Cardiac CT Made Easy: An Introduction to Cardiovascular Multidetector Computed Tomography PDF
Preview Cardiac CT Made Easy: An Introduction to Cardiovascular Multidetector Computed Tomography
Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page i CARDIAC CT MADE EASY Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page iii CARDIAC CT MADE EASY An Introduction to Cardiovascular Multidetector Computed Tomography Paul Schoenhagen MD, FAHA The Cleveland Clinic Foundation Cleveland, Ohio USA Arthur E Stillman MD, PhD Sandra S Halliburton PhD Richard D White MD, FACC CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2006 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130325 International Standard Book Number-13: 978-0-203-08993-4 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page v Contents List of case studies vii Contributing authors ix Acknowledgments xi Introduction xiii 1. Cardiovascular MDCT imaging 1 2. CT perspective of normal cardiovascular anatomy 5 3. Clinical cardiovascular applications 9 3.1 Acquired cardiovascular diseases 9 3.1.1 Cardiac chambers and myocardium 9 3.1.2 Atherosclerotic coronary artery disease 19 3.1.3 Coronary veins and coronary sinus 37 3.1.4 Pericardial disease 44 3.1.5 Cardiac masses 54 3.1.6 Valvular heart disease 57 3.1.7 Aortic disease 63 3.1.8 Pulmonary circulation 79 3.1.9 Peripheral arteries 87 3.2 Adult congenital heart disease 87 3.2.1 Cardiac chambers and myocardium 88 3.2.2 Coronary arteries 89 v Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page vi vi CARDIAC CT MADEEASY 3.2.3 Coronary veins and coronary sinus 94 3.2.4 Pericardial disease 94 3.2.5 Valvular heart disease 94 3.2.6 Aortic disease 98 3.2.7 Pulmonary veins 98 3.2.8 Arteriovenous shunt defects 98 4. Technical aspects of multidetector computed tomography 101 4.1 Scan acquisition 101 4.1.1 Current and future scanner systems 101 4.1.2 ECG referencing 102 4.1.3 Acquisition mode 102 4.1.4 Special image reconstruction to improve temporal 103 resolution 4.1.5 Radiation exposure and tube current modulation 104 4.1.6 Contrast media 105 4.1.7 Control of heart rate: beta-blocker 107 4.1.8 Control of vessel tone: nitroglycerin 107 4.1.9 Imaging protocols 107 4.2 Image reconstruction and interpretation 107 4.2.1 The axial CT image 108 4.2.2 Two-dimensional reformation 108 4.2.3 Three-dimensional reformation 109 4.2.4 Dynamic and four-dimensional reconstruction 111 4.2.5 Image artifacts 111 5. Conclusion 115 Appendices 117 Template for pharmacological heart rate control 117 Template for pharmacological vasodilatation 118 References 119 Index 133 Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page vii List of case studies Case 1: Figures 9–12: hypertrophic obstructive cardiomyopathy Case 2: Figures 22 and 23: left ventricular non-compaction Case 3: Figures 33–35: significant coronary luminal stenosis (1) Case 4: Figures 36–39: significant coronary luminal stenosis (2) Case 5: Figure 40: left main disease Case 6: Figures 41–43: left main compression Case 7: Figures 44–46: left ventricular outflow tract pseudoaneurysm caus- ing coronary compression Case 8: Figures 47 and 48: left main dissection Case 9: Figures 52–54: bypass graft assessment Case 10: Figures 55 and 56: stented bypass graft Case 11: Figures 57–59: bypass graft aneurysm Case 12: Figure 60: location of bypass grafts Case 13: Figures 61 and 62: coronary assessment in patient with contraindica- tion for cardiac catheterization, aortic valve thrombus Case 14: Figures 63 and 64: coronary assessment in patient with contraindica- tion for cardiac catheterization, aortic dissection Case 15: Figures 65 and 66: coronary stent Case 16: Figures 87 and 88: suspected fibrosarcoma Case 17: Figures 100 and 101: aortic root mass Case 18: Figures 122–124: pre- and postoperative imaging, aortic root replacement in patient with Marfan’s syndrome Case 19: Figure 128: endocarditis and ascending aortic graft infection Case 20: Figures 153–155: anomalous coronary artery vii Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page viii Acknowledgments We wish to acknowledge the technologists and nurses in the Radiology Department at the Cleveland Clinic Foundation. viii Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page ix Contributing authors Timothy Crowe BS Steven E Nissen MD FACC Department of Cardiovascular Department of Cardiovascular Medicine Medicine Technical Director, Intravascular Medical Director, Cleveland Clinic Ultrasound and Angiography Core Cardiovascular Coordinating Center Laboratories The Cleveland Clinic Foundation The Cleveland Clinic Foundation Cleveland, Ohio Cleveland, Ohio Paul Schoenhagen MD FAHA Sandra S Halliburton PhD Department of Radiology, Section of Department of Radiology, Section of Cardiovascular Imaging Cardiovascular Imaging Department of Cardiovascular The Cleveland Clinic Foundation Medicine Cleveland, Ohio The Cleveland Clinic Foundation Cleveland, Ohio Stacie A Kuzmiak RT (R) CT Department of Radiology, Section of Randolph M Setser DSc Cardiovascular Imaging Department of Radiology, Section of The Cleveland Clinic Foundation Cardiovascular Imaging Cleveland, Ohio The Cleveland Clinic Foundation Cleveland, Ohio ix Cardiac CT Made Easy-Prelims.qxd 11/8/2006 9:03 PM Page x x CARDIAC CT MADEEASY Arthur E Stillman MD PhD Joanie A Weaver RT (R) MR Department of Radiology, Section of Department of Radiology, Section of Cardiovascular Imaging Cardiovascular Imaging The Cleveland Clinic Foundation The Cleveland Clinic Foundation Cleveland, Ohio Cleveland, Ohio E Murat Tuzcu MD FACC Richard D White MD FACC Department of Cardiovascular Department of Radiology and Medicine Cardiovascular Medicine Medical Director, Intravascular Clinical Director, Center for Integrated Ultrasound Core Laboratory Non-Invasive Cardiovascular The Cleveland Clinic Foundation Imaging Professor of Medicine, Cleveland The Cleveland Clinic Foundation Clinic Lerner College of Medicine Cleveland, Ohio Case Western Reserve University Cleveland, Ohio MDCT Made Easy Intro.qxd 11/8/2006 9:02 PM Page xi Introduction Cardiovascular computed tomography (CT) imaging is a relatively new and rapidly evolving diagnostic modality. Growing experience and advances in CT scanner technology constantly expand clinical applications. This book provides an introduction to cardiovascular CT technology. It describes the principles of multidetector computed tomography (MDCT) for cardiovascular applications, clinical indications and imaging protocols, clinical find- ings of common cardiovascular disease conditions, and practical aspects of scan acquisition and interpretation. A comparison with other imaging modalities such as conventional angiography, intravascular ultrasound, magnetic resonance imaging, and echocardiography allows understanding of the current strengths and limita- tions of CT in the assessment of specific clinical questions. The text is illustrated by a large number of selected images, highlighting key findings. Based on the Atlas and Manual of Cardiovascular Multidetector Computed Tomography, the material has been extensively updated. In particular, the recent transition to 64-slice scanners is reflected in an increased number of images. The information has been shortened as well as updated to provide a complete but brief introduction to CT imaging. The order of the chapters has been changed and some of the material has been restructured into case presentations to provide a primarily clinical guide. xi
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