Integrated Cardiothoracic Imaging with MDCT PDF
Preview Integrated Cardiothoracic Imaging with MDCT
I Contents MEDICAL RADIOLOGY Diagnostic Imaging Editors: A. L. Baert, Leuven M. Knauth, Göttingen K. Sartor, Heidelberg III Contents M. Rémy-Jardin · J. Rémy (Eds.) Integrated Cardiothoracic Imaging with MDCT With Contributions by J. Aldrich · H. Alkadhi · C. R. Becker · L. Bonomo · K. Boroto · L. Boussel · E. Bouvier F. Cademartiri · C. Camus · P. Camus · A. Caulo · T. Couvreur · P. Douek · M. Dupont B. Elicker · J.-B. Faivre · J. Feignoux · D. Fleischmann · T. Flohr · P. Foucher D. Gamondès · B. Ghaye · A. B. Gorgos · A.-L. Hachulla · X. Hamoir · D. M. Hansell J. Kirsch · E. Klotz · L. La Grutta · J.–P. Laissy · A. R. Larici · F. Laurent · M. C. C. Lin G. Macis · E. Maffei · F. Maggi · B. Marincek · J. R. Mayo · L. Menchini · N. R. Mollet M. Montaudon · B. Ohnesorge · A. A. Palumbo · V. Pansini · F. Pontana M. Prokop · S. D. Qanadli · J. Rémy · M. Rémy-Jardin · D. Revel · E. Rizzo · A. Rutten J.–L. Sablayrolles · P. Stolzmann · M. L. Storto · N. Sverzellati · N. Tacelli J. M. Trautenaere · C. S. White · S. M. Yoo Foreword by A. L. Baert With 247 Figures in 487 Separate Illustrations, 102 in Color and 37 Tables 123 IV Contents Martine Rémy-Jardin, MD, PhD Professor, Department of Radiology C.H.R.U. de Lille Hôpital Calmette Boulevard du Prof. J. Leclercq 59037 Lille Cédex France Jacques Rémy, MD Professor, Department of Radiology C.H.R.U. de Lille Hôpital Calmette Boulevard du Prof. J. Leclercq 59037 Lille Cédex France Medical Radiology · Diagnostic Imaging and Radiation Oncology Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Knauth · M. Molls · C. Nieder · K. Sartor Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISBN 978-3-540-72386-8 e-ISBN 978-3-540-72387-5 DOI 10.1007 / 978-3-540-72387-5 Medical Radiology · Diagnostic Imaging and Radiation Oncology ISSN 0942-5373 Library of Congress Control Number: 2008924374 (cid:2) 2009, Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permit- ted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permis- sion for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover-Design and Layout: PublishingServices Teichmann, 69256 Mauer, Germany Printed on acid-free paper – 21/3180xq 9 8 7 6 5 4 3 2 1 0 springer.com V Contents Foreword This remarkable book explores yet another frontier of multidetector CT imaging, namely the widespread application of this high-performance radiological technique in the screening for cardiac and coronary artery lesions among the large group of patients at risk who undergo MDCT owing to respiratory symptoms. The volume convincingly demonstrates the exciting new role which both general and chest radiologists can play in this medical fi eld, as well as the many new potentially medically relevant applications of MDCT in daily radiological practice. The editors are internationally renowned for their pioneering efforts in defi ning the role and scope of high resolution CT and MDCT for the study of the lung. They have published numerous articles and several highly successful handbooks on this topic. In addition, they have been able to involve many leading experts in the fi eld as individual contributing authors to this volume. Here, they brilliantly describe and illustrate how the fast scanning techniques and ultrahigh temporal resolution offered by state-of-the-art MDCT techniques can detect and characterise the numerous interaction processes that occur between two vital chest organs: the heart and the lungs. I would like to congratulate both the editors and the authors for this outstanding volume, which is an excellent and timely addition to this book series. I can highly recommend this handbook not only to all radiologists involved in chest imaging, but also to cardiologists, cardiac surgeons, pneumologists and lung surgeons as an indispensable guide for the optimal diagnostic and therapeutic management of their patients. I am convinced that this work will rapidly fi nd well deserved recognition and suc- cess among our readership. Leuven Albert L. Baert VII Contents Preface Since its introduction into medical imaging practice in the 1980s, the major technologi- cal revolution of the scanner has focused mainly on temporal resolution. Indeed, on this basis, is it possible to classify equipment into two groups: scanners