X-Ray Computed Tomography

ABCIC

Case Report

Recurrent Intracardiac Masses in an Orthotopic Heart Transplant Recipient

Bilal Saeed et al. Natdanai Punnanithinont Shareef Mansour Paulo Savoia Promporn Suksaranjit

Introduction

As long-term survival improves among heart transplant recipients, rare post-transplant complications, including intracardiac masses, are being increasingly recognized.

Severe left atrial (LA) dilation and atrial arrhythmias may further contribute to blood stasis and thrombus formation in transplant recipients. LA thrombi in these patients may mimic neoplastic masses and represent important diagnostic and therapeutic challenges. Contributing factors include atrial dilation, arrhythmias, foreign material, and the components of Virchow’s triad, namely abnormal blood flow, endothelial injury, and hypercoagulability.^,

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ABCIC

Case Report

A Hidden Connection: Anomalous Left Circumflex Artery Arising From the Right Pulmonary Artery Unveiled by Cardiovascular Computed Tomography

Mubariz Ahmed Hassan et al. Ashraf Alzahrani Mohammad Mhanna Ola Abdelkarim … Rodrigo Bello Paulo Savoia Promporn Suksaranjit Kimberly Delcour

Introduction

Congenital coronary artery anomalies are uncommon but clinically significant conditions that may present across a broad spectrum, ranging from incidental findings to myocardial ischemia, ventricular arrhythmias, heart failure (HF), and sudden cardiac death (SCD). In adults, anomalous coronary origins may be particularly challenging to recognize because symptoms are often nonspecific and may overlap with more prevalent causes of chest pain, dyspnea, or palpitations.

In rare cases, a coronary artery may originate from the pulmonary arterial circulation, resulting in myocardial perfusion that depends on collateral flow from the remaining coronary arteries arising from the aorta, thereby predisposing the myocardium to ischemia-related electrical instability. Noninvasive anatomical imaging plays a pivotal role in establishing a definitive diagnosis, particularly when conventional angiography is inconclusive.

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ABC

Letter to the Editor

Prognostic Value of the Inflammatory Burden Index (IBI) in Coronary Events

Luis Antonio Cavalcanti Matias et al. Pedro Pereira Tenório

Dear Editor,

We read with great interest the original article entitled “Cardiac CT-Detected Vulnerable Plaques and Risk of Future Acute Myocardial Infarction: Predictive Value of CAC Scores and Inflammatory Burden Index”. We want to congratulate the authors, Ömür et al., on their timely investigation into the integration of anatomical and inflammatory markers for predicting acute coronary events.

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ABC

Original Article

Cost-Effectiveness Analysis of Coronary Computed Tomography Angiography as the Preferred Exam in the Investigation of Stable Chest Pain in the Brazilian Private Healthcare System

Afonso Shiozaki et al. Jorge Torreão Isabela Bispo Santos da Silva Costa Anuncia Bouzas Suarez … Marcelo Tozatti da Silva Thiago Godoy de Oliveira Luana Emanuelly Sinhori Lopes Marcelo Eidi Nita Henrique Trad Carlos E. Rochitte

Abstract

Background

Cardiovascular disease is the leading cause of mortality worldwide. Strategies that prioritize early diagnosis can reduce the incidence of related complications and cost.

Objective

To assess the cost-effectiveness of coronary computed tomography angiography (CCTA) as the initial diagnostic strategy for stable chest pain in patients with intermediate pre-test probability of stable coronary artery disease (CAD), in comparison with invasive coronary angiography (ICA).

Methods

A cost-effectiveness analysis was conducted comparing CCTA and ICA, considering data from the Brazilian private healthcare system. The model considered the direct costs of diagnostic exams, medical supplies, hospitalization for myocardial infarction, and myocardial revascularization in the 5 regions of Brazil. A budget impact analysis was performed regarding the gradual incorporation of CCTA over 5 years, considering 100,000 lives as the eligible population.

