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Non-invasive imaging
Cardiac CT beyond coronary angiography: current and emerging non-coronary cardiac applications
  1. Milind Y Desai
  1. Correspondence to Dr Milind Y Desai, Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA; desaim2{at}ccf.org

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Within the last decade, non-invasive assessment of the coronary arteries using multidetector computed tomography (MDCT) has emerged as the newest application in diagnostic cardiology, leading to many technological advancements and substantial improvements in image acquisition and analysis.1 The early enthusiasm and rapid advancement has been tempered by concerns regarding increased radiation exposure, especially the wide range of radiation doses that a patient gets exposed to, for the same clinical indication.2 3

However, in the last couple of years, the field of cardiac CT has made significant technological strides in areas of radiation reduction4 5 (prospective imaging, high pitch 100 kVp imaging, and electrocardiographic dose modulation), improved temporal resolution with dual source scanning6 (significantly improving cine imaging), increased supero-inferior coveragew1 (enabling single-beat imaging), improved injection protocols, and dual energy imaging (potentially enabling plaque characterisation).w2 As a result, the utility of MDCT can now be broadened to answer a multitude of clinical questions within cardiovascular medicine, albeit in conjunction with other non-invasive techniques such as echocardiography, myocardial perfusion scintigraphy, and cardiac magnetic resonance (CMR) imaging. Of course, the fundamental tenet of a new diagnostic modality is that its utilisation has to be matched with careful evaluation of appropriateness of a given indication, coupled with the knowledge that one diagnostic modality might be more appropriate than the other.1 This review of the current state-of-the art discusses the various non-coronary cardiac applications of MDCT, along with some of the emerging applications (box 1).

Box 1

Box 1 Various non-coronary cardiac indications of CT

Current applications

  • Electrophysiology applications

    • Atrial fibrillation and pulmonary venous anatomy

    • Cardiac resynchronisation therapy and coronary venous anatomy

  • Reoperative cardiothoracic surgery

  • Valvular heart disease

    • Aortic valve

    • Mitral valve

    • Prosthetic valves

  • Transcatheter aortic valve implantation

  • Left ventricular systolic function

  • Pericardial diseases

    • Effusion

    • Constriction

  • Cardiac masses

    • Benign

    • Malignant

  • Non-ischaemic cardiomyopathies

  • Congenital heart disease

    • Simple and complex

Emerging …

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