Cardiac CT (eBook)

Marc Dewey (Autor)

eBook Download: PDF

2010 | 2011
XIII, 333 Seiten
Springer Berlin (Verlag)
978-3-642-14022-8 (ISBN)

Infos

Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored.

Dr. Marc Dewey has published more than 50 papers on noninvasive cardiac imaging over the last five years. Among them are landmark papers published in the Annals of Internal Medicine and the New England Journal of Medicine. He is a reviewer for over 20 journals among them the Annals of Internal Medicine, JAMA, and The Lancet and received the highest scientific award of the German Röntgen Society - the Wilhelm-Conrad-Röntgen-Preis. Dr. Dewey's team is well known for the cardiac imaging workshops held at the Charité in Berlin and he is a renowned speaker on cardiac imaging. Experts for the scanners of all four vendors such as Dr. Katharina Anders, Dr. Martin K. Hoffmann, Dr. Eugenio Martuscelli, and Dr. Elke Zimmermann contributed to the corresponding chapters of 'Cardiac CT'. The second edition again focuses on cardiac CT in clinical practice and features newly edited chapters about radiation exposure, coronary artery stents, bypass grafts, coronary anomalies, and congenital heart disease. Also, upcoming clinical applications of cardiac CT, for instance plaque imaging and functional assessment, are covered by experts such as Dr. Paul Schoenhagen und Dr. Gudrun Feuchtner.

