Imaging

Cardiomyopathy

Preliminary Diagnosis: Cardiomyopathy

I. What imaging technique is first-line for this diagnosis?

2-D echocardiography

II. Describe the advantages and disadvantages of this technique for diagnosis of cardiomyopathy.

Advantages

  • Can assess for chamber dilatation, myocardial wall thinning or thickening, abnormal ejection fraction and increased end-diastolic volume, systolic obstruction

  • Diagnostic

Disadvantages

  • Imaging may be limited by obese body habitus or significant breast tissue

III. What are the contraindications for the first-line imaging technique?

No significant contraindication

IV. What alternative imaging techniques are available?

  • Angiography

  • Plain radiographs of the chest: PA and lateral views

  • MRI

  • CT with IV contrast

  • Nuclear medicine

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cardiomyopathy.

Angiography

Advantages

  • Able to assess for chamber dilatation, myocardial wall thinning, abnormal ejection fraction, and increased end-diastolic volume

  • Able to assess for coronary artery pathology and anomalies

  • Diagnostic

Disadvantages

  • Invasive

  • Expensive

  • Exposure to ionizing radiation

  • Exposure to iodinated contrast

Plain radiographs of the chest: PA and lateral views

Advantages

  • Chest radiography is abnormal 85% of the time in dilated cradiomyopathy.

Disadvantages

  • Not sensitive or specific for cardiomyopathy

  • Unable to obtain dynamic assessment of cardiac function

MRI

Advantages

  • Dynamic MRI (with gadolinium) allows accurate assessment of ventricular function.

  • Able to evaluate anatomy, perfusion, and tissue characterization

Disadvantages

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Expensive

CT with IV contrast

Advantages

  • Can be used with IV contrast to perform CTA to assess for coronary artery anomalies

Disadvantages

  • Limited use in assessment of cardiac pathology

  • Exposure to ionizing radiation

  • Exposure to iodinated contrast

Nuclear medicine

Advantages

  • PET scanning may show changes in perfusion, gallium uptake correlates with myocardial inflammation in DCM

Disadvantages

  • Expensive

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

Angiography

  • Pregnancy is a relative contraindication.

  • Renal failure is a relative contraindication due to contrast exposure.

Plain radiographs of the chest: PA and lateral views

No significant contraindications

MRI

  • Absolute contraindication in those with non-MR-compatible hardware

CT with IV contrast

  • Relative contraindication in pregnancy

  • Renal failure is a relative contraindication due to contrast exposure.

Nuclear medicine

  • Relative contraindication in pregnancy

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