Clinical Applications of Cardiac CT PDF
Preview Clinical Applications of Cardiac CT
Clinical Applications of Cardiac CT Second Edition Filippo Cademartiri • Giancarlo Casolo • Massimo Midiri Editors Clinical Applications of Cardiac CT Second Edition In collaboration with: Erica Maffei Sara Seitun Chiara Martini Giuseppe Tarantini Francesco Prati 123 Editors: Filippo Cademartiri Cardiovascular Imaging Unit, “Giovanni XXIII” Hospital, Monastier di Treviso (TV), Italy Giancarlo Casolo Cardiology Unit, Versilia Hospital, Lido di Camaiore (LU), Italy Massimo Midiri DIBIMEF, Department of Radiology, “P. Giaccone” University Hospital, Palermo, Italy In collaboration with: Erica Maffei Sara Seitun Chiara Martini Giuseppe Tarantini Francesco Prati ISBN 978-88-470-2521-9 ISBN 978-88-470-2522-6 (eBook) DOI 10.1007/978-88-470-2522-6 Springer Milan Dordrecht Heidelberg London New York Library of Congress Control Number: 2011942914 © Springer-Verlag Italia2012 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from Springer. Violations are liable to pro- secution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for gene- ral 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. 9 8 7 6 5 4 3 2 1 2012 2013 2014 Cover design: Ikona S.r.l., Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing and binding: Arti Grafiche Nidasio, Assago (MI), Italy Printed in Italy Springer-Verlag Italia S.r.l. – Via Decembrio 28 – I-20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com) Preface to the Second Edition The second edition of Clinical Applications of Cardiac CT is the result of 2 years of hard work. The first edition was released in 2008 and there are several reasons for having a second edition planned and published after 3 years. Without doubt the main reason is related to the rapid deve- lopment of the technology comprising the subject matter of this book. Since we finalized the first edition several things in the field of CCT (Cardiac Computed Tomography) have changed. The technology has developed allowing for more robust and reliable scanning with significant radiation dose reduction; newer applications have been introduced such as myocardial perfusion; consistent data on the prognostic value of CCT have been published. Large trials have been undertaken with the aim of better defining the clinical role of CCT in different contexts. We have better insight into clinical applications, we know CCT is useful in many more fields than in the past, and we also expect CCT to grow in functional imaging and begin to replace other imaging modalities. For all these reasons CCT is no longer the same, nor is the way we teach CCT. We therefore decided to update the first edition on the basis of all these considerations and also in an attempt to improve the structure and layout of the educational content. In doing so we have tried to better focus the first section of the book on the clinical aspects related to CCT applications. The next three sections, targets of coronary and non coronary imaging, CT semeiology and technique respectively, have been revised and enriched with up-to-date information, while the last two sections have been revised to take into account the changing clinical scenario for CCT. We contacted several new authors from the Italian and international arena to further enrich the contents of the book. We are happy and proud of the result and we think that, in addition to upda- ting the book, there has been an improvement in the overall content and layout. November 2011 Filippo Cademartiri Giancarlo Casolo Massimo Midiri v Acknowledgements General Acknowledgements A book, whether it is new or the second edition of an earlier one, is always a journey, sometimes the journey is long and sometimes it is also arduous. But wherever it takes you it always allows you to learn a lot about the topic you are dealing with. A good book is also the result of the coop- eration between individuals and the expression of a certain network of knowledge. As with the first edition, this volume is the result of a great deal of hard work by all of the authors and many others. Over the past two years many people have been involved who con- tributed in numerous ways to its completion. In particular we would like to thank Springer-Verlag Italia in the persons of Antonella Cerri, Donatella Nebulone and Elisa Geranio for having supported us with the utmost professionalism in this project. Many others provided ideas, energy and assistance and to them we would like to express our most sincere gratitude. Filippo Cademartiri Giancarlo Casolo Massimo Midiri Personal Acknowledgements As usual for me, I would like to thank Prof. Gabriel P. Krestin, who has been the architect of my abilities in the subject matter of this volume. Without the fortunate meeting which allowed me to work alongside him I would