Inhalt

Foreword 5
Acknowledgments 6
Contents 7
Contributors 9
1: Introduction 12
2: Technical and Personnel Requirements 13
2.1Technical Requirements 13
2.2Purchasing a Scanner 17
2.3Personnel Requirements 18
2.3.1Guidelines of the ACR 19
2.3.2Guidelines of the ACC 19
Recommended Reading 20
3: Anatomy 22
3.1Coronary Arteries 22
3.1.1Coronary Artery Dominance 26
3.1.2Coronary Artery Segments 28
3.1.3Frequent Coronary Artery Variants 33
3.2Myocardium 36
Recommended Reading 37
4: CT in the Context of Cardiovascular Diagnosis and Management 38
4.1CT as a Supplement to Other Noninvasive Imaging Tests 38
4.2Role of CT in Clinical Cardiology 38
4.3CT as a Screening Test: Indications in Asymptomatic Individuals? 39
4.4Risk–Benefit of Cardiac CT: Economic and Biological Costs of Cardiac Imaging 40
Recommended Reading 40
5: Cardiac CT in Clinical Practice 41
5.1Introduction 41
5.2Cardiovascular Risk Refinement (in Asymptomatic Individuals) 41
5.3Patients with Stable Chest Discomfort 43
5.4Acute Chest Pain 44
5.5Rule-Out of Coronary Artery Disease in Specific Situations 46
5.6Noninvasive Angiographic Follow-Up After Coronary Revascularization 46
5.7CT-Assisted Cardiac Interventions 46
5.8Ventricular Function, Myocardial Infarction, and Valvular Heart Disease 47
Recommended Reading 48
6: Clinical Indications 50
6.1Suspected Coronary Artery Disease 50
6.2Other Appropriate Clinical Indications 51
6.3Potential Clinical Indications 55
6.4Currently No Clinical Indications 56
6.5Patient Referral 58
Recommended Reading 58
7: Patient Preparation 60
7.1Patient Information Sheets 60
7.2General Information 60
7.3 Contraindications 63
Recommended Reading 64
8: Physics Background and Radiation Exposure 65
8.1Physics of CT 65
8.2Physics of Cardiac CT 67
8.2.1Spatial Resolution 67
8.2.2Temporal Resolution 67
8.2.3Image Noise and Radiation Exposure 68
8.2.4Retrospective ECG Gating and Prospective ECG Triggering 69
8.3Patient Dosimetry and Radiation Exposure 72
8.3.1Dosimetry 72
8.3.2Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP) 72
8.3.3Organ and Tissue Doses 74
8.3.4Effective Dose 76
Recommended Reading 77
9: Examination and Reconstruction 78
9.1Examination 78
9.1.1Calcium Scoring 78
9.1.2Positioning and ECG 79
9.1.3Nitroglycerin 81
9.1.4Beta Blockade and If Channel Blockade 81
9.1.5Planning the Scan 83
9.1.6Breath-Hold Training 83
9.1.7Scanning Parameters 85
9.1.8Contrast Agent 85
9.1.9Starting the Scan 87
9.1.10After the Scan 88
9.2Reconstruction 88
9.2.1Slice Thickness and Fields of View 89
9.2.2Temporal Resolution and the Cardiac Reconstruction Phase 93
9.2.3Iterative Reconstruction 96
Recommended Reading 96
10a: Toshiba Aquilion 64 and Aquilion ONE 98
10a.1Examination 98
10a.1.1Preparation 98
10a.1.2Defining the Scan Range 98
10a.1.3Surestart 99
10a.1.4Breath-Hold Training and Premedication 101
10a.2Reconstruction 103
10a.3Aquilion ONE 106
10a.3.1Preparation 106
10a.3.2The Role of the Cone Beam for Defining the Scan Range 107
10a.3.3Planning the Scan Range Using a Calcium Scan 109
10a.3.4Surestart 112
10a.3.5Scan Modes 113
10b: Siemens Somatom Sensation and Definition 115
10b.1Preparing the Examination 115
10b.2Image Acquisition 115
10b.3Image Reconstruction 119
10b.4Dual-Source CT (“Somatom Definition”) 122
10b.5Second Generation Dual-Source CT (“Somatom Definition FLASH”) 123
10c: Philips Brilliance 64 and iCT 126
10c.1Preparing and Starting the Examination 126
10c.2Prospective Axial Acquisition (“Step & Shoot”)
10c.2.1Scan Protocol 129
10c.2.2Dose Indication Box 129
10c.2.3Injection Protocol 129
10c.3Retrospective Helical Image Acquisition 129
10c.3.1Scan Protocol 130
10c.4Reconstruction 131
10d: General Electric Light Speed VCT and Discovery CT750HD 133
10d.1Electrode Placement and ECG 133
10d.1.1Electrode Placement 133
10d.1.2ECG Monitor 133
10d.2Scan Preparation 133
10d.2.1Breathing Instructions 133
10d.2.2Scout Scans 134
10d.3Scan Modes, Bolus Timing, and Image Acquisition 135
10d.3.1CT Coronary Angiography Scan Modes 135
10d.3.2Bolus Timing 135
10d.3.3Image Acquisition 136
10d.4Image Reconstruction 140
10d.5Discovery CT750 HD 140
10d.5.1Technical Characteristics 140
10d.5.2Image Acquisition and Specific Reconstruction Kernels 140
10d.5.3Adaptive Gating and ECG Editor 142
11: Reading and Reporting 144
11.1Reading 144
11.1.1Selecting Cardiac Phases 144
11.1.2Systematic Approach 146
11.1.3Source Images 146
11.1.4Curved Multiplanar Reformations 150
11.1.5Maximum-Intensity Projections 157
11.1.6Volume Rendering and Angiographic Emulation 158
11.1.7Typical Artifacts 158
11.1.8Cardiac Function 163
11.2Reporting 169
11.2.1Structured Reporting 169
11.2.2Medical History, Symptoms, and Questions to be Answered 169
11.2.3Technical Approach and Image Quality 169
11.2.4Description of Findings 169
11.2.5Overall Impression and Recommendations 170
Recommended Reading 170