Results

The cost-effectiveness analysis comparing CCTA to ICA, estimated for a population of 100,000 lives, demonstrated cost savings of BRL 1,021.00 per life or a total of BRL 102,069,703.00 by the end of the fifth year. When considering the regional average cost of CCTA, for a population of 100,000 over 5 years, we observed the following cost savings per life and in 5 years, respectively: BRL 1,226.00 and BRL 122,577,793.00 in the North Region; BRL 1,460.00 and BRL 145,988,367.00 in the Northeast Region; BRL 1,625.00 and BRL 162,502,626.00 in the Central-West Region; BRL 1,313.00 and BRL 131,270,230.00 in the Southeast Region; and BRL 1,043.00 and BRL 104,268,937.00 in the South Region.

Conclusion

As an initial strategy for investigating stable chest pain, CCTA is cost-effective compared to ICA and is associated with significant cost reductions in the Brazilian private healthcare system.

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ABCIC

Original Article

Overview of Professional Practice in Computed Tomography and Cardiac Magnetic Resonance Imaging in Brazil

Isabela Bispo Santos da Silva Costa et al. Jorge Andion Torreão Juliano de Lara Fernandes Henrique Trad … Gabriela Liberato Roberto Sasdelli Neto Silvio Henrique Barberato Ibraim Masciarelli Pinto Tiago Senra

Abstract

Background:

Non-invasive imaging for cardiovascular disease diagnosis has grown in volume and relevance in recent years, and it is important for early detection of cardiovascular diseases. There is a lack of data from Brazil on the availability of methods such as computed tomography (CT) and cardiac magnetic resonance imaging (CMR).

Objective:

This study assessed the regional distribution of professional practice and the exams performed, correlating these factors with population data and the number of active professionals.

Methods:

A nationwide survey was conducted by means of an online questionnaire applied to professionals who perform CT and CMR, compared with demographic data and the number of scans performed within Brazilian public and private healthcare systems.

Results:

A total of 219 professionals filled out the questionnaire, 139 (63.8%) male, 161 (73.9%) cardiologists, and 46 (21.1%) radiologists. Regarding regional distribution, the Southeast had 125 professionals (57.3%), the Northeast 35 (16.1%), the South 30 (13.8%), the Central-West 22 (10.1%), and the North 6 (2.8%). The profile of these professionals in Brazilian regions was similar, with no statistical differences observed regarding the proportion of men (p = 0.2451), cardiologists (p = 0.1325), radiologists (p = 0.4564), or training time > 2 years (p = 0.8519). The Southeast had the highest absolute number of exams, and the North had the lowest.

Conclusion:

The data revealed structural disparities in access to cardiovascular imaging throughout Brazil, in terms of both number of professionals and number of exams performed. The regional discrepancies observed in this study reflect distinct demographic and economic circumstances in Brazilian regions.

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ABCIC

Editorial

"Triple Rule-Out": Including the Abdominal Aorta With a Clear Conscience?

Tiago A. Magalhães

Less is More – Less Radiation Dose, More Patient Safety

The main strength of the study lies in its methodological approach. The authors selected patients who had previously undergone the TRO CTA protocol including the abdominal aorta with full electrocardiographic synchronization. After obtaining consent, they performed a new examination using the partial electrocardiographic synchronization protocol, enabling a robust comparison through a “matched case-control” model. This approach minimizes bias related to anatomical and technical variability among different individuals.

The results were interesting. The dose reduction was significant: the mean effective dose of the protocol with partial ECG synchronization was 47.9% lower than that of the protocol with full synchronization (17.0 mSv vs. 32.6 mSv, p<0.001). It is noteworthy that this reduction in radiation dose was not accompanied by a compromise in image quality. The quantitative assessment of attenuation values in critical vascular regions – such as the ascending aorta, descending aorta, abdominal aorta, and pulmonary trunk – showed no statistically significant differences. Similarly, the subjective qualitative evaluation demonstrated equivalence between the two protocols in terms of image quality of the assessed anatomical structures.

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ABCIC

Review Article

Pericardial Agenesis: When Should This Diagnosis Be Considered?

Bruna Barbosa Chagas de Almeida et al. Bruna Zanforlin Jácome Bernardo Nascimento Lourenço Alessandro Zakhia de Seixas … Juliana Serafim da Silveira Eliza de Almeida Gripp

Abstract

Pericardial agenesis (PA) is a rare condition characterized by the partial or complete absence of the pericardium. The consequences associated with this condition can be quite serious. Therefore, understanding the peculiarities of this disease is essential for accurate diagnosis and treatment.