which control physiological motion and those which are subjected to physiological motion. Techni- cal innovations have lead to an elaboration of this classifi cation. Cardiac synchronisa- tion is becoming an increasingly high-performance procedure, with ever less radiation exposure. Even without the use of the latter, accelerating rotation times controls motion in the slice plane and acquisition volume ever better. These physiological movements are caused by beats induced by the heart and vessels (which are quadri-dimensional) and, depending on patient condition, by oesophageal peristalsis, poorly controlled coughing, involuntary Valsalva maneuver as contrast material passes into the system, or disrupted control of apnea at full lung capacity. All anatomical structures of the thorax and their possible lesions are thus subjected to shifts. It has been shown that detection, analysis and quantifi cation are improved by the suppression of all paracar- diac motion artefacts. It can also be shown that all paracardiac gains are the result of “cardiac arrest” during acquisition. One example demonstrates this accurately: dou- ble-source technology offers temporal resolution of 83 ms without cardiac gating. It is able to acquire the entire thoracic level in 3 s, as well as the proximal coronary arteries in diastole if the cardiac frequency is at 75 bpm. Only total immbolisation of structures and lesions suppresses motion artefacts which can have an effect not only on spatial resolution, but also on contrast resolution since shifted structures will be under-sampled. The results of this progress have an impact on CT practices. While thoracic imaging and cardiac imaging are two distinct special- ties, the thoracic radiologist of today can no longer neglect examination of the heart and coronaries as he used to with earlier generations of equipment. Thus technology has opened an era of “cardiothoracic imaging” which prompts the thoracic radiologist to take a keen interest in cardiopulmonary interactions, while the cardiac radiologist needs to extend his fi eld of analysis. These interactions are manifold: embryologic, anatomic, mechanical, physiological, physiopathological, and therapeutic. The time has come for these two specialties, thoracic imaging and cardiac imaging, to integrate the inseparable part of what was previously the domain of another specialist in their own activities. This book is a trial of integrated cardiothoracic imaging in which a number of fi elds are addressed in order to alert the reader to the scale of the task, without, however, attempting to be exhaustive. The modest objective of the book is to attract the reader’s VIII Preface attention to the cardiac effect of pulmonary vascular disease, the cardiovascular comorbidities of COPD and the cardiovascular causes and effects of their acute exacerbation, the cardiorespiratory tropism of sarcoidosis or scleroderma, as well as the management of equivocal symptoms which can be of either cardiac or respiratory origin. The reader may fi nd overlaps between chapters. These are certainly redun- dant if they express converging opinions while, in contrast, interesting if they express confl icting opinions resulting from the author’s own experience and demonstrate that the use of imaging at the boundary between heart and lungs has not yet found its balance. The reader may also encounter chapters lacking suffi cient detail, such as the study of the cardio-pericardiac extent of neighbouring diseases (media- stinal, bronchopulmonary, pleural or even sub-diaphragmatic), or of therapeu- tic interactions between heart and lungs, a review of which alone would have merited a book of this size. We would like to express our profound gratitude to all the authors who con- tributed to this book, which represents a collective work of pioneers who have just opened the door to a new specialty. Lille Martine Rémy-Jardin Jacques Rémy IX Contents Contents Part I : Technological Approach to Cardiothoracic Imaging. . . . . . . 1 1 From Sixteen Slices to Nowadays – Cardiothoracic Imaging with CT Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 Cardiac Gating Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 23 3 Cardiothoracic Image Postprocessing Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 37 4 Contrast Medium Utilization Dominik Fleischmann and Margaret C. C. Lin . . . . . . . . . . . . . . . . . . . 