L & rsquo; cardiac imaging includes an arsenal of & rsquo; d & rsquo examination; additional interest is as follows :
Standard chest x-ray :
– Remains the & rsquo; review 1time intention before a :
+ Physical examination
+ suspect electrical tracing ( ECG)
– quick and inexpensive examination.
– Often allows to draw a fairly reliable overall picture of the patient's health.
– Technique non invasive, available and inexpensive
– Review key heart disease.
Computed tomography and nuclear magnetic resonance :
The technological advances of machines and the current possibilities of & rsquo; sectional imaging (CT : TDM multi- detectors and MRI), have contributed to the & rsquo; morphological and functional noninvasive exploration of the heart.
cardiac scintigraphy :
– diagnosis of & rsquo tool; isotopic exploration infarction
– Necessary before the following risk factors : Diabetes, Smoking, Hypertension and dyslipidemia
– Asked immediately before abnormal electrical tracing(ECG) : complete left branch block
– Injection of a radioactive tracer : Thallium 201 or technetium
– Special sensor: Scintigraphe:
+ Saves the distribution of the injected substance in different parts of the & rsquo; organ examined.
+ This distribution is displayed as a series of points "Glitter" corresponding to the areas marked by the active product.
heart catheterization :
invasive method d & rsquo; relatively old exploration (cardiac and vascular catheterization) is characterized by selective injections of iodinated contrast agent in the heart chambers and the coronary arteries.
Angiography Cardiac / Coronagraphy :
Technique & rsquo; examination having rapidly evolved knowledge of the structures and functioning of the normal and pathological heart by haemodynamic and morphological study of the heart chambers and vessels.
– Catheterization of the & rsquo; femoral artery : left heart or great vessels
– The femoral vein catheterization : right heart
TECHNICAL RESOURCES EXPLORATION :
1- INCIDENCES :
4 clichés: Face, profile, Oblique right anterior (BEANS) / Left anterior oblique
– Standing face shot : Posteroanterior (ray entering from the back, plate on the anterior chest), deep breath and high voltage (115-130kV).
– Cliché profile : same conditions, only the & rsquo; incidence changes becoming Side (left part against the plate).
– Cliché and OAD : right part of the body placed against the plate making a 45 ° angle with the RX.
– Cliche in OAG : left side placed against the plate making a 45 ° angle with the RX RADIOGRAPH THORACIC +++++
2- TECHNICAL ACHIEVEMENT AND CONSTANT USED Chest :
– Exposure time : short shot and made Apnea
– Distance fover-film : 2m for distance thorax Face
3- QUALITY LAYOUT :
Criteria for checking the quality of the thorax :
- Distance between the inner edge of the collarbone thorny : equal to the right and left.
- Epineuse of 3th thoracic vertebra centered (CXR, is Front)
- Air-fluid level in the gastric pouch (patient standing)
- diaphragmatic right : at or below the front of the sixth costal arch &) Butts bag costo-diaphragmatic : visible (shot made deep breath)
- Spine and vessels visible behind the heart : appearance meaning that & rsquo; exposure is correct.
OBLIQUE IMPACT OR CROSS HEART :
- Technique & rsquo; imaging US, l & rsquo; & rsquo or echocardiography, cardiac ultrasound or & rsquo; Doppler heart, quickly found its place among the medical applications of ultrasound.
- Non invasive, available, d & rsquo; frequent indication (child, pregnant woman and duration lOmn 30mn )
- morphological and functional information.
– Morphology and kinetics of heart valves
– Various features of the heart operation
IMAGING SECTIONAL :
CT MULTI-SENSORS HEART AND VASCULAR :
– Morphological and functional exploration of coronary and heart
– Requiring development d & rsquo; special examination with good patient preparation.
– Acquisition synchronized on & rsquo; ECG
– Reconstruct the images in the different phases of the cycle.
CARDIAC MRI :
Reference method for the & rsquo; imaging:
– Congenital heart disease, cardiac tumors
– Large vessels and pericardium
Thanks to :
– A good spatial and temporal resolution
– A Three-dimensional approach
– Excellent contrast between the circulating blood and the myocardium.
Determination parciné MRI :
standardized, Precise and Reproducible.
– ventricular volumes
– d & rsquo fraction; ejection
– myocardial mass
– kinetics segmental
MRI contrast after gadolinium injection : considerable diagnostic value for :
– many diseases:
– tumoral, inflammatory, ischemic
– Specify the & rsquo; d & rsquo etiology; cardiomyopathy.
– Reference method in & rsquo; analysis of myocardial viability (ischemic heart disease)
Major advantage of the & rsquo; MRI :
- To associate the & rsquo; study of myocardial viability : l & rsquo; analysis of the infusion
- Functional approach of heart muscle :
– Functions right and left ventricular resting
– When d & rsquo; d provocation tests & rsquo; myocardial ischemia.
