262.3 🩺 內科專科考前版

262.3.0.1 1⃣ Cardiac Amyloidosis Imaging Workflow

  1. Suspect from clinical (HFpEF + LVH + low voltage ECG + bilateral CTS)
  2. Free light chains (FLC ratio): AL amyloid
  3. Echo: apical sparing (cherry-on-top)
  4. CMR: subendocardial circumferential LGE + elevated T1 + ECV
  5. PYP scan: ATTR (if negative FLC)
  6. Biopsy (if AL suspected): bone marrow, fat pad, or cardiac
  7. Subtype determination (AL vs ATTR) for treatment selection

262.3.0.2 2⃣ Cardiac Sarcoidosis Diagnosis

  • Clinical syndrome + imaging + biopsy
  • CMR: patchy LGE + edema
  • FDG-PET: active inflammation
  • Biopsy (endomyocardial or extracardiac): definitive
  • Treatment: corticosteroids ± additional immunosuppressants

262.3.0.3 3⃣ Sub-Clinical Atherosclerosis Detection

  • CAC score primary tool
  • Carotid intima-media thickness (CIMT) by ultrasound (alternative)
  • CCTA: detect non-calcified plaque
  • Brachial-ankle PWV: arterial stiffness
  • Combined data for risk stratification

262.3.0.4 4⃣ AI in Cardiac Imaging

  • Automated segmentation + measurement
  • LVEF estimation
  • Stenosis detection
  • Plaque characterization
  • Increasing FDA-approved tools (2023+)
  • Quality assurance + workflow optimization

262.3.0.5 5⃣ 健保 / Taiwan

  • 健保 CT + MRI covered for indications
  • Stress nuclear available in tertiary centers
  • 健保 PYP / FDG-PET for specific indications
  • AI-enabled imaging emerging in some institutions

262.3.0.6 6⃣ Pre-TAVR Planning

  • CCTA: aortic annulus sizing (critical for valve selection)
  • Aortic root measurements
  • Iliofemoral anatomy for access
  • Coronary heights
  • CMR for complementary information

262.3.0.7 7⃣ Cardio-Oncology Imaging

  • Pre-chemotherapy: echo + baseline GLS
  • During chemo: serial echo
  • CMR if echo equivocal
  • LGE + strain for early detection of cardiotoxicity

262.3.0.8 8⃣ Pulmonary Hypertension Workup

  • Echo (initial — TR jet for PASP)
  • Right heart catheterization (gold standard for PAH diagnosis)
  • CT (chronic thromboembolic disease — CTEPH)
  • VQ scan (CTEPH screening)
  • Cardiac MRI (functional assessment + 4D flow)

262.3.0.9 9⃣ Future + Innovations

  • Photon-counting CT (better resolution + lower radiation)
  • AI-enabled imaging across modalities
  • Combined PET/MRI scanners
  • Quantitative perfusion CT
  • Real-time MRI

262.3.0.10 10. Radiation Dose Awareness

  • CAC: ~ 1 mSv
  • CCTA: 2-10 mSv (depending technique)
  • SPECT: ~ 9-10 mSv
  • PET: ~ 3-5 mSv
  • Cardiac MRI: 0 mSv (no radiation)
  • Coronary angiography: 5-10 mSv
  • Pediatric + young + repeated: prefer low-radiation alternatives