53 5 Dose Reduction in Chest CT John R. Mayo and John Aldrich. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6 Acquisition Protocols Jacques Kirsch, Michaël Dupont, and Xavier Hamoir . . . . . . . . . . . . . . 79 Part II: Anatomical and Physiological Approach to Cardiothoracic Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7 Cardiac and Coronary Artery Anatomy and Physiology Jean-Louis Sablayrolles, Erik Bouvier, Jean Marc Trautenaere, and Jacques Feignoux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Part III: Heart-Lung Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8 Physiological Interactions Francois Laurent and Michel Montaudon . . . . . . . . . . . . . . . . . . . . . 109 9 Drug-Induced Respiratory Disease in Cardiac Patients Philippe Camus, Clio Camus, and Pascal Foucher. . . . . . . . . . . . . . . . . 131 X Contents Part IV: Medical Applications of Integrated Cardiothoracic Imaging Cardiac Complications of Thoracic Disorders . . . . . . . . . . . . . . . . . . . . . . . . 159 10 Diseases of the Pulmonary Circulation Martine Rémy-Jardin, Andrei-Bodgan Gorgos, Vittorio Pansini, Jean-Baptiste Faivre, and Jacques Rémy. . . . . . . . . . . . . . . . . . . . . . . 161 11 COPD and Cardiac Comorbidities Jacques Rémy, Anne-Lise Hachulla, and Jean-Baptiste Faivre . . . . . . . . 175 12 Immunologic Lung Diseases Delphine Gamondès and Didier Revel . . . . . . . . . . . . . . . . . . . . . . . . 197 13 Sleep-Related Hypoventilation/Hypoxemic Syndromes (SRHH) Jacques Rémy and Nunzia Tacelli . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Thoracic Consequences of Cardiac Diseases. . . . . . . . . . . . . . . . . . . . . . . . . 207 14 Imaging Findings Associated with Left-Sided Cardiac Dysfunction Nicola Sverzellati and David M. Hansell . . . . . . . . . . . . . . . . . . . . . 209 MDCT Management of Ambiguous Symptoms . . . . . . . . . . . . . . . . . . . . . . . 219 15 Evaluation of Chest Pain, Hemoptysis and Dyspnea Seung Min Yoo and Charles S. White . . . . . . . . . . . . . . . . . . . . . . . . . 221 Evaluation of Asymptomatic Cardiac Diseases . . . . . . . . . . . . . . . . . . . . . . . 239 16 Lesions of Proximal Coronary Arteries Filippo Cademartiri, Ludovico La Grutta, Anselmo Alessandro Palumbo, Erica Maffei, and Nico R. Mollet . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 17 Myocardial Infarction Christoph R. Becker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 18 Aortic Bicuspidia, Silent Ductus Arterious Salah D. Qanadli and Elena Rizzo. . . . . . . . . . . . . . . . . . . . . . . . . . . 257 19 Cardiac Calcifi cations Annemarieke Rutten and Mathias Prokop . . . . . . . . . . . . . . . . . . . . . 269 XI Contents 20 Left Superior Vena Cava Thierry Couvreur and Benoît Ghaye. . . . . . . . . . . . . . . . . . . . . . . . . 289 21 Partial Anomalous Venous Return Benoît Ghaye and Thierry Couvreur. . . . . . . . . . . . . . . . . . . . . . . . . 307 22 Pulmonary Valvular Stenosis Jacques Rémy and Kahimano Boroto . . . . . . . . . . . . . . . . . . . . . . . . . 325 23 Right-to-Left Shunts Loic Boussel, Philippe Douek, and Brett Elicker . . . . . . . . . . . . . . . . . 327 Diseases of the Pericardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 24 MDCT: Evaluation of Congenital and Acquired Diseases of the Pericardium Paul Stolzmann, Borut Marincek, and Hatem Alkadhi. . . . . . . . . . . . . 341 Diseases of the Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 25 Lung Perfusion Ernst Klotz, Jacques Rémy, François Pontana, Jean-Baptiste Faivre, Vittorio Pansini, and Martine Remy-Jardin . . . . . . . . . . . . . . . . . . . . 363 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 26 Pulmonary Embolism from Cardiac Origin Lorenzo Bonomo, Anna Rita Larici, Fabio Maggi, Laura Menchini, Andrea Caulo, and Maria Luigia Storto . . . . . . . . . . . . . . . . . . . . . . 381 27 Pectus Excavatum and the Heart Lorenzo Bonomo, Guiseppe Macis, and Andrea Caulo . . . . . . . . . . . . . . 397 28 Thoracic Surgery and Asymptomatic Coronary Artery Disease Jean-Pierre Laissy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 29 Diseases Developing Coronaro-Bronchial Anastomoses Jean-Pierre Laissy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
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