The Cardiac and Pulmonary Imaging Section emphasizes the comprehensive evaluation of both the respiratory and cardiovascular systems using appropriate imaging modalities. Imaging studies supervised, performed, and interpreted include:

• chest radiographs in adults
• chest CT and high-resolution lung CT in adults
• cardiac CT and coronary CT
• angiography in adults and children
• cardiac MRI in adults and children
• thoracic MR angiography in adults and children
• MRI of the brachial plexus, thyroid, and parathyroid
• thoracic biopsies

The Cardiac and Pulmonary Imaging Section is responsible for studies performed at UCSF Medical Center, UCSF Children’s Hospital, Mt. Zion Medical Center at UCSF, and China Basin Landing. The section also manages and interprets most of the cardiothoracic imaging studies at the San Francisco VA Medical Center and San Francisco General Hospital.

Coronary CT Angiography Program
The Coronary CT Angiography Program is a collaborative effort run jointly by the Cardiac and Pulmonary Imaging Section and the Division of Cardiology.

Coronary CT angiography is a new and advanced non-invasive test performed on a 64-detector CT scanner; it is also known as the 64-slice CT scan. In about five seconds, the test provides direct visualization of the arteries and heart, allowing for highly accurate detection of early coronary artery disease (CAD) and the assessment of coronary artery obstruction. Recent studies have shown high accuracy of CT angiography for detection of coronary stenosis or occlusion, with a negative predictive value of 93-100 percent (aggregate of 97 percent).

Compared to a traditional CT scan, the 64-slice scan can acquire clear images of the heart and its blood vessels in multiple slices in rapid sequence without the blurring effects of cardiac motion. Using advanced technology, the information is reconstructed into 3-D views of the heart and its blood vessels, revealing not only narrowed areas of the blood vessels, but also early disease in the vessel walls that may not be narrowed. During the test, patients receive an IV injection of a contrast agent (“dye”). They are asked to hold their breath for five seconds during the scan. The entire procedure takes about an hour, including premedication with a beta blocker (usually IV metoprolol) and sublingual nitroglycerine, unless contraindicated. The test is only available at select leading Heart and Vascular Centers in the U.S.

Patients with suspected CAD typically undergo an exercise stress test, stress perfusion scintigraphy, or stress echocardiography, but these exams do not provide a direct look at the coronary arteries. Definitive diagnosis is based on catheter-based X-ray angiography, but this study is invasive and relatively expensive, and approximately 40 percent of diagnostic angiograms are normal.

CT angiography can eliminate the need for a catheter-based X-ray angiography in a substantial proportion of patients, particularly those who are at low to moderate risk for CAD. Indications include a history of atypical chest pain or a history of chest pain without EKG changes or elevated serum levels of cardiac enzymes. Other indications include evaluation of coronary bypass grafts, assessment of coronary anomalies, and early detection of coronary artery disease in the asymptomatic patient with multiple coronary risk factors, such as smoking, male gender, age over 40 years, elevated serum cholesterol, and family history of coronary disease.

CAD is the leading cause of morbidity and mortality in the United States and other industrialized countries. Patients can present with chest pain, but sudden death is the initial presenting symptom in up to 50 percent of patients. By accurately and quickly detecting heart disease, CT angiography greatly reduces the risk of life-threatening problems related to CAD and means better treatment, a faster recovery time and increased comfort and convenience for patients at risk for CAD.

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