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ABCIC

Review Article

My Approach To Myocardial Extracellular Volume Quantification Using Cardiac Computed Tomography

Gabriel C. Camargo et al. Letícia R. Sabioni

Abstract

The quantification of myocardial extracellular volume (ECV) has demonstrated both diagnostic and prognostic value in various heart diseases. While ECV is typically assessed using cardiac magnetic resonance imaging (CMR), it can also be measured through cardiac computed tomography (CCT) imaging. This article discusses the application of CCT for myocardial ECV calculation, detailing the technique, its advantages and disadvantages, and its potential clinical applications.

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ABCIC

Editorial

Metformin in Combination with Immune Checkpoint Inhibitors: Myocardial FDG Uptake Can Predict Prognosis?

Claudio Tinoco Mesquita et al. Ana Beatriz Couto Marina Schmid Nunes Fernanda Azevedo Silva

In Brazil, the estimate for 2023-2025 indicates that there will be 704,000 new cancer cases in the country, 221,000 of which will be non-melanoma skin cancers, cited as the most common type. After this type of cancer, breast cancer has the highest incidence, with 74,000 cases, followed by prostate cancer, with 72,000 cases, colorectum cancer, with 46,000 cases, and lung cancer, with 32,000 new cases. The cancer epidemiological profile in Brazil is like countries with a high income; however, it differs when analyzed by region, indicating significant regional inequalities. While in the country’s more developed regions (South and Southeast), the age-adjusted incidence rates range between 180 and 190 cases per 100,000 inhabitants, in less developed regions (North and Northeast), these rates vary from 157 to 164 cases per 100,000 inhabitants. The highest cancer mortality in Brazil is due to lung cancer (13.7% of cancer deaths), followed by colorectum cancer (10.4% of cancer deaths), and then breast cancer (8% of cancer deaths).

Immune checkpoints, like PD-1, PD-L1, and CTLA-4, regulate the immune system and help to equilibrate immune activation and suppression. They act by avoiding a strong immune response that could attack normal cells. Tumor cells can use these mechanisms to elude the immune system, decreasing its response. The mechanisms used for immune system evasion in lung cancer are linked to PD-1 inhibition, which reduces the activity of tumor immunity cells. Additionally, there is a decrease in T-lymphocyte proliferation and cytokine production (IL-2 and IFN-γ), allowing neoplastic cells to proliferate.

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ABCIC

Review Article

Cardiac Sarcoidosis: The Chameleon of Cardiology

Diego Moraes De Moura et al. Aluísio José De Oliveira Monteiro Neto Marcelo Dantas Tavares de Melo Fábio Fernandes

Abstract

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology, characterized by the formation of non-caseating granulomas in multiple organs. Cardiac involvement, an important cause of morbidity and mortality in these patients, has been generating interest in cardiology, because it is a cause of heart failure, atrioventricular blocks, and ventricular arrhythmias with unfavorable prognosis; however, there are specific treatments with the potential to change the natural history of this condition. The main challenge of cardiac sarcoidosis (CS) is diagnosis, given that the gold standard method of endomyocardial biopsy has limited sensitivity due to the focal nature of the pathology.

Accordingly, cardiovascular imaging methods play the role of guiding most diagnoses of CS. In this scenario, knowledge about these methods, their main findings, and their rational use are essential to the diagnosis of this disease with such diverse presentations.

Electrocardiogram and echocardiography are practical and widely available exams; however, they provide greater diagnostic capacity in patients with clinically manifest disease. On the other hand, to identify incipient forms, which are often silent, it is necessary to use advanced imaging methods, such as positron emission tomography with 18F-fluorodeoxyglucose and cardiac magnetic resonance, which primarily identify signs of active inflammatory activity and fibrosis, respectively. Despite the advances in these imaging methods, due to the lack of studies comparing them with the gold standard (endomyocardial biopsy), the diagnosis of CS currently remains a major challenge.

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