Cardiothoracic Imaging
Leadership
- Director, Cardiothoracic Imaging Division
- Herman I. Libshitz, MD Professor in Thoracic Radiology
Services Offered
Advanced Cardiac Imaging
The advanced cardiac imaging group at Jefferson provides cardiac imaging with both CT and MRI. Coronary CT angiography (cCTA) with 64-slice scanners is one of the most dramatic developments in imaging in recent years. Both outpatient and inpatient cCTA examinations are performed to visualize the coronary arteries noninvasively with only an intravenous injection of contrast material. “Triple rule-out” cCTA scans are performed for emergency department patients in order to exclude coronary disease, aortic dissection and pulmonary embolism in patients presenting with chest discomfort. Cardiac MRI examinations are primarily performed to demonstrate myocardial viability and function, and for the diagnosis of cardiomyopathy and congenital heart disease.
cCTA has been shown to have a negative predictive value of almost 100% for coronary disease. In other words, if your patient has a negative cCTA, you can be virtually assured the patient has no significant coronary disease. cCTA should be performed on a CT scanner with multislice technology and at least 64 slices. TJUH currently has 2 64-slice CT scanners. MRI has demonstrated remarkable accuracy in defining viable myocardium. At Jefferson’s advanced cardiac imaging group, cCTA and cardiac MR studies are supervised by radiologists with years of experience in both noninvasive and invasive imaging of the heart.
- Calcium scoring – a rapid CT examination of the heart performed without administration of contrast material and with a very low radiation exposure (~1 mSv). Calcium scoring has been shown to be highly predictive of the presence of cardiac disease and the likelihood of future cardiac events.
- cCTA – CT angiography requires an injection of iodinated contrast material to visualize the coronary arteries. Using our newest prospective ECG-gating techniques, the radiation dose for cCTA of the coronary arteries has been reduced to the range of 3-5mSv (compared with 12-16mSv for a nuclear stress test).
- Cardiac MRI – Using the latest gradient echo sequences, high quality bright blood cine images of the heart clearly demonstrate cardiac function (steady state free precession images). Fast spin echo sequences are used for black blood images to evaluate cardiac morphology. Although cCTA is preferred for evaluation of coronary anatomy, cardiac MRI provides a better non-invasive technique to evaluate the myocardium.
Multidetector CT is performed using state of the art 64 and 16 channel equipment which considerably reduces the scanning time and helps to reduce the duration of breath hold in patients with dyspnoea. The scan acquires the volume data and makes it possible to obtain contiguous thin slices, multiplanar reconstruction and 3D images which helps to make precise diagnosis.
High resolution CT is done with thin sections reconstructed with high spatial frequency algorithms. It is normally done with skipped areas between the thin sections and often the scans are performed both during suspended inspiration and expiration. It is helpful for evaluation of chronic interstitial process like emphysema and interstitial fibrosis and in some patients with diffuse lung disease.
CT angiography of the chest is done with high speed state of the art scanners following accurately timed rapid injection of contrast. It is the primary imaging method for detecting abnormalities of thoracic aorta like dissection, aneurysm or coarctation. It is also becoming a primary imaging method for detecting pulmonary embolism in patients with chest pain.
CT guided lung biopsies are scheduled in association with division of body imaging and cardiovascular and interventional radiology. It is a pain free procedure where fine needle are passed into the lung lesions under local anesthesia and CT guidance and cells are aspirated for cytological analysis. The aspirated sample can also be submitted for microbiology for culture and sensitivity to find infection. Sometimes a small piece of tissue can be obtained (core biopsies) for detailed pathology. Utmost care is taken to avoid potential complications.
Chest drain insertions, radiofrequency tumor ablations and embolization of arteriovenous malformations are performed by division of Cardiovascular and Interventional Radiology.
Ventilation perfusion scans to assess for pulmonary embolism and PET/CT scans for lung tumor staging are performed by division of Nuclear Medicine.