12: Coronary Artery Bypass Grafts 172
12.1Introduction 172
12.2Vade Mecum of Coronary Surgery 172
12.3Technical Considerations 173
12.3.1CT Scanner 173
12.3.2Scan Range and Direction 173
12.3.3Contrast Agent 173
12.3.4Acquisition Protocols 173
12.3.5Reconstruction and Reading 175
12.4Diagnostic Accuracy of CT 178
Recommended Reading 179
13: Coronary Artery Stents 180
13.1Clinical Background 180
13.2Challenges 180
13.3Beam Hardening, Blooming, and Artificial Lumen Narrowing 181
13.3.1Beam Hardening 181
13.3.2Blooming and Artificial Lumen Narrowing 181
13.4Data Acquisition and Image Reconstruction 183
13.4.1Temporal Resolution 183
13.4.2Spatial Resolution: Scanning 183
13.4.3Spatial Resolution: Image Reconstruction 183
13.5CT Wish List 185
13.6Reading and Interpretation 185
13.7Clinical Results and Recommendations 190
13.8Outlook 190
13.8.1Scanners 190
13.8.2Stents 190
Recommended Reading 191
14: Coronary Artery Plaques 192
14.1Plaque Imaging 192
14.2Plaque Identification, Characterization, and Quantification 193
14.2.1Plaque Identification 193
14.2.2Plaque Characterization 193
14.2.3Plaque Quantification 193
14.3Retrospective Analysis of Composition of Individual Lesions: Relationship to Clinical Presentation 197
14.4Prospective Prognostic Value of Plaque Burden and Composition 198
14.5Clinical Recommendations 199
14.6Future of Plaque Imaging 199
Recommended Reading 201
15: Cardiac Function 202
15.1Performance of CT for Assessment of Cardiac Function 202
15.2Clinical Use of Cardiac CT 204
15.3Adjustment of CT Examination Protocols for Evaluation of Cardiac Function 204
15.3.1Contrast Bolus Design 204
15.3.2ECG-Gating Techniques 204
15.3.3Image Reconstruction 204
15.4Definition of Cardiac Function Parameters 205
15.5Analysis of Cardiac Function on Different Commercial Workstations 206
15.5.1Vital Images (Vitrea Workstation) 206
15.5.2Siemens (syngo.via™, Cardio-vascular Engine) 208
15.5.3Philips (Brilliance Workspace, Comprehensive Cardiac) 211
15.5.4GE (Advantage Workstation) 214
15.5.5Terarecon (Aquarius iNtuition) 216
Recommended Reading 217
16: Cardiac Valves 218
16.1Reading and Reporting 218
16.2CT Examination Technique 218
16.3Valvular Heart Disease 219
16.3.1Aortic Stenosis 219
16.3.2Bicuspid Aortic Valve 221
16.3.3Aortic Valve Calcification 223
16.3.4Aortic Regurgitation 223
16.3.5Mitral Stenosis 225
16.3.6Mitral Regurgitation 225
16.3.7Mitral Annular Calcification 226
16.3.8Mitral Valve Prolapse 227
16.3.9Infective Endocarditis 227
16.3.10Prosthetic Valves 229
Recommended Reading 231
17: Coronary Artery Anomalies 232
17.1Embryonic Development 232
17.2Classification 235
17.3Clinical Relevance 237
17.3.1Benign Coronary Anomalies 237
17.3.2Malignant Coronary Anomalies 241
17.3.3Further Anomalies 245
17.4Cardiac CT 248
Recommended Reading 248
18: Congenital and Acquired Heart Disease 249
18.1Introduction 249
18.2Technical Considerations 250
18.2.1Size of Vascular Structures 250
18.2.2Heart Rate and Premedication 251
18.2.3Respiratory Artifacts 252
18.2.4Speed of Contrast Agent Injection 252
18.2.5Iodine Concentration of Contrast Agent 252
18.2.6Scanning Protocol 252
18.3Congenital Heart Disease 252
18.3.1Aortic Arch 253
18.3.2Persistent Ductus Arteriosus (PDA) 254
18.3.3Transposition of the Great Arteries 254
18.3.4Tetralogy of Fallot 256
18.3.5Sequestration 257
18.3.6Origin of the Left Pulmonary Artery from the Right Pulmonary Artery (Pulmonary Sling) 258
18.4Coronary Artery Anomalies 258
18.4.1Myocardial Bridging 259
18.4.2Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA or Bland-White-Garland Syndrome) 259
18.4.3Kawasaki Disease 261
Recommended Reading 264
19: Typical Clinical Examples 265
19.1Normal Coronary Arteries 265
19.2Coronary Artery Plaques 265
19.3Coronary Artery Stenoses 265
19.4Coronary Artery Bypass Grafts 265
19.5Coronary Artery Stents 265
19.6Noncardiac Findings 265
19.7Extracoronary Cardiac Findings 265
20: Results of Clinical Studies 318
20.1Coronary Arteries 318
20.2Coronary Artery Bypasses 319
20.3Coronary Artery Stents 320
20.4Cardiac Function 320
21: Outlook 321
21.1Technical Developments 321
21.1.1Single Heart Beat Whole-Heart CT 321
21.1.2Multisource Scanning 322
21.1.3Better Temporal Resolution 323
21.1.4Better Spatial Resolution 323
21.2Clinical Developments 325
21.2.1Coronary Stent Imaging 325
21.2.2Myocardial Perfusion and Viability Imaging 326
21.2.3Coronary Plaque Quantification and Characterization 326
21.2.4Asymptomatic High-Risk Patients 327
Recommended Reading 327
Index 329

Produkt-Details

• Erscheint lt. Verlag: 16.11.2010
• Zusatzinfo: XIII, 333 p. 270 illus., 162 illus. in color.
• Verlagsort: Berlin
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Schlagworte: Computed tomography • Coronary Angiography • Coronary arteries • Imaging • Radiology
• ISBN-10: 3-642-14022-X / 364214022X
• ISBN-13: 978-3-642-14022-8 / 9783642140228