Integrated Cardiothoracic Imaging with MDCT

Integrated Cardiothoracic Imaging with MDCT (Medical Radiology / Diagnostic Imaging)......Page 1
Front-matter......Page 2
Title Page......Page 3
Copyright Page......Page 4
Foreword......Page 5
Preface......Page 6
Table of Contents......Page 8
Part I:
Technological Approach to
Cardiothoracic Imaging......Page 11
1.1 Introduction and Overview......Page 12
1.2.1 Technology......Page 16
1.2.2 MDCT Scan and Image Reconstruction Techniques......Page 17
1.3 CT Systems with Area Detectors......Page 19
1.4 Dual-Source CT (DSCT)......Page 22
1.5 Radiation Dose and Radiation Dose Reduction......Page 25
References......Page 28
2.2 ECG-Triggered Axial Scanning......Page 32
2.3 ECG-Gated Spiral/Helical Scanning......Page 37
2.4.1 ECG Gating with Increased Pitch......Page 42
2.4.2 Alternative Synchronization of Data Acquisition and Cardiac Motion......Page 43
References......Page 44
3.2 Axial Images......Page 46
3.3 Multiplanar Reformations (MPRs)......Page 47
3.4 Maximum Intensity Projections (MIPs)......Page 49
3.5 Volume-Rendering Techniques (VRT)......Page 51
3.6.1 Advanced Cardiac Evaluation......Page 54
3.6.2 Advanced Cardiothoracic Evaluation......Page 58
References......Page 59
4.1 Introduction......Page 61
4.2.1 Early Arterial Contrast Medium Dynamics......Page 62
4.2.1.1 Effect of Injection Flow Rate on Arterial Enhancement (§1)......Page 63
4.2.2 Early Contrast Medium Dynamics in the Chest......Page 64
4.3.3 Right Ventricular Opacification in Cardiac CT......Page 66
4.4 CM Injection Strategies for Cardiovascular CT......Page 67
4.4.1 Basic Strategy: Injection Time Equals Scan Time......Page 68
4.4.2 Basic Strategy with Additionally Increased Scanning Delay......Page 69
4.5 Conclusion......Page 70
References......Page 71
5.1 Introduction......Page 72
5.2 Radiation Bioeffects......Page 73
5.3 Radiation Dose Measurement......Page 75
5.4 Scanner Radiation Efficiency......Page 76
5.5 Radiation Dose Reduction at the CT Scanner Level......Page 78
5.6 Dose Reduction in Chest CT......Page 80
Reference......Page 83
6.3 Heart Rate Control......Page 86
6.4.1 Rotation Speed and Collimation......Page 87
6.4.2 Tube Current and Voltage......Page 89
6.4.3 Prospective ECG Gating......Page 90
6.5.3 Reconstruction Kernel......Page 91
Reference......Page 92
Part II:
Anatomical and Physiological Approach to
Cardiothoracic Imaging......Page 94
7.1 Anatomical Basis......Page 95
7.1.1.4 The Right Ventricle......Page 96
7.1.1.5 The Left Atrium......Page 97
7.1.1.6 The Left Ventricle......Page 98
7.1.2.4 Tricuspid Valves......Page 99
7.1.3.2 Division of Coronary Arteries......Page 102
Segmentation of the Right Coranary Artery......Page 103
Segmentation of the Left Coranary Artery......Page 105
7.1.3.5 Myocardium Segmentation......Page 106
I – Ventricular Systole......Page 107
7.2.2 Pressure/Volume Curves......Page 108
7.2.3 Systolic and Diastolic Functions......Page 109
Difficulty of QRS Detection......Page 110
The Presence of a Pacemaker Is Responsible for Two Types of Problems......Page 111
Reference......Page 112
Part III:
Heart-Lung Interactions......Page 113
8.2 Physiological Basis of Heart-Lung Interactions......Page 114
8.3.1 Aorta......Page 115
8.3.2 Lung......Page 117
8.3.3 Coronary Arteries......Page 119
8.3.3.1 Optimal Reconstruction Window for Coronary Angio-Computed Tomography......Page 121
