Cardiac Structures
Atria Ventricles Valves Interventricular Septum Pericardium Coronary Arteries
Vascular Landmarks
Aortic Root Ascending Aorta Aortic Arch Pulmonary Arteries Pulmonary Veins Superior And Inferior Vena Cava
Functional Targets
Wall Motion Valve Function Myocardial Perfusion Cardiac Output Shunt And Flow Assessment
First Line Functional Imaging
Transthoracic Echo (TTE) For Valve Disease Heart Failure And Pericardial Effusion | Transesophageal Echo (TEE) For Endocarditis Prosthetic Valve Assessment And Intraoperative Guidance
Coronary Anatomy And Calcium Scoring
Coronary CT Angiography For CAD Assessment | Coronary Calcium Score For Risk Stratification | CT For Aortic Disease Pulmonary Embolism And Preprocedural Planning (TAVR, Ablation)
Tissue Characterization And Function
Gold Standard For Ventricular Volumes And Ejection Fraction | Late Gadolinium Enhancement For Scar And Fibrosis | T1 T2 Mapping For Inflammation And Infiltrative Disease
Perfusion And Viability
Myocardial Perfusion Imaging With SPECT Or PET For Ischemia And Viability | Quantitative Flow With PET For Absolute Myocardial Blood Flow
Parasternal Apical Subcostal Suprasternal
Parasternal Long And Short Axis | Apical 4 2 And 3 Chamber Views | Subcostal For Pericardial Effusion And IVC Assessment | Use Doppler For Valve Gradients And Regurgitation Quantification
Color Spectral And Continuous Wave
Measure Peak Velocities Calculate Gradients And Valve Areas | Use PW Doppler For Flow Profiles And CW For High Velocity Jets
Exercise Or Pharmacologic
Assess Inducible Wall Motion Abnormalities During Exercise Or Dobutamine Stress | Acquire Baseline And Peak Images For Comparison
ECG Gated Contrast Enhanced
Use Prospective Or Retrospective ECG Gating Based On Heart Rate | Beta Blockade To Lower Heart Rate When Appropriate | Sublingual Nitroglycerin To Dilate Coronaries | Thin Slice Acquisition And Iterative Reconstruction
Noncontrast ECG Gated
Noncontrast Acquisition For Agatston Score | Use Standardized Protocols For Reproducibility | Report Score And Percentile For Risk Stratification
TAVR And EP Planning
High Resolution Imaging Of Aortic Root Iliac Vessels And Left Atrium For Device Sizing And Access Planning | 3D Reconstructions For Surgical And Interventional Teams
SSFP For Function
Short Axis Stack From Base To Apex For Volumes And EF | Long Axis Views For Valve And Wall Motion Assessment | Use Breath Holds And ECG Gating
Scar And Fibrosis Detection
Acquire 10–15 Minutes After Contrast Injection | Inversion Time Scout To Null Normal Myocardium | Use PSIR Or Phase Sensitive Techniques For Better Contrast
Tissue Characterization
T1 Mapping For Diffuse Fibrosis And Amyloid | T2 Mapping For Edema And Inflammation | First Pass Perfusion For Ischemia Assessment During Pharmacologic Stress
Stress Rest Imaging
Use Technetium Or Thallium Tracers | Pharmacologic Or Exercise Stress | Gated SPECT For Function And Wall Motion | Compare Stress And Rest To Identify Reversible Ischemia
Quantitative Flow And High Sensitivity
FDG For Viability And Rubidium Or N13 For Perfusion | PET Allows Absolute Myocardial Blood Flow Quantification And Superior Diagnostic Accuracy In Many Settings
Metabolic And Perfusion Correlation
Use FDG PET Or Rest Thallium To Assess Metabolic Activity In Areas Of Reduced Perfusion | Correlate With Wall Motion To Guide Revascularization Decisions
Beta Blockade And Rhythm Considerations
Screen For Contraindications To Beta Blockers | Optimize Heart Rate For Coronary CTA | Use Rate Control Or Alternative Gating Strategies For Atrial Fibrillation
Iodinated And Gadolinium Agents
Assess Renal Function Prior To Iodinated Or Gadolinium Contrast | Follow Institutional Guidelines For Gadolinium Use In Renal Impairment | Document Contrast Type And Volume
Minimization Strategies
Use Prospective ECG Gating Low kVp For Small Patients Iterative Reconstruction And Dose Modulation To Reduce CT Dose | For Nuclear Studies Use Weight Based Activity And PET When Higher Sensitivity Reduces Dose
Implants And Claustrophobia
Screen For Pacemakers And MR Conditional Devices | Use MR Conditional Protocols And Monitor Patients With Implanted Devices Per Manufacturer Guidance | Offer Sedation For Claustrophobic Patients When Needed
Volumes Mass And EF
Report End Diastolic And End Systolic Volumes Indexed To Body Surface Area Left And Right Ventricular Ejection Fraction Myocardial Mass And Regional Wall Motion Abnormalities
Stenosis Grading And Plaque Characterization
Describe Location And Severity Of Stenoses Plaque Composition (Calcified Mixed Noncalcified) And Any High Risk Features Such As Positive Remodeling Or Low Attenuation Plaque
Scar Pattern And Tissue Mapping
Document Presence Extent And Pattern Of Late Gadolinium Enhancement T1/T2 Mapping Values And Perfusion Defects | Correlate With Clinical Context And Prior Imaging
EF
Ejection Fraction | Percentage Of Blood Ejected From Ventricle During Systole
LGE
Late Gadolinium Enhancement | MRI Technique To Detect Myocardial Scar Or Fibrosis
CTA
Computed Tomography Angiography | Contrast Enhanced CT For Vascular Assessment
SPECT PET
Nuclear Techniques For Myocardial Perfusion And Viability
Agatston Score
Coronary Artery Calcium Score | Quantifies Coronary Calcification For Risk Stratification