Cardiovascular Radiology

Cardiovascular Radiology Indian Medical PG Question 1: Investigation of choice for valvular heart disease-

• A. Nuclear Cardiac imaging
• B. Precordial Doppler
• C. 2 D- Echocardiography (Correct Answer)
• D. MRI

Cardiovascular Radiology Explanation: ***2 D- Echocardiography*** - **Transthoracic echocardiography (TTE)** is the initial and most common investigation for valvular heart disease due to its non-invasiveness, accessibility, and ability to visualize valve morphology and function in real-time [1]. - It provides critical information on valve structure, leaflet motion, chamber dimensions, ventricular function, and pressure gradients, allowing diagnosis and assessment of severity [2]. *Nuclear Cardiac imaging* - Primarily used for assessing **myocardial perfusion** and viability, rather than direct visualization of valve structure and function. - While it can indirectly assess the impact of valvular disease on ventricular function, it does not provide detailed information about the valves themselves. *Precordial Doppler* - **Doppler echocardiography** is a component of a full echocardiogram, used to quantify blood flow velocities and pressure gradients across valves [1]. - However, "precordial Doppler" is not a standalone comprehensive investigation for valvular disease; it must be combined with 2D imaging for a complete assessment. *MRI* - **Cardiac MRI (CMR)** offers excellent anatomical detail and precise quantification of ventricular volumes and function, and can assess valvular regurgitation. - It is often used as a complementary study in specific cases, particularly for complex congenital heart disease or when echocardiography is inconclusive, but it is not the primary or initial investigation due to cost and accessibility.

Cardiovascular Radiology Indian Medical PG Question 2: Best imaging modality for acute pulmonary embolism

• A. V/Q scan
• B. CT pulmonary angiogram (Correct Answer)
• C. Chest X-ray
• D. MRI

Cardiovascular Radiology Explanation: ***CT pulmonary angiogram*** - This is the **gold standard** imaging modality for diagnosing acute pulmonary embolism due to its high sensitivity and specificity in visualizing pulmonary arteries. - It rapidly provides detailed images of the pulmonary vasculature, allowing for direct visualization of **thrombi**. *V/Q scan* - A **V/Q scan** measures ventilation and perfusion of the lungs and is less definitive than CTPA, especially in patients with pre-existing lung disease. - It is often considered when **CTPA is contraindicated**, such as in cases of severe renal impairment or contrast allergy. *Chest X-ray* - A **chest X-ray** is generally used to rule out other causes of chest pain and shortness of breath, such as pneumonia or pneumothorax, rather than to diagnose PE directly. - It has **low sensitivity and specificity** for pulmonary embolism, as findings are often non-specific or normal even in the presence of PE. *MRI* - **Magnetic resonance angiography (MRA)** can be used, but it is typically reserved for patients who cannot undergo CTPA or V/Q scan due to contraindications like **pregnancy** or **renal failure**. - It often takes longer to perform and has lower spatial resolution compared to CTPA for pulmonary artery visualization.

Cardiovascular Radiology Indian Medical PG Question 3: IOC for Acute Aortic Dissection in a Clinically Unstable patient is?

• A. NCCT
• B. TEE (Correct Answer)
• C. MRI
• D. CT-Angio

Cardiovascular Radiology Explanation: ***TEE (Transesophageal Echocardiography)*** - **TEE is the investigation of choice** for acute aortic dissection in **hemodynamically unstable patients** due to its **portability and rapidity**. - Can be performed at the **bedside** without transporting the critically ill patient, minimizing risk. - Provides rapid diagnosis (5-10 minutes) with **>95% sensitivity and specificity** for detecting intimal flap and false lumen. - Simultaneously assesses **complications** such as aortic regurgitation, pericardial effusion/tamponade, and ventricular function. - Particularly excellent for visualizing the **ascending aorta** and aortic root. *CT-Angio* - **CT angiography** is the **investigation of choice** for acute aortic dissection in **hemodynamically STABLE patients**. - Provides excellent anatomical detail of the entire aorta, clearly showing the intimal flap, true and false lumens, and branch vessel involvement. - Requires **patient transport** to the radiology department, which is **unsafe in unstable patients**. - Best for comprehensive surgical planning in stable patients. *MRI* - **MRI** offers the highest anatomical detail and is considered the gold standard for **chronic dissection follow-up**. - Its lengthy acquisition time (30-60 minutes) and incompatibility with monitoring equipment make it **unsuitable for acutely unstable patients**. *NCCT* - **Non-contrast CT** may show indirect signs like the **hyperdense crescent sign** in the aortic wall. - Cannot reliably differentiate true and false lumens or assess the full extent of dissection. - Insufficient for definitive diagnosis or management planning.

