262.4 📌 章末速蚘

262.4.0.0.1 Cardiac CT
  • CAC score for primary prevention risk stratification (intermediate ASCVD risk)
  • CCTA: high NPV; first-line for low-intermediate chest pain (ESC 2024)
262.4.0.0.2 Cardiac MRI
  • Gold standard tissue characterization
  • LGE patterns:
    • Subendocardial CAD distribution = infarction
    • Mid-wall septal = DCM
    • Patchy mid-wall = sarcoidosis
    • Epicardial = myocarditis
    • Subendocardial circumferential = amyloidosis
    • Septal junction = HCM
    • Sub-tricuspid free wall = ARVC
  • T1 / T2 mapping + ECV: quantitative tissue characterization
  • Viability: LGE > 50% = non-viable
  • Cardiomyopathy workup + myocarditis + cardiac masses
262.4.0.0.3 Nuclear Cardiology
  • SPECT MPI: reversible (ischemia) vs fixed (scar) defects
  • PET: higher resolution + CFR
  • FDG-PET: cardiac sarcoidosis (active inflammation)
  • PYP / HMDP: ATTR amyloidosis (+ negative FLC → non-invasive diagnosis)
  • FDG mismatch with perfusion: hibernating myocardium
262.4.0.0.4 Multimodality Approach
  • Chest pain (2024 ESC): CCTA first-line low-intermediate; stress imaging higher; coronary angiography highest risk
  • Cardiomyopathy: CMR + PET (sarcoid) + PYP (amyloid)
  • Aortic disease: CTA gold standard
  • PE: CTPA
  • Pericardial / cardiac mass: CMR
262.4.0.0.5 盧醫垫 hint
  • Intermediate ASCVD risk + statin decision: CAC score very useful
  • Suspected HCM + cardiomyopathy: cardiac MRI essential
  • HFpEF + low voltage ECG + LVH echo: amyloidosis workup (CMR + PYP scan + FLC)
  • Cardiac sarcoidosis: FDG-PET for active inflammation; CMR for fibrosis
  • Chest pain low-intermediate risk: 2024 ESC CCTA first-line