Noninvasive Imaging of Ischemic Heart Disease

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.50
Procedures: 2.50
Neck and Chest: 2.50

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Cardiac Procedures: 2.50

Registered Radiologist Assistant: 4.00
Procedures: 4.00
Thoracic Section: 4.00

Outline

1. Introduction
2. Pathophysiology of Ischemic Heart Disease
3. Noninvasive Anatomic Assessment of Coronary Artery Stenosis
4. Noninvasive Functional Assessment of Coronary Artery Stenosis
   1. Cardiac MR Stress Perfusion Imaging
      1. Dual-Bolus Method
      2. Dual-Sequence Method
   2. CT Stress Perfusion Imaging
      1. Static CT Stress Perfusion
      2. Dynamic CT Stress Perfusion
   3. Fractional Flow Reserve CT
   4. PET Myocardial Perfusion Imaging
   5. SPECT Myocardial Perfusion Imaging
   6. Stress Echocardiography
5. Comparison of Noninvasive Imaging Modalities to Assess Physiologic Significance of Coronary Artery Stenosis
6. Myocardial Infarction
   1. Cardiac MRI
   2. Computed Tomography
   3. PET and SPECT
7. Imaging Complications of MI
8. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the imaging modality considered to be the standard for detecting coronary artery stenosis
2. understand imaging modalities that can be used to assess fractional flow reserve of the coronary artery
3. identify which noninvasive imaging modality is best suited to evaluate myocardial infarction
4. identify the fatty deposits primarily responsible for atheroma formation
5. define myocardial ischemia
6. list imaging modalities that can detect fatty metaplasia associated with MI
7. understand the Agaston coronary calcium score
8. describe CCTA retrospective acquisition
9. understand the components of coronary artery plaque as it relates to CCTA
10. identify the greatest strength of CCTA in the detection of coronary artery stenosis
11. list the vasodilating agents used for cardiac stress testing
12. identify the cardiac slices obtained with MR stress perfusion using saturation recovery pulse and FLASH read out
13. understand the timing of gadolinium contrast administration when using vasodilating stress agents
14. understand SSFP as it relates to contrast to noise ratio
15. describe how fully quantitative MR methods affect cardiac stress perfusion diagnostic accuracy
16. explain arterial input function as it relates to dual bolus and dual sequence methods
17. list the disadvantages associated with cardiac MR stress perfusioni
18. dentify the stress cardiac drug that is more likely to induce severe chest pain, ventricular tachycardia or ventricular fibrillation
19. describe how the BOLD MR technique works
20. understand the image timing associated with a CT stress and rest perfusion study
21. describe how myocardial blood flow in milliliters per gram per minute can be measured using fully quantitative and semiquantitative analysis
22. understand how dual-energy CT minimizes beam hardening artifacts
23. explain fractional flow reserve CT
24. understand the abnormal value for fractional flow reserve
25. identify patients not recommended for fractional flow reserve CT
26. explain what PET radionuclide imaging relies on
27. identify which PET myocardial perfusion imaging is often performed first
28. explain myocardial flow reserve ratio
29. understand radiation exposure regarding PET MPI compared to SPECT MPI
30. understand radiation exposure with SPECT MPI based on one versus two day imaging protocols
31. list the radionuclide agents used for SPECT MPI
32. describe SPECT MPI soft attenuation perfusion artifacts
33. understand how echocardiography evaluates cardiac wall motion before, during and after stress
34. understand the limitations of stress echocardiography and large patients
35. list the imaging modalities that offer fully quantitative measurements of myocardial blood flow
36. identify the best noninvasive imaging technique to functionally assess coronary artery stenosis
37. list the noninvasive cardiac imaging modality(ies) that is/are most widely available
38. identify the imaging modalities that are considered to be a high performance tier one option
39. identify the standard imaging modality to best evaluate myocardial viability
40. understand the technologist’s role regarding inversion time when performing a cardiac MRI to assess for myocardial infarction
41. list the newer LGE methods that offer a breathing motion correction algorithm
42. understand what a matched stress and rest myocardial perfusion defect on PET or SPECT MPI represents
43. identify the imaging modalities ideal at identifying complications associated with myocardial infarction
44. understand the condition of Dressler syndrome
45. identify the imaging modality that offers an effective first line examination to exclude CAD in patients with a low pretest probability