Handbook of Cardiovascular CT (eBook)

Contents 7
Contributors 9
1 Cardiovascular CT Angiography: Concepts Important to Image Acquisition and Reconstruction 13
1.1 Concepts for Image Acquisition 13
1.2 Preview Scans 15
1.3 Image Reconstruction and Analysis 17
1.4 Clinical Data with Coronary Artery Calcification 13
1.4.1 Risk Stratification in Asymptomatic Patients 21
1.5 Coronary Calcium -- Basis and Background 17
1.6 Coronary Artery Calcification and Obstructive Disease 17
1.6.1 Prediction of Events in Asymptomatic Persons using Coronary Calcium 22
1.7 Clinical Pearls for Coronary Calcium Assessment 17
2 Cardiovascular CT Imaging: Essentials for Clinical Practice 27
2.1 Patient Selection and Indications for Coronary CTA 27
2.2 Patient Preparation 28
2.3 IV Placement 29
2.4 Hydration Policy 29
2.5 Pre-Procedure Patient Medication 29
2.6 Contrast Issues 30
2.7 Conclusion 32
3 Cardiovascular Calcium: Assessment and Impact of Interventions 34
3.1 Imaging Pearls 37
4 Assessment of Cardiac Function 40
4.1 Introduction 40
4.2 Nomenclature 40
4.3 Methods 41
4.4 Ventricular Anatomy and Function 42
4.5 Chamber Measurements 44
4.6 Indications/Appropriateness 45
4.7 Conclusions 45
4.8 Imaging Pearls 47
5 CTA as an IVUS Equivalent: Plaque Characterization and Percutaneous Coronary Intervention 50
5.1 Quantitative CTA 50
5.2 Plaque Characterization 51
5.3 CTA-Guided PCI 55
5.3.1 Clinical Paradigm 55
5.4 Optimal Stent Deployment 57
5.5 Conclusions 58
5.6 Imaging Pearls 58
6 Coronary Angiography of Native Vessels 60
6.1 Spatial Resolution 61
6.2 Coronary CTA for Identification of Native Vessel Coronary Stenoses 61
6.3 Limitations Specific to Coronary CTA 62
6.4 Imaging Pearls 63
7 Coronary CT Angiography after Percutaneous Coronary Intervention 68
7.1 Introduction 68
7.2 Current State of the Literature 69
7.3 Strengths and Limitations Indications and Contraindications
7.4 Comparison to Other Modalities 71
7.5 Future Directions 71
7.6 Imaging Pearls 72
7.6.1 Patient Preparation 72
7.6.2 Opacification and Scanning 72
7.6.3 Image Reconstruction 72
7.6.4 Interpretation 74
7.6.5 Pitfalls 78
8 Coronary Angiography After Surgical Revascularization 80
8.1 Imaging Pearls 86
9 Perfusion and Delayed Enhancement Imaging 88
9.1 Overview 88
9.2 MDCT for Detection of Myocardial Fibrosis and Viability 89
9.3 Ischemia Detection by MDCT 91
9.4 Imaging Pearls: Delayed Enhancement 93
9.5 Imaging Pearls: Ischemia 94
10 Cardiac SPECT and PET: Complementary Roles with Cardiac CT 96
10.1 Introduction 96
10.2 Imaging for Prevention 96
10.3 Imaging for Diagnosis 98
10.4 Imaging for Intervention 100
10.5 Imaging Pearls 105
10.5.1 Imaging for Prevention 105
10.5.2 Imaging for Diagnosis 105
10.5.3 Imaging for Intervention 105
11 CCT Imaging: Cardiac Electrophysiology Applications 107
11.1 Cardiovascular Substrates Associated with Sudden Cardiac Death 107
11.2 Electrophysiologic Mapping and Radiofrequency Catheter Ablation 108
11.2.1 Atrial Fibrillation Ablation 108
11.3 Cardiac Resynchronization Therapy 114
11.4 Imaging Pearls 116
11.4.1 General 116
11.4.2 Sudden Death Substrates 116
11.4.3 Atrial Fibrillation Ablation 116
11.4.4 Resynchronization Therapy 117
12 Pericardial/Myocardial Disease Processes 120
12.1 Introduction 120
12.2 CT Imaging of Myocardial Disease 120
12.3 CT Imaging of Pericardial Disease 123
12.4 Imaging Pearls 126
13 Assessment of Cardiac and Thoracic Masses 128
13.1 Subject Overview 128
13.2 Interpreting Cardiac Masses 131
13.3 Clinical Pearls 133
14 Computed Tomography Evaluation in Valvular Heart Disease 140
14.1 Introduction 140
14.2 General Considerations 140
14.3 Specific Valvular Abnormalities 143
14.3.1 Aortic Stenosis 143
14.3.2 Aortic Regurgitation 144
14.3.3 Mitral Stenosis 144
14.3.4 Mitral Regurgitation 145
14.3.5 Infective Endocarditis 145
14.3.6 Prosthetic Valves 146
14.3.7 Imaging Pearls 146
15 The Aorta and Great Vessels 150
15.1 Introduction 150
15.2 Normal Anatomy 150
15.3 Diseases of the Aorta 151
15.3.1 Aortic Aneurysm 151
15.3.2 Aortic Dissection 153
15.3.3 Atherosclerosis 154
15.4 Disease of the Great Vessels 154
15.5 Imaging Pearls 158
15.5.1 Carotid Artery Disease 158
15.5.2 Aortic Atherosclerosis 159
15.5.3 Aortic Dissection 159
15.5.4 Aortic Aneurysm 159
16 Adult Congenital Heart Disease 161
16.1 Clinical Pearls 169
17 Cardiovascular CT: Assessment of the Lower Extremity Vasculature 175
17.1 Alternative Anatomic Test: MRA 176
17.2 Alternative Anatomic Test: DSA 176
17.3 Indications (Lower extremity MDCTA) [ 15 ] 177
17.4 Contraindications 180
17.5 Scan Preparation: 182
17.6 Image interpretation 185
17.7 Dataset Reconstruction 187
17.8 Software Techniques for Interpretation 187
18 Imaging Decisions: Cardiovascular CT Versus Cardiovascular MR 190
18.1 Patient Selection and Preparation 190
18.2 Characterization of Cardiovascular Substrates 191
18.3 Imaging Pearls 197
19 Radiation Safety: Radiation Dosimetry and CT Dose Reduction Techniques 202
19.1 Introduction 202
19.2 Fundamentals of Radiation Dosimetry 202
19.2.1 Absorbed Dose 202
19.2.2 Equivalent Dose 203
19.2.3 Effective Dose 205
19.2.4 CT Dosimetry 206
19.2.5 CTDI 206
19.2.6 Dose-Length Product 208
19.2.7 The Effective Dose from CT 208
19.2.8 CT Dose Reduction Techniques 209
19.2.9 Dose Optimization Objectives 210
19.2.10 AEC Guided by Image Noise 210
19.2.11 AEC Guided by Reference Image 211
19.2.12 AEC Guided by Reference mAs 212
19.2.13 Computed Tomography of the Heart 212
19.3 Conclusion 213
20 Competency, Appropriateness, and Quality in Cardiovascular CT 216
20.1 Appropriateness and Quality 220
20.2 Certification and Laboratory Accreditation 220
21 Cardiac Anatomy by Computed Tomographic Imaging 222
21.0 Abbreviations 223
Index 257