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Chapter 17: Computed Tomography of the Heart

Advancements in CT technology have made it possible to noninvasively image the beating heart. Which of the following statements regarding cardiac CT is false?

A. Cardiac CT can assess left and right ventricular remodeling

B. Cardiac CT can assess regional myocardial wall motion and thickening

C. Cardiac CT is comparable to first-pass radionuclide angiography for the calculation of post-MI LVEF

D. Cardiac CT can detect myocardial iron overload

E. Cardiac CT can detect intracardiac thrombus

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 17) While cardiac CT can provide some information about tissue characterization, it cannot reliably detect iron overload, and this is typically assessed by cardiac MR. Cardiac CT can assess left and right heart size as well as regional myocardial wall motion and thickening (options A and B).1,2 Cardiac CT is comparable to first-pass radionuclide angiography for the calculation of left ventricular ejection fraction in patients with myocardial infarction (option C).3 Cardiac CT could effectively detect intracardiac masses such as thrombi and tumors, particularly when these masses are nonmobile or calcified (option E).4

A 35-year-old obese woman with a significant family history of premature coronary heart disease presented to the emergency department complaining of a 2-week history of intermittent chest pain. Initial ECG and biomarkers were within normal limits. After an equivocal stress test, she underwent cardiac CT. Which of the following statements about cardiac CT and coronary artery calcification (CAC) is false?

A. The severity of angiographic coronary artery stenosis is directly related to the total CAC

B. Cardiac CT can detect coronary atherosclerosis at its earliest stages

C. CAC is caused by atherosclerosis in the coronary arteries

D. CAC is not found in normal coronary arteries

E. There is a strong linear correlation between total coronary artery plaque area and the extent of CAC

The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 17) The presence of CAC is clearly indicative of coronary atherosclerosis,5,6 serving as a marker for CAD; but importantly, the severity of angiographic coronary artery stenosis is not directly related to the total CAC. CAC is thought to begin early in life, and CT can detect coronary atherosclerosis at its earliest stages. Although lack of calcification does not categorically exclude the presence of atherosclerotic plaque, calcification occurs exclusively in atherosclerotic arteries and is not found ...

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