8.4.1 Effect of the Systemic Venous Return......Page 122
8.4.3 Effect of Cardiac Output......Page 123
8.4.5 Consequences in Designing Protocols......Page 125
8.4.6 Effect of Physiological Parameters on Pulmonary Perfusion......Page 126
8.5 Interaction among Pulmonary, Systemic, and Lymphatic Circulations......Page 127
8.6 Heart-Lung Interactions in Near-Normal Anatomical Conditions......Page 129
References......Page 132
9.1 Introduction......Page 136
9.3.2 Naranjo Criteria......Page 139
9.3.4 Proposal......Page 140
9.4 Patterns of Drug-Induced Injury......Page 141
9.4.1.1.1 Drug-Induced Angioedema......Page 144
9.4.1.1.2 Anaphylaxis......Page 145
9.4.1.2.1 Acute Bronchospasm......Page 146
9.4.1.3.2 Acute Eosinophilic Pneumonia......Page 148
9.4.1.3.4 Acute Organizing Pneumonia......Page 149
9.4.1.3.5 Acute Pulmonary Edema......Page 150
9.4.1.3.8 Methemoglobinemia......Page 151
9.4.2.2 Pulmonary Infiltrates and Eosinophilia......Page 152
9.4.2.3 Amiodarone Pneumonitis – Amiodarone Pulmonary Toxicity (APT)......Page 153
9.4.2.5 Pulmonary Fibrosis......Page 156
9.4.2.7 Pulmonary Hypertension......Page 157
References......Page 161
Part IV: Medical Applications of Integrated Cardiothoracic Imaging - Cardiac Complications of Thoracic Disorders......Page 163
10.1.1.1 Cruoric Emboli......Page 164
10.1.1.2 Noncruoric Emboli......Page 168
10.1.2.1 Evaluation of Cardiac Consequences at the Time of Initial Diagnosis......Page 169
10.1.2.2 Changes Observed after Thromboendarterectomy......Page 170
10.1.3 Cardiac Changes in Other Causes of Pulmonary Hypertension......Page 171
10.1.5 Foramen Ovale Patency (FOP)......Page 172
10.3 Diseases of Pulmonary Veins......Page 173
References......Page 174
11 COPD and Cardiac Comorbidities......Page 178
11.1.1 Definitions New Concepts of COPD and Cardio-Vascular Comorbidities......Page 179
11.1.2 Cardio-Vascular Comorbidities......Page 180
11.1.3 Technological Impacts of Cardiothoracic Imaging......Page 181
11.1.4 The Opportunity of Developing Biomarkers in Cardiothoracic Imaging......Page 183
11.2.2.1 Pulmonary Artery Distensibility (PAD)......Page 184
11.2.2.3 Measurement of the Transverse Diameter of the Main Pulmonary Artery (MPA) on Cross-Sectional Images......Page 185
11.3.1 Patent Foramen Ovale (PFO)......Page 186
11.3.3.1 RVEF......Page 187
11.3.3.2 Tricuspid Annular Plane Systolic Excursion (TAPSE)......Page 188
11.3.3.4 Interventricular Septal Configuration......Page 189
11.4.2 Left Ventricular Dysfunction (LVD)......Page 190
11.4.3 Ischemic Cardiomyopathy......Page 191
11.4.3.3 Coronary Artery Disease......Page 192
11.4.5 Cardio-Vascular Imaging and Invasive Treatments of COPD......Page 193
11.5.3 Partial Anomalous Pulmonary Venous Return (PAPVR)......Page 194
References......Page 196
12.2 Pulmonary Manifestations of Systemic Disease......Page 199
12.3.2 Valvular Heart Disease......Page 200
12.3.3 Myocardial Disease and Coronary Artery Disease......Page 202
References......Page 204
13.1.2.1 Obesity-Hypoventilation Syndrome (OHS)......Page 205
13.2.1 Early Signs of Atherosclerosis......Page 206
13.3.5 Patent Foramen Ovale (PFO)......Page 207
References......Page 208
14.1 Introduction......Page 209
14.3 Vascular Changes......Page 210
14.5 Predominantly Interstitial Edema......Page 212
14.6 Alveolar Edema......Page 214