TECHNICAL PROTOCOL :
Different sequences are used to provide :
1- morphological assessment in:
-conventional anatomical planes
-Specific plans of the heart
2- Analysis of cardiac functional parameters :
– ventricular mass – d & rsquo fraction; ejection – Volume d & rsquo; ejection
– Thickness infarction – Kinetics segmental and global &) Volumes ventricular end-diastolic and systolic TV
3- hemodynamically including sequences in phase contrast for quantization: Flow rates / speeds (pulmonary- systemic)
4- Analysis of the infusion 1is passing infarction
5- MRA with gadolinium
6- delayed enhancement (myocardial viability) +++++
SCINTIGRAPHY HEART :
myocardial scintigraphy : Further examination to assess the: heart function (perfusion, metabolism, cellular integrity…).
Confirm or coronary character & rsquo; chest pain by identifying the & rsquo; perfusion status infarction
Myocardial scintigraphy coupled to a: -Test d & rsquo; effort and / or drug stimulation.
1- normal vasculature :
Perfusion tracer uptake in the myocardium : normal
Pain presented by the patient are not d & rsquo; CHD
2- abnormal vascularization :
It is more or less extensive and is characterized by : tracer uptake defect on the myocardium
A 2th passing under the camera 3, 4, indeed 24 hours, to compare the initial images to images taken at rest.
CARDIAC CATHETERIZATION :
Insert a probe opaque to X-rays in the right cavities through the femoral vein and left cavities by & rsquo; femoral artery.
1- Measure intracardiac and intravascular pressure
2- Take blood samples
3- lnjecter various indicators to measure cardiac output and detect an intracardiac shunt
4- lnjecter the iodinated contrast agent for a morphological and functional study of cavities / vessels: – ANGIO-CARDIOGRAPHIE – CORONOGRAPHIE
INDICATION OF EVERY MEANS & rsquo; EXPLORATION :
COUPLE : RX STANDARD + ECHOCARDIOGRAPHIE
Broad indications before or after electrical examination (ECG)
TWO TYPES & rsquo; INDICATIONS :
– NOT APPROPRIATE
RELEVANT INDICATIONS :
– INDICATIONS CLASSIC:
– Pulmonary embolism / Aortic dissection
– Evaluation of aneurysms of the & rsquo; aorta
– ANATOMY REVIEW
– DIAGNOSTIC RESULTS OF CORONARY PATIENTS
INDICATIONS NOT APPROPRIATE :
- acute chest pain and ECG modification with or increase in cardiac enzymes.
- Patient at high risk or with a positive intermediate functional test.
- asymptomatic patient, low risk after myocardial revascularization (bypass Surgery, Stent)
- Characterization of the plaque
- Measuring the aortic valve area
- Realization of single calcium score in the symptomatic patient or proven coronary
– Myocardial viability (detection of necrosis)
– cardiac shunts
CATHETERIZATION / angiography :
- Acquired valvular heart disease
- ischemic heart disease
- Pulmonary arterial hypertension or heart failure
- Post Heart Surgery
– Cut , Morphology of the cardiac silhouette
– Container and contents.
CHEST X-RAY PROFILE LEFT :
- ovoid heart
- front edge :
– upper arc (ascending aorta)
– lower arc (right ventricle : CEO)
- top edge :
– 1/3 inferior (right ventricle : CEO)
– 2/3 superior (right ear : FROM)
SEMIOLOGY ABNORMAL :
1- DILATATION / CARDIAC HYPERTROPHY CAVITIES
2- BIG SHIPS
– Aortic Coarctation
– NEVRYSME OF & rsquo; AORTA
– DISSECTION L & rsquo; AORTA
Expansion of the & rsquo; right atrium :
Enlargement of the & rsquo; lower right arch that seems more convex.
– Hyper-convexity and overhang of & rsquo; arc Lower Right (AID)
In case of :
– atresia triscupide
– CIA high flow
Dilatation of the right ventricle :
- Projection of & rsquo; lower left arch with rounded appearance
- Pointe raised.
Hypertrophic Dilation RV :
– Overhang of & rsquo; lower left arc raised edge (heart in the shoe & rsquo; extreme)
– Obstacle in the pulmonary route ( valvular stenosis or trunk of the & rsquo; pulmonary artery)
– Heart in shoe : Tétratologie of Fallot : complex heart defect that combines between severe stenosis of the pulmonary route with important HVD
Dilation of the pulmonary artery :
causes : Abnormal protrusion of & rsquo; average arc.
Expansion of the & rsquo; aorta :
causes : projection of & rsquo; arc top right
LAYOUT CHEST :
View pathological calcifications that may affect :
– heart valves -the pericardium
– the vessel wall including the & rsquo; aorta
The technical means for the & rsquo; exploration heart and great vessels are numerous but the choice depends:
– studied pathology
– Patient Clinical Status
– electrical tracing
– Availability of devices & rsquo; exploration.
– If the information is sufficient, preferably starting the & rsquo; exploration by d & rsquo technique, minimally invasive imaging or completely harmless in case the & rsquo; ultrasound B-mode and Doppler cardiovascular.
– Each technique provides one or more semiotic signs of its own and the & rsquo; combination of different types & rsquo; review, is often complementary.
The standard cliché remains essential that the technical achievement must be respected ( quality criteria )
L & rsquo; echocardiography examination 1time intention: morphological and functional
L & rsquo; imaging noninvasive cut :
– Coronary CT =
– MYOCARDIAL VIABILITY MRI =
Dr Lecheheb's course – Faculty of Constantine