EDITORIAL COMMENT One stop cardiac investigation ‘CT or echocardiography’: beyond ejection fraction Robin Chung Æ Mamdouh Zidan Æ Michael Y. Henein Received: 6 September 2007 / Accepted: 6 September 2007 / Published online: 2 October 2007 Ó Springer Science+Business Media B.V. 2007 The principle aim of diagnostic cardiovascular imaging is to provide clinically relevant information regarding cardiac anatomy and function. This may be broadly categorised into coronary vascular anatomy, plaque architecture, myocardial perfusion, cavity volume, valvular pathology, and haemodynamics. Each of the major cardiac imaging techniques (chest X-ray, coronary angiography, cardiac MRI, multi- slice CT, SPECT, FDG-PET, echocardiography) provides a subset of this information to varying degrees according to strengths and weaknesses of the particular modality. The techniques may be compared by invasiveness, spatial resolution, temporal resolu- tion, radiation dose, cost, repeatability, and availability. In this issue of IJCI Bansal et al. report their study comparing 16-slice multi-detector computed tomography (16CT) with conventional 2-dimensional echocardiography for assessment of left ventricular function by cavity volumes and ejection fraction. Their study population consisted of 52 patients with suspected coronary artery disease (CAD) who were referred for routine cardiological investigation. The computed tomography scans were acquired using a 16-slice scanner with contrast enhancement but without dose modulation. Echocardiographic assess- ment of cavity volumes and ejection fraction were calculated from Simpson’s and biplane Simpson’s planimetry. Their results showed significant correla- tion between the two modalities for biplane cavity volume measurements (LVESV r = 0.69; LVEDV r = 0.73; P \ 0.01) with echocardiography consis- tently underestimating cavity volume, but very close agreement for ejection fraction (CT EF = 59.7 ± 12% vs. Echo EF = 58 ± 13%, r = 0.59; P \ 0.01). Previous studies [1, 2] have reported similar results to that by Bansal et al. and there is evidence for consistent over- or under- estimation with multi- detector CT and echocardiography, respectively, compared with cardiac MRI. Technical limitations as well as the immutable laws of physics govern the strengths and weaknesses of the major cardiac imaging techniques. Cardiac MRI is accepted as the ‘gold standard’ measurement for ventricular cavity volume, and therefore ejection fraction, by calculation. Cardiac MRI is also known for its excellent tissue delineation, useful when assessing infarcted myocardium or fibrosis. These Editorial comment on the article by Bansal et al. in the current issue of this journal. R. Chung Echocardiography Department, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK M. Zidan Department of Cardiology, Medical School, Alexandria University, Alexandria, Egypt M. Y. Henein (&) Department of Cardiology, West Middlesex University Hospital, Twickenham Road, Isleworth TW7 6AF, UK e-mail: henein@googlemail.com 123 Int J Cardiovasc Imaging (2008) 24:327–329 DOI 10.1007/s10554-007-9268-y