconstruction along small axis of ventricular cavities (grid, A and C) is planned at axes perpendicular to plane of interventricular septum. Such images are useful for morphologic study of right ventricle: shape of each compartment; myocardial thickness; and convexity, shape, and thickness of interventricular septum. MDCT also permits calculation of ventricular volumes and ejection fractions. If images are reconstructed in multiple phases of cardiac cycle, cine images of heart contraction can provide information regarding myocardial kinetics and help identify areas of dyskinesis, restrictive cardiomyopathy, and constrictive pericarditis.

 

Figure 2
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  		Fig. 1B —CT scan of heart from 46-year-old man with non-small cell lung cancer. Images were acquired with 16-MDCT scanner with cardiac gating as part of preoperative evaluation of patient's tumor (temporal resolution, 250 msec; diastolic phase, A and B; systolic phase, C and D). Image reconstruction along small axis of ventricular cavities (grid, A and C) is planned at axes perpendicular to plane of interventricular septum. Such images are useful for morphologic study of right ventricle: shape of each compartment; myocardial thickness; and convexity, shape, and thickness of interventricular septum. MDCT also permits calculation of ventricular volumes and ejection fractions. If images are reconstructed in multiple phases of cardiac cycle, cine images of heart contraction can provide information regarding myocardial kinetics and help identify areas of dyskinesis, restrictive cardiomyopathy, and constrictive pericarditis.

 

Figure 3
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  		Fig. 1C —CT scan of heart from 46-year-old man with non-small cell lung cancer. Images were acquired with 16-MDCT scanner with cardiac gating as part of preoperative evaluation of patient's tumor (temporal resolution, 250 msec; diastolic phase, A and B; systolic phase, C and D). Image reconstruction along small axis of ventricular cavities (grid, A and C) is planned at axes perpendicular to plane of interventricular septum. Such images are useful for morphologic study of right ventricle: shape of each compartment; myocardial thickness; and convexity, shape, and thickness of interventricular septum. MDCT also permits calculation of ventricular volumes and ejection fractions. If images are reconstructed in multiple phases of cardiac cycle, cine images of heart contraction can provide information regarding myocardial kinetics and help identify areas of dyskinesis, restrictive cardiomyopathy, and constrictive pericarditis.

 

Figure 4
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  		Fig. 1D —CT scan of heart from 46-year-old man with non-small cell lung cancer. Images were acquired with 16-MDCT scanner with cardiac gating as part of preoperative evaluation of patient's tumor (temporal resolution, 250 msec; diastolic phase, A and B; systolic phase, C and D). Image reconstruction along small axis of ventricular cavities (grid, A and C) is planned at axes perpendicular to plane of interventricular septum. Such images are useful for morphologic study of right ventricle: shape of each compartment; myocardial thickness; and convexity, shape, and thickness of interventricular septum. MDCT also permits calculation of ventricular volumes and ejection fractions. If images are reconstructed in multiple phases of cardiac cycle, cine images of heart contraction can provide information regarding myocardial kinetics and help identify areas of dyskinesis, restrictive cardiomyopathy, and constrictive pericarditis.

 

Figure 5
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  		Fig. 2A —42-year-old woman with chronic thromboembolic disease. Axial image from non-ECG-gated CT scan of thorax, taken at level of right ventricular inflow chamber, depicts prominent papillary muscles (arrow) connected via fine chordae tendineae (arrowhead) to tricuspid valve leaflets. Note severe right ventricular dilatation resulting from chronic right ventricular heart failure.

 

Figure 6
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  		Fig. 2B —42-year-old woman with chronic thromboembolic disease. At slightly more caudal level, moderator band is well depicted (arrow) as it ramifies from interventricular septum to anterolateral wall of right ventricular apex. Moderator band conducts electrical apparatus of right bundle of His. Note also dilated segmental pulmonary artery in right lower lobe and evidence of intramural thrombus (arrowhead) resulting from chronic thromboembolic disease.

 

Figure 7
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  		Fig. 3 —67-year-old man with congestive heart failure. Axial image at level of left ventricle, from contrast-enhanced CT scan of thorax without cardiac gating, shows prominent anterior papillary muscle (arrow). Left atrium is markedly dilated. Papillary muscle can also be seen in right ventricular apex (arrowhead).

 

Figure 8
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  		Fig. 4 —52-year-old woman with suspected pulmonary embolus. Axial image from CT of thorax obtained without ECG gating shows prominent crista terminalis in right atrium (arrow), which should not be mistaken for intracavitary thrombus.

 

Figure 9
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  		Fig. 5 —Contrast-enhanced CT scan of thorax (360° rotation, no cardiac gating) in 72-year-old man with chronic obstructive airways disease. Axial image at level of atria depicts excessive amount of fat in interatrial septum, leading to marked septal thickening (star), which is termed "lipomatous hypertrophy of interatrial septum."

 

Figure 10
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  		Fig. 6 —Contrast-enhanced CT examination of thorax (360° rotation, no cardiac gating) in 57-year-old man with chronic obstructive airways disease. Axial slice at level of atria shows abundant fat in interatrial septum, with relative preservation of fossa ovalis (arrow), creating appearance that simulates patent foramen ovale.

 

Figure 11
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  		Fig. 7A —49-year-old woman with pulmonary artery hypertension. Sagittal multiplanar reformatted image 3 mm thick was taken from contrast-enhanced CT study of thorax obtained with 16-MDCT scanner and cardiac gating (temporal resolution, 250 msec). Scan depicts stenosis of pulmonary outflow channel at level of pulmonary valve and marked poststenotic dilatation of pulmonary trunk. Leaflets of pulmonary valve are easily seen (arrows).

 

Figure 12
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  		Fig. 7B —49-year-old woman with pulmonary artery hypertension. Angiographic image corresponding to A.

 

Figure 13
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  		Fig. 8 —49-year-old man with atypical chest pain. Axial contrast-enhanced CT image at level of dilated left ventricle obtained without cardiac gating depicts focal calcification in ventricular apex (arrow) as result of a previous myocardial infarction. Lack of enhancement in subendocardium of left ventricle (arrowhead) is also consistent with myocardial ischemia or previous infarction in distribution of left anterior descending coronary artery.

 

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