Table 10.

Ten things to know about imaging of other body organs applicable to preventive cardiology (brain, kidney, and ovary).

(1)In individuals without symptomatic cardiovascular, cerebrovascular, or peripheral vascular disease, CVD risk factors such as diabetes mellitus, obesity, hyperlipidemia, and cigarette smoking are independently associated with brain imaging changes before the manifestation of clinical cardiovascular or cerebrovascular disease. [181] (2)Brain imaging findings associated with CVD risk factors include: (a) structural brain changes such as reduction in whole-brain volume, (b) white matter changes such as white matter hyperintensities and microbleeds, and (c) functional brain changes such as reduced cerebral blood flow. [181, 190, 191] (3)Brain image findings of structural, white matter, and functional brain changes associated with CVD risk factors may contribute to cognitive decline. [190, 192] (4)CVD risk factors that contribute to reduced whole brain volume on brain imaging include hypertension, obesity, dyslipidemia, and cigarette smoking. [181, 193] (5)Even light physical activity can help maintain brain volume over time. [181, 193] (6)Fibromuscular dysplasia is an arteriopathy that predominantly occurs in younger women that may result in aneurysm, dissection, or occlusion of the renal, carotid, vertebral arteries, and coronary arteries. Clinically, fibromuscular dysplasia may contribute to hypertension, neurological signs and symptoms, and dissection of an epicardial artery resulting in unstable angina, myocardial infarction, left ventricular dysfunction, or possibly sudden cardiac death. [194] Noninvasive imaging of the kidneys include duplex ultrasound, CT angiography, and magnetic resonance angiography. [195] Definitive diagnosis of fibromuscular dysplasia and imaging-directed potential treatment usually requires catheter-based angiography of the renal arteries, and possible percutaneous angioplasty. [196] Cardiac angiographic features of fibromuscular dysplasia include spontaneous coronary artery dissection, smooth narrowing of coronary arteries, intramural hematoma, coronary artery spasm, and tortuosity (historically described as “string of beads”). [194] (7) Also, while not specifically applicable to kidney imaging, the presence of kidney disease can affect decisions regarding cardiac imaging: • The decision to perform cardiac imaging study in patients with CKD should be directed towards individuals at higher CVD risk (e.g., with symptomatic CVD) and those most likely to benefit from revascularization. [183] • Stress echocardiography, MPI SPECT, and MPI PET are safe in patients with kidney insufficiency. • Coronary CT angiography utilizes iodinated contrast which increases the risk of contrast-induced nephropathy; CMR utilizes gadolinium-based contrast agents that increase the risk of nephrogenic systemic fibrosis. [183] • Many patients with CKD have extensive coronary artery calcification, limiting the diagnostic value of CCTA. [183] (8)The findings of “cysts” on imaging women with PCOS represent antral follicles arrested in development that accumulate follicular fluid giving the appearance of cysts. [197] Due to improved ultrasound imaging techniques, some believe the threshold for polycystic ovary morphology should be 19 – 25 follicles per ovary, instead of the more established criteria of 12 or more follicles per ovary. [198] (9)The diagnosis of polycystic ovaries is usually made via ultrasound, which should not be performed for this purpose in girls < 8 years of age. [199] (10) The presence of polycystic ovary morphology is not required for the diagnosis of PCOS. The Rotterdam Consensus for PCOS includes two or more of the following: [200] • Hyperandrogenism (clinical or biochemical) • Ovulatory dysfunction (menstrual irregularities) • Polycystic ovary morphology by ultrasound

Sentinel Guidelines and References2020 Cardiac imaging for Coronary Heart Disease Risk Stratification in Chronic Kidney Disease [183]2019 Chronic Kidney Disease and Coronary Heart Disease [185]2018 Recent advances in renal imaging. [186]2018 International evidence-based guideline for the assessment and management of polycystic ovary syndrome. [199]2014 Brain imaging changes associated with risk factors for cardiovascular and cerebrovascular disease in asymptomatic patients [181]