never have achieved the desired results. My personal thanks are also due to the Erasmus Medical Center in Rotterdam, in the persons of Maja Thijse-Stemerdink, Nico Mollet, Pim de Feyter, Koen Nieman, Annick Weustink and many others who contributed to the training of many of the authors who participated in this volume. I would then like to thank my co-editors (Massimo Midiri and Giancarlo Casolo) who are exceptional individuals and professionals who share my same vision of the subject matter. Thanks from the bottom of my heart to all of the “fellows” who had the patience to bear with me in Rotterdam, in Parma, and in Monastier and then to participate in this undertaking. Thanks to cardiologists, cardiac surgeons and all the clinicians for their collaboration and critical appraisal which always serves for improvement. Thanks also to the open minded profes- sionals who started appreciating the role and importance of CCT. Thanks to my closest collaborators Erica Maffei and Chiara Martini, because they are still fol- lowing me and helping me with several projects. Filippo Cademartiri vii Foreword to the First Edition For a very long time, radiologists have considered examination of the moving heart as the “holy grail” of noninvasive imaging. Echocardiography – with its high spatial and temporal resolution – has opened an entire avenue of possibilities for evaluating myocardial contractility or heart valve function. However, echocardiography does not allow alterations of the coronary arteries to be visualized. Similarly, magnetic resonance imaging and myocardial scintigraphy have proven to be valuable techniques in assessing myocardial perfusion and function, even in complex disea- ses. Despite these advances, invasive catheter angiography has remained the gold standard for visualization of the coronary artery lumen. Introduction of multislice CT was a real breakthrou- gh, approaching the capabilities of catheter angiography with its unprecedented technological development from simultaneous data acquisition of 4 slices, through 16, 64, to over 300 slices in a single gantry rotation. With temporal resolutions under 100 milliseconds currently feasible, multislice CT comes close to catheter angiography for coronary lumen visualization. That this technology could be implemented and optimized, that its value as well as its role in the clinical workup of patients with suspected coronary artery disease could be assessed in less than one decade, has only been possible due to the enthusiasm and hard work of many radiolo- gists, cardiologists, and image processors in close collaboration with industrial engineers and developers. Many of the pioneers of this technology have been members of multidisciplinary teams. Their natural curiosity, spirit of innovation, mutual understanding in a supportive environ- ment, and – last but not least – strong desire to benefit patients by improving healthcare have been the key to their success. In many institutions, the introduction of multislice coronary CT-angiography for research and clinical purposes was overshadowed by turf battles between different specialties. At Erasmus MC, the “Rotterdam Model” was developed and proved to be a fruitful ground for the advance- ment of this technology. Under the leadership of Professor Pim de Feijter, a well-recognized car- diologist and expert in cardiac imaging, the Departments of Radiology and Cardiology built a communal, multidisciplinary group of medical specialists, research fellows, trainees and radio- graphers. Over the years this group has hosted more than 50 radiologists and cardiologists from all over the world and in all different stages of training. The year 2000 witnessed the start of a very prized and meaningful collaboration with the ima- ging community in Italy when Filippo Cademartiri, one of the editors of this book, arrived at Erasmus MC. Since then, an entire generation of Italian residents and fellows have spent a year in Rotterdam learning about and doing research on coronary CT angiography. These scientists from Palermo, Rome, Parma, Trieste, Verona, Ferrara and Genoa have contributed with enthu- siasm and hard work to the output of this very successful enterprise. Eight of these residents, as well as some of their Dutch colleagues, have co-authored chapters in this book. The exchange of scientific personnel over the years has led to strong ties and collaborations with many of their mentors and colleagues, some of whom have also contributed to this book. On behalf of the enti- re Erasmus MC as well as on a personal level, I am very proud and pleased to have established these ties, many of which have become long lasting friendships. ix x Foreword to the First Edition I would like to congratulate all the editors and authors of Clinical Applications of Cardiac CT for having produced a comprehensive overview of the technique and clinical application of this new diagnostic tool. It is a multifaceted, highquality work that will provide both present and futu- re generations with an insight into this exciting and still developing area of medical imaging. Rotterdam, July 2008 Prof. Gabriel P. Krestin Chairman, Department of Radiology Erasmus MC University Medical Center Rotterdam The Netherlands Contents Section I - Epidemiology and Clinical Assessment 1 Epidemiology of Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Tessa S.S. Genders and M.G. Myriam Hunink 2 Physiology and Pathophysiology of Coronary Circulation . . . . . . . . . . . . . . . . . . . . 