Pitfalls and pearls in the imaging of cardiac ischemia

Area of Science:

• Cardiovascular Imaging
• Radiology
• Medical Diagnostics

Background:

• Coronary artery disease is a primary cause of cardiac ischemia and a significant global mortality factor.
• Cardiac ischemia assessment relies on various imaging techniques, including coronary CT calcium scoring, coronary CT angiography, and cardiac MRI.
• While valuable, current CT and MRI modalities possess inherent limitations.

Purpose of the Study:

• To review the established roles of CT and MRI in evaluating cardiac ischemia.
• To discuss common imaging mimics, technical limitations, and potential pitfalls associated with these cardiac imaging modalities.
• To provide a comprehensive overview for clinicians utilizing CT and MRI in cardiac patient assessment.

Main Methods:

• Literature review of current research and clinical guidelines on cardiac CT and MRI.
• Analysis of imaging artifacts, patient-specific factors, and technical challenges in coronary CT and cardiac MRI.
• Synthesis of information regarding the diagnostic accuracy and limitations of each modality.

Main Results:

• Coronary CT calcium scoring provides prognostic information on atherosclerosis burden.
• Coronary CT angiography visualizes coronary anatomy and stenosis but can be limited by motion and calcification.
• Cardiac MRI offers functional and tissue characterization but requires specialized expertise and longer scan times.

Conclusions:

• CT and MRI are essential tools for assessing cardiac ischemia, each with distinct strengths and weaknesses.
• Awareness of technical limitations and potential pitfalls is crucial for accurate interpretation of cardiac CT and MRI.
• Optimizing imaging protocols and understanding potential mimics can improve diagnostic confidence in evaluating coronary artery disease.