Cardiovascular Radiology Indian Medical PG Question 4: MUGA scan is not useful in:

• A. Stroke volume
• B. Regional wall perfusion (Correct Answer)
• C. Left ventricular ejection fraction
• D. Regional wall motion

Cardiovascular Radiology Explanation: ***Regional wall perfusion*** - A MUGA scan assesses **ventricular function** through blood pool imaging, evaluating wall motion and ejection fraction. - It does not directly visualize or quantify myocardial perfusion, which is the flow of blood through the coronary arteries to the heart muscle. *Stroke volume* - A MUGA scan accurately measures **end-diastolic volume** and **end-systolic volume**, from which stroke volume (EDV – ESV) can be calculated. - This parameter directly reflects the amount of blood pumped out by the ventricle with each beat. *Left ventricular ejection fraction* - The MUGA scan is considered a gold standard for calculating **left ventricular ejection fraction** (LVEF), a key indicator of cardiac pump function. - It uses a count-based method from gated blood pool images to determine the percentage of blood ejected from the left ventricle. *Regional wall motion* - MUGA scans are highly effective in assessing **regional wall motion abnormalities**, identifying areas of **hypokinesis**, **akinesis**, or **dyskinesis**. - This is crucial for diagnosing and monitoring conditions like myocardial ischemia or infarction, and is a primary utility of the scan.

Cardiovascular Radiology Indian Medical PG Question 5: Which imaging modality is most sensitive for detecting early ischemic stroke?

• A. Ultrasound
• B. PET scan
• C. CT
• D. MRI with DWI (Correct Answer)

Cardiovascular Radiology Explanation: ***MRI with DWI*** - **Diffusion-weighted imaging (DWI)** within an MRI scan is highly sensitive in detecting **cytotoxic edema** within minutes of **ischemic stroke** onset. This makes it crucial for early diagnosis and treatment decisions. - DWI can identify areas of restricted water diffusion, which is a hallmark of acute cellular injury due to **ischemia**, even before changes are visible on conventional T1 or T2-weighted MRI sequences. *CT* - While frequently used in acute stroke settings, **non-contrast CT** is primarily used to **rule out hemorrhagic stroke** and may only show subtle or no signs of acute ischemia in the first few hours. - Early ischemic changes on CT, often referred to as the **"ischemic penumbra"**, may appear hours after stroke onset, making it less sensitive for very early detection compared to DWI. *Ultrasound* - **Transcranial Doppler (TCD) ultrasound** can evaluate blood flow velocities in intracranial arteries and detect stenoses or occlusions but is not a primary imaging modality for directly visualizing brain parenchymal ischemia. - Cervical ultrasound (e.g., **carotid duplex**) assesses extracranial vessels but cannot directly detect **ischemic changes** within the brain tissue itself. *PET scan* - **PET (Positron Emission Tomography)** can assess brain metabolism and blood flow but is typically not the preferred or most sensitive modality for **early detection of acute ischemic stroke** due to its complexity, cost, and limited availability in emergency settings. - PET is more commonly used in research or for assessing chronic conditions and **metabolic abnormalities**, rather than acute stroke diagnosis.

Cardiovascular Radiology Flashcard 1 of 5

Question: Cardiac CT is done in CAD and for _____ scoring.*scoring method?

Answer: coronary calcium

Cardiovascular Radiology Flashcard 2 of 5

Question: _____ shaped left ventricle is seen in Hypertrophic cardiomyopathy

Answer: Banana

Cardiovascular Radiology Flashcard 3 of 5

Question: _____ sign is seen on left lateral angiograms in endocardial cushion defects

Answer: Gooseneck

Cardiovascular Radiology Flashcard 4 of 5

Question: What is the investigation of choice to assess the thickness of the pericardium?_____

Answer: MRI

Cardiovascular Radiology Flashcard 5 of 5

Question: The x-ray given in the question shows the _____ sign suggestive of LA enlargement

Answer: double-density