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Cardiac Radiology) CAE002-b F-18 FDG PET/CT and MRI In the Diagnosis and Management of Cardiac Sarcoidosis Education Exhibits Location: CA Community, Learning Center Participants Richard Anthony R. Coulden MD (Presenter): Nothing to Disclose Emer Sonnex : Nothing to Disclose Hefin Jones FRCR : Nothing to Disclose Indrajeet Das MBBCh, MRCP : Nothing to Disclose Jonathan Thomas Abele MD : Nothing to Disclose TEACHING POINTS In patients with established non-cardiac sarcoidosis, both FDG PET/CT and cardiac MRI can be used to diagnose cardiac involvement. We will learn how and why: 1. FDG PET/CT identifies active disease and can be used in both diagnosis and management. Serial PET allows assessment of response to immunosuppressive treatment. 2. Cardiac MRI identifies myocardial edema and scar. It has proven value in diagnosis but its role in monitoring disease in response to treatment is unclear. 3. Cardiac MRI provides additional value in assessment of ventricular volumes and function and maybe a helpful surrogate in monitoring treatment response. 4. FDG PET/CT and MRI are complementary techniques. TABLE OF CONTENTS/OUTLINE 1. Criteria for clinical diagnosis of cardiac sarcoidosis (Japanese Ministry of Health and Welfare) 2. How to use FDG PET/CT for inflammatory cardiac imaging 3. How to use cardiac MRI for infiltrative cardiomyopathies 4. Relative roles of Cardiac MRI and FDG PET/CT in: a. the imaging diagnosis of cardiac sarcoidosis b. follow-up of disease activity and response to immunosuppressive treatment. CAE004-b Dynamic Myocardial Perfusion Imaging by 3rd Generation Dual-Source CT Education Exhibits Location: CA Community, Learning Center Participants Marisa Marjolein Lubbers MD (Presenter): Nothing to Disclose Adriaan Coenen MD : Nothing to Disclose Akira Kurata : Nothing to Disclose Marcel L. Dijkshoorn RT : Consultant, Siemens AG Koen Nieman MD, PhD : Speakers Bureau, Siemens AG Speakers Bureau, Toshiba Corporation Research Grant, Bayer AG Research Grant, General Electric Company Gabriel P. Krestin MD, PhD : Consultant, General Electric Company Research Grant, General Electric Company Research Grant, Bayer AG Research Grant, Siemens AG Speakers Bureau Siemens AG TEACHING POINTS After attending this educational presentation the participant should: 1. Have an understanding of the physiological background of dynamic myocardial perfusion CT and the quantification of absolute myocardial blood flow. 2. Be able to perform a myocardial CT perfusion scan, including patient preparation, scan protocol and adenosine stress infusion protocol and post-processing 3. Be able to analyze and evaluate myocardial perfusion images and calculate the absolute myocardial bloodflow TABLE OF CONTENTS/OUTLINE 1. Principles of myocardial perfusion CT and absolute quantification of myocardial blood flow 2. CT acquistion: patient preparation contrast agent injection protocol adenosine stress infusion protocol scan parameters and protocol delayed enhancement CT imaging post processing 3. Practical implications of 3rd generation dual-source CT in terms of tube voltage, coverage, and dose 4. Analyze (absolute) myocardial blood flow data 5. Image analysis using 16-segment AHA-model 6. Potential artefacts and diagnostic pitfalls 7. Case examples CAE005-b Imaging the Fontan Circulation: What? When? How? Why? Education Exhibits Location: CA Community, Learning Center Participants Rachel Charis Brook MBBS, MA : Nothing to Disclose Ausami Abbas MBBS (Presenter): Nothing to Disclose Cheryl Main BMBS : Nothing to Disclose Charles Robert Peebles MBBS : Nothing to Disclose Stephen Harden MRCS, FRCR : Nothing to Disclose James Stuart Shambrook MBBS : Nothing to Disclose TEACHING POINTS The aim of this education exhibit is to provide the reader with a comprehensive understanding of: 1. The major historical variations in surgical techniques and post-surgical anatomy seen on MRI and CT in patients with a Fontan circulation 2. How and why standard CTPA techniques must be adapted to appropriately image patients with a Fontan circulation 3. The potential complications associated with Fontan circulation and imaging findings TABLE OF CONTENTS/OUTLINE 1. Anatomical variations of Fontan circulation seen on MRI and CT: Classical Fontan procedure Modified Fontan procedure Intra-atrial Conduit Extra-cardiac Conduit 2. Staged approach to achieving Total Cavopulmonary Fontan circulation 3. Optimising imaging protocols for Fontan patients CTPA techniques utilised to adequately opacify the Fontan circuit - Illustrations of Dual injection and delayed phase techniques 4. Potential complications associated with the Fontan circulation - review of imaging findings: Thromboembolic events Systemic ventricular failure Aortopulmonary collateral vessels and associated pulmonary haemorrhage Right atrial dilatation (classic fontan circulation) Liver cirrhosis Portosystemic hypertension Arterialized hepatic nodules CAE006-b The Role Of CT and MRI In The Diagnosis and Evaluation Of Cardiac Shunts Education Exhibits Location: CA Community, Learning Center Participants Ausami Abbas MBBS (Presenter): Nothing to Disclose Rachel Charis Brook MBBS, MA : Nothing to Disclose Cheryl Main BMBS : Nothing to Disclose James Stuart Shambrook MBBS : Nothing to Disclose Charles Robert Peebles MBBS : Nothing to Disclose Stephen Harden MRCS, FRCR : Nothing to Disclose TEACHING POINTS The aim of this presentation is to educate the reader on: 1. The role of cardiac MRI (CMR) and CT in the diagnosis and differentiation of intra & extra-cardiac shunts 2. To illustrate how CMR can evaluate the functional significance of cardiac shunts 3. To demonstrate the major complications associated with cardiac shunts. TABLE OF CONTENTS/OUTLINE 1. Demonstrate the key CMR and CT features of the common intra-cardiac shunts including: - Ostium premium, ostium secundum and sinus venosus (superior and inferior) types of atrial septal defect - Ventricular Septal Defects - Atrioventricular septal defects - Coronary sinus defects 2. Demonstrate the CMR and CT features of the common extra-cardiac shunts including: - Patent ductus arteriosus - Partial anomalous pulmonary venous drainage - Scimitar syndrome - Pulmonary arteriovenous malformations - Coronary artery fistulae 3. Demonstrate the common pattern of cardiac chamber enlargement associated with the different types of cardiac shunts 4. Demonstrate how phase contrast MRI sequences can be used to quantify the functional significance of both intra and extra-cardiac shunts 5. The major complications that can occur secondary to cardiac shunts including: - Paradoxical embolic events - Pulmonary Hypertension - Eisenmenger's syndrome CAE008-b Clinical CT Cardiac Structural Anatomy Reconstructed within the Cardiac Contour: Cardiac Skeleton and Inferior Pyramidal Space Education Exhibits Location: CA Community, Learning Center Participants Shumpei Mori (Presenter): Nothing to Disclose Tomofumi Takaya : Nothing to Disclose Tatsuya Nishii MD : Nothing to Disclose Atsushi K. Kono MD,PhD : Nothing to Disclose Tatsuro Ito MD : Nothing to Disclose Sachiko Takamine : Nothing to Disclose Sei Fujiwara : Nothing to Disclose Kazuro Sugimura MD, PhD : Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group Ken-Ichi Hirata : Nothing to Disclose TEACHING POINTS Profound anatomical knowledge about the three-dimensional orientation of cardiac skeleton, including interatrial septum (IAS), interventricular septum (IVS), and each valvular annulus is important to perform safe interventions. The inferior pyramidal space is the extracardiac fibro-adipose tissue extending between the atrial and ventricular musculatures. Many important structures are concentrated around or inside the inferior pyramidal space. The aims of the presentation are: 1, to demonstrate a series of clinical structural images of the IAS, IVS, each valvular annulus, and inferior pyramidal space reconstructed in combination with the cardiac contour using multidetector computed tomography; and 2, to discuss the clinical implications of findings based on accumulated insights made by pioneers. TABLE OF CONTENTS/OUTLINE 1. IAS 1-1. Foramen ovale 1-2. Non-coronary aortic sinuses 1-3. Coronary sinus 2. IVS 2-1. Muscular septum 2-2. Membranous septum 3. Each valvular annulus 3-1. Aortic valve annulus 3-2. Pulmonary valve annulus 3-3. Mitral valve annulus 3-4. Tricuspid valve annulus 4. Inferior pyramidal space 5. Radiolucent band CAE009-b Clinical CT Cardiac Structural Anatomy Reconstructed within the Cardiac Contour: Ventricular Outflow Tract Education Exhibits Location: CA Community, Learning Center Participants Shumpei Mori (Presenter): Nothing to Disclose Tomofumi Takaya : Nothing to Disclose Tatsuya Nishii MD : Nothing to Disclose Atsushi K. Kono MD,PhD : Nothing to Disclose Tatsuro Ito MD : Nothing to Disclose Sachiko Takamine : Nothing to Disclose Sei Fujiwara : Nothing to Disclose Kazuro Sugimura MD, PhD : Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group Ken-Ichi Hirata : Nothing to Disclose TEACHING POINTS The right and left ventricular outflow tracts are common sites of idiopathic ventricular arrhythmia. Although three-dimensional (3D) anatomical accuracy to recognize the exact site of the catheter position is integral, the fluoroscopic definition of the anatomy around outflow tract is variable and 3D anatomical recognition
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