Quarterly Medical Review Cardiovascular imaging : Increasingly efficient

ent téléchargé le 24/02/2018 Il est interdit et i Imaging of the heart and the great vessels changed rapidly these last 20 years. Arteriogram which was the technique of reference is now with no interest in our current practice whereas CT angiogram (CTA) and MR angiogram (MRA) appear to play a keyrole with echocardiography. Because of the rapid technical evolution of both technologies (CT and MR), some indications were debated in terms of detection, diagnosis, planning before intervention, follow-up. Sometimes they can be competitive but most of the time they are complementary. In this journal, you will find the expertise of the best team in their field who describe the place of the imaging and their role for the management of the different pathologies. The first paper is dedicated to CoroCT scan and the indication in your practice [1]. CoroCT scan does not replace coronarography today, if we analysed the recent literature. Because of the lack of spatial resolution, the presence of false positive or false negative results and the technical compromise with temporal resolution, this exam should be integrated in a multidisciplinary approach. This could be seen as a failure for some physicians. However, coroCT scan is a very specific exam to screen patients for possible coronary disease. This exam should be used in your current practice to detect patients with intermediate cardiovascular risk factors, because of the excellent negative predictive value. Of course, there are a lot of other indications that you will discover in the excellent chapter of Salah D. Qanadli. With cardiac MR and ischemic cardiopathies chapter, J. Wright and J. Bogaert cover the indications of this technique [2]. You will be surprised about the high number of indication where cardiac MR can be with interest. Cardiac MR is the only exam that shows clearly the myocardium infarct with late enhancement sequences. Linear high intensity of the signal is very sensitive and specific of the infarct. Technique of perfusion at rest or under stress is very sensitive in the detection of severe coronary stenosis. Compared to scintigraphy, spatial resolution of cardiac MR is much better with higher sensitivity and no irradiation. With the advantages to evaluate the morphology of the heart and the infarct, the global and regional function, perfusion and viability, cardiac MR in ischemic cardiopathies should be considered as a challenger of nuclear medicine, if available for the everyday practice. Cardiac failure will be the most popular cardiopathy due elderly population (with coronary disease or not). Hypertrophy of the left ventricle is also relatively frequent and is due to several pathologies (genetic, sport, amylosis, tumor. . .). These diseases are well studied by cardiac MR and Silvera et al. clearly shows multiple examples [3]. Indications of cardiac MR in order to evaluate the origin of the hypertrophy or the cause of the cardiac dilatation with low ejection fraction are now well assessed. Cardiac MR should be performed relatively systematically in