14.8 Distinction between Cardiogenic and Non-Cardiogenic Pulmonary Edema......Page 215
14.10 Ancillary Abnormalities......Page 216
References......Page 217
15.1.1 Introduction of Chest Pain......Page 219
15.1.2.1 Introduction of ACS......Page 220
15.1.2.2 MDCT Technique in the Evaluation of ACS......Page 221
15.1.2.3 Role of MDCT in the Evaluation of ACS......Page 222
15.1.2.4 Limitations and Prospective of MDCT in the Evaluation of ACS......Page 223
15.1.3.2 Aortic Dissection (AD)......Page 224
15.1.3.3 Intramural Hematoma (IMH)......Page 226
15.1.3.5 Traumatic Aortic Pseudoaneurysm......Page 227
15.2.1 Introduction to Hemoptysis......Page 228
15.2.2 Technical Aspects and Role of MDCT in the Evaluation of Hemoptysis......Page 229
15.3.1 Overview of Dyspnea......Page 231
15.3.2 Technical Aspects and Role of MDCT in the Evaluation of Dyspnea......Page 232
References......Page 233
16.1 Introduction......Page 236
16.3 Diagnostic Performance and Applications......Page 237
16.4 MSCT Coronary Plaque Imaging......Page 238
16.5 Non-Coronary Applications......Page 240
16.6 Triple Rule-Out of Cardiothoracic Diseases......Page 242
References......Page 244
17.1 Introduction......Page 246
17.2 Myocardial Perfusion Imaging......Page 247
17.3 Viability imaging......Page 249
17.4 Myocardial Infarction Sequelae......Page 250
References......Page 251
18.2 Anatomy and Pathology of the Aortic Bicuspidia......Page 252
18.3.2 Vascular Complications......Page 253
18.4.2 Bicuspid Valve Features......Page 254
18.4.3.1 Aortic Valve Stenosis......Page 257
18.4.5 Screening of Cardiac Complications......Page 259
18.4.6 Screening of Associated Congenital Anomalies......Page 260
References......Page 261
19.2 Scanning Technique and Artifacts......Page 263
19.2.1 Non-Gated Acquisitions......Page 264
19.2.2 Prospective ECG Triggering......Page 265
19.2.3 Retrospective ECG Gating......Page 266
19.3.1 Basic Concepts of Calcium Scoring......Page 267
19.3.3 Volume Score......Page 268
19.3.5 Accuracy and Reproducibility of Calcium Scoring......Page 269
19.3.6 Calcium Score and Cardiovascular Risk......Page 271
19.3.7 Guidelines for Interpretation and Use......Page 272
19.5 Mitral Valve Calcifications......Page 273
19.6.1 Ventricular Wall Calcifications......Page 275
19.7 Pericardial Calcifications......Page 277
19.8.1 Cardiac Thrombus......Page 278
19.8.3 Cardiac Myxoma......Page 279
References......Page 280
20.1 Introduction......Page 283
20.3.1 Normal Development of RSVC......Page 284
20.3.2 Persistence of LSVC......Page 285
20.4.3 LIV......Page 287
20.4.5 Azygos System......Page 288
20.6.2 Right-to-Left Shunt......Page 289
20.6.3 Left-to-Right Shunt......Page 290
20.7 Clinical Presentation......Page 291
20.8.1 X-Ray......Page 292
20.8.3.2 Echocardiography......Page 293
20.9.1 Left Mediastinal Veins......Page 294
20.9.5 Dilated Coronary Sinus......Page 295
20.10.3 Surgical......Page 296
References......Page 297
21 Partial Anomalous Venous Return......Page 300
21.2.2 PAPVR......Page 301
21.4 Global Anomalous Pulmonary Venous Return......Page 302
21.6.1.3 PAPVR in the IVC......Page 303
21.6.1.4 Others......Page 304
21.6.2.2 PAPVR in a Persistent LSVC......Page 305
21.6.2.4 PAPVR in the Coronary Sinus......Page 306
21.6.3 More Complex PAPVR......Page 307
21.7.1 Abnormal Pathway of Segmental Pulmonary Vein......Page 308