7 Andrea I. Guaricci, Luigi Di Biase, and Giancarlo Casolo 3 Subclinical Atherosclerosis and Primary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . 15 Giuseppe Tarantini, Paolo Buja, and Michela Facchin 4 Chronic (Stable) Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Giancarlo Casolo 5 Acute Coronary Syndrome: Clinical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Paolo Buja and Giuseppe Tarantini Section II - Targets of Coronary and non Coronary Imaging 6 Coronary Plaques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Antonio L’Abbate, Massimo Lombardi, and Gualtiero Pelosi 7 Myocardial Ischemia & Viability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Paolo G. Camici and Ornella Rimoldi 8 Left and Right Ventricular Function, Contractility, Geometry, and Mass . . . . . . . 69 Andrea I. Guaricci, Natale Daniele Brunetti, Roberta Romito, Giancarlo Casolo, and Matteo Di Biase 9 Pulmonary Veins and Cardiac Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Maurizio Del Greco, Flavia Ravelli, and Massimiliano Marini Section III - CT Semeiology 10 Heart Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ludovico La Grutta, Giovanni Gentile, Giuseppe Runza, Massimo Galia, Filippo Cademartiri, and Massimo Midiri 11 Calcium Score and Coronary Plaque . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Sara Seitun, Erica Maffei, Chiara Martini, Margherita Castiglione Morelli, Anselmo A. Palumbo, and Filippo Cademartiri xi xii Contents 12 Coronary Artery Stenosis on Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Sara Seitun, Erica Maffei, Chiara Martini, Margherita Castiglione Morelli, and Filippo Cademartiri 13 Coronary Artery Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Francesca Pugliese, Katarzyna Gruszczynska, Ian Baron, Ceri L. Davies, and Steffen E. Petersen 14 Evaluation of Bypass Grafts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Riccardo Marano, Giancarlo Savino, Carlo Liguori, and Lorenzo Bonomo 15 Myocardial Viability and Stress Perfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Tust Techasith, Brian Ghoshhajra, and Udo Hoffmann 16 Evaluation of Cardiac Volumetric and Functional Parameters . . . . . . . . . . . . . . . . 175 Giancarlo Messalli, Giuseppe Runza, Ludovico La Grutta, Erica Maffei, Chiara Martini, Massimo Midiri, Jan Bogaert, and Filippo Cademartiri 17 Cardiac Veins and Pulmonary Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Maurizio Centonze, Giulia Casagranda, Maurizio Del Greco, Andrea Laudon, Alessandro Cristoforetti, and Giandomenico Nollo 18 Collateral Findings on Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Roberto Malagò, Camilla Barbiani, Andrea Pezzato, Ugolino Alfonsi, Erica Maffei, Roberto Pozzi Mucelli, and Filippo Cademartiri 19 Reporting in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Erica Maffei, Chiara Martini, Udo Hoffmann, and Filippo Cademartiri 20 Training and Implementation in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Erica Maffei, Chiara Martini, and Filippo Cademartiri Section IV - Technique 21 CT and CT Angiography - Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Erica Maffei, Chiara Martini, and Filippo Cademartiri 22 CT of the Heart: Scan Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Erica Maffei, Chiara Martini, and Filippo Cademartiri 23 Patient Preparation for Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Erica Maffei, Chiara Martini, and Filippo Cademartiri 24 Contrast Material Administration in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Erica Maffei, Chiara Martini, and Filippo Cademartiri 25 Principles of Cardiac CT Scan Protocol Optimization . . . . . . . . . . . . . . . . . . . . . . . 247 Erica Maffei, Chiara Martini, and Filippo Cademartiri 26 Management of Radiation Dose in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Erica Maffei, Chiara Martini, and Filippo Cademartiri 27 Artifacts in Cardiac CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Roberto Malagò, Andrea Pezzato, Camilla Barbiani, Ugolino Alfonsi, Erica Maffei, Filippo Cademartiri, and Roberto Pozzi Mucelli
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