Radiation
diagnostics &
treatment of
Cardiovascular
System
Sanchita Dutta l 3M20
Introduction:
Cardiovascular radiology involves imaging of the heart and
vascular system to diagnose structural, functional, and
pathological conditions.
Objectives:
Evaluate cardiac anatomy
Assess function (contractility, EF)
Detect vascular abnormalities
Guide interventions
IMAGINGMODALITIES
A. CHEST X-RAY (CXR)
First-line, basic investigation
Key signs:
01.
Cardiomegaly →
02.
Boot-shaped heart →
Heart failure,
cardiomyopathy
Views:
PA (posteroanterior)
AP (portable, ICU)
Lateral view
Tetralogy of Fallot
What to assess:
Cardiac size → Cardiothoracic ratio (<50% normal)
Heart borders
Pulmonary vasculature
Calcifications
03.
Water bottle shape →
Pericardial effusion
IMAGING MODALITIES
enlarged heart, is identified on a chest
X-ray (CXR) when the cardiothoracic
ratio (CTR)—the width of the heart
compared to the total inner thoracic
diameter—exceeds 50% (
Ventricular Septal Defect (VSD): A
large hole in the wall (septum)
Pulmonary Stenosis: Narrowing of
the pulmonary valve
Overriding Aorta: The aorta (the
main artery carrying blood to the
body) is shifted to the right and sits
directly over the VSD
Right Ventricular Hypertrophy: The
muscular wall of the right ventricle
becomes thickened
typically indicating a large pericardial
effusionThis shape occurs when an
excessive amount of fluid—often a liter
or more—accumulates in the sac
surrounding the heart (the pericardium)
ECHOCARDIOGRAPHY (ULTRASOUND)
Most important initial cardiac imaging
Types:
Transthoracic (TTE)
Transesophageal (TEE)
Doppler echo
Uses:
Chamber size
Valve function
Ejection fraction
Congenital defects
Advantages:
No radiation
Bedside availability
Limitations:
Operator dependent
Limited in obese/COPD patients
Transesophageal Echocardiogram
CT (COMPUTED TOMOGRAPHY)
CT Angiography (CTA)
Gold standard for vascular imaging
Uses:
Coronary artery disease
Pulmonary embolism
Aortic dissection
Findings:
Vessel narrowing
Plaques (calcified/non-calcified)
Thrombus
Advantages:
High resolution
Fast
Disadvantages:
Radiation
Contrast nephropathy
MRI (CARDIAC MRI)
Best for:
Soft tissue characterization
Myocardial viability
Cardiomyopathies
Uses:
Myocarditis
Fibrosis (late gadolinium enhancement)
Congenital heart disease
Advantages:
No radiation
Excellent detail
Limitations:
Expensive
Contraindicated in some implants
01.
Soft tissue
characterization
02.
Myocardial
viability
03.
Cardiomyopathies
Goal: Differentiate hibernating myocardium (alive
but weak) from scar tissue (dead/infarcted).
Key Tool (MRI): Uses Late Gadolinium Enhancement
Edema & Inflammation
Fat and Iron infiltration -
(LGE).
Viable: <50% of the wall thickness is scarred.
Non-viable: >50% of the wall thickness is scarred.
Hyperphobic- wall thickness &
scarring
accumulation of fat & iron
Alternative (PET): Looks for "mismatch"—low blood
Dialated-enlarged heart
deposition
flow but active glucose metabolism (signs of life).
Restricted-Cardiac amyloidosis
Fibrosis- Indentifies bothfocal
scar & fibrosis
Alternative (Echo): Uses Dobutamine to see if the
muscle still has "contractile reserve" (can it squeeze
when stimulated?).
Purpose: Decides if a patient needs a stent/bypass
(revascularization) or if the damage is permanent.
or sarcoidosis
CONTRAST AGENTS
Types:
Iodinated contrast (CT)
Gadolinium (MRI)
Risks:
Allergy
Nephropathy
Thank
you very
much!