21.7.3 Left Superior Vena Cava......Page 309
21.8.2 Computed Tomography......Page 311
21.8.5 Others......Page 312
21.9 Consequences of PAPVR......Page 313
21.10 Treatment......Page 314
References......Page 315
22 Pulmonary Valvular Stenosis......Page 318
23.2.1.1 Tetralogy of Fallot......Page 320
23.2.1.2 Pulmonary Atresia......Page 321
23.2.1.4 Complete Transposition of the Great Vessels......Page 322
23.2.1.5 Truncus Arteriosus......Page 323
23.3.1 Congenital Abnormal Systemic Venous Connection......Page 324
23.4.1 Introduction......Page 325
23.4.3.1 Hepatopulmonary Syndrome......Page 326
23.5.1 Introduction......Page 327
23.5.5 Bronchioloalveolar Cell Carcinoma......Page 328
References......Page 329
24.1 Introduction......Page 331
24.2.2 CT Anatomy of Pericardial Structures......Page 332
Inferior Aortic Recess......Page 333
Postcaval Recess......Page 334
24.3 CT Techniques for Diagnosis of Pericardial Disease......Page 335
24.4.1.2 Pericardial Cysts......Page 336
24.4.2.1 Pericarditis......Page 337
Acute Pericarditis......Page 338
Constrictive Pericarditis......Page 339
24.4.2.3 Pneumopericardium......Page 340
24.4.2.4 Tamponade......Page 342
Benign Neoplasms......Page 343
Primary Malignant Neoplasms......Page 344
Secondary Malignant Neoplasms......Page 347
References......Page 348
25.1 Part I: Technical Introduction......Page 350
25.1.2 Single-Energy Analysis......Page 351
25.1.3 Dual-Energy Analysis......Page 353
25.2.1 General Considerations......Page 354
25.2.2 Physiological Basis of Lung Perfusion Imaging......Page 355
25.2.3 Lung Perfusion Imaging......Page 356
25.2.3.3.1 Acute Pulmonary Embolism......Page 357
25.2.3.3.3 Small Airway Diseases......Page 360
25.2.3.3.5 Preoperative Assessment of Postoperative Pulmonary Function......Page 362
25.2.3.4 Advantages and Limitations of Perfusion Imaging......Page 363
References......Page 364
26.2 Etiology, Symptoms, and Clinical Findings......Page 366
26.3 Diagnosis and Imaging Findings......Page 373
26.4 Treatment......Page 377
References......Page 378
27.1 General Considerations......Page 381
27.2 Physiopathology......Page 382
27.3 Indications for Surgery and Evaluation with Diagnostic Imaging......Page 383
27.3.1 Haller’s Index......Page 384
27.3.3 Length of Sternal Involvement on Cranio-Caudal Axis......Page 385
27.3.5 Sternal Torsion......Page 386
27.4 Cardiac Compression......Page 388
27.5 Pectus Excavatum and Mitral Valve Prolapse......Page 389
27.6 Pectus Excavatum and Marfan Syndrome......Page 390
27.6.2 Aortic Dissection......Page 391
27.8 Pectus Excavatum and Compression of the Inferior Vena Cava......Page 392
References......Page 393
28.1 Risk Stratification......Page 395
28.2 CAD and Thoracic Surgery: Medical, Interventional or Surgical Management?......Page 396
28.3 Currently Available Preoperative Cardiac Imaging Assessment......Page 397
28.5 Conclusion......Page 398
References......Page 399
29.1 Anatomy......Page 401
29.2.1 Congenital......Page 402
29.3 Are There Different Underlying Causes withCoronary-Pulmonary Artery Fistula? Controversies with Hypertrophic Coronary-to-Bronchial Anastomosis......Page 403
29.4.2 Takayasu Arteritis......Page 404
29.5 Imaging Studies, Treatment and Prognosis......Page 405
References......Page 406
Subject Index......Page 408
List of Contributors......Page 422