Oudkerk / Reiser Coronary Radiology

2. Auflage 2009
ISBN: 978-3-540-32984-8
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 357 Seiten

Reihe: Medical Radiology

During the past decade, coronary radiology has undergone rapid development. This second edition of the only available monograph on the subject places special emphasis on the role of non-invasive techniques, which can supply information on the condition of the coronary arteries within one simple and short examination. The modalities considered in detail include CT angiography with multidetector and dual-source tomography, 2D and 3D visualization techniques, and MR coronary angiography. Invasive procedures are not neglected, however, and a separate section includes chapters on conventional catheterization, quantitative angiography, and intravascular and quantitative ultrasound. In addition, a section devoted to coronary calcification clearly explains its development and the use of modern techniques in its visualization and quantification. The informative text is supported by a large number of high-quality color images of the coronary and cardiac anatomy.

Autoren/Hrsg.

Oudkerk, Matthijs

Reiser, Maximilian F

Inhaltsverzeichnis

1;Foreword;5
2;Preface;6
3;Table of contents;8
4;1 Coronary Anatomy;10
4.1;1.1 Introduction;10
4.2;1.2 Physiological and Anatomical Bases;11
4.3;1.3 Normal Coronary Anatomy;14
4.3.1;1.3.1 Left Coronary Anatomy;15
4.3.1.1;1.3.1.1 Left Main Coronary Artery;15
4.3.1.2;1.3.1.2 Left Anterior Descending Coronary Artery;15
4.3.1.3;1.3.1.3 The Circumflex Artery;16
4.3.2;1.3.2 Right Coronary Anatomy;16
4.3.2.1;1.3.2.1 Right Coronary Artery;16
4.3.2.2;1.3.2.2 Determination of Dominance;17
4.4;1.4 Visualization of the Normal Coronary Artery Tree ;17
4.4.1;1.4.1 Anatomy on Catheter Coronary Angiography;17
4.4.2;1.4.2 Anatomy on Multi-detector CT;17
4.5;1.5 Anomalies of the Coronary Artery Tree;27
4.5.1;1.5.1.1 Coronary Artery Fistula;27
4.5.2;1.5.1.2 Anomalous Origin of a Coronary Artery from the Pulmonary Trunk ;28
4.5.3;1.5.1.3 Myocardial Bridging;29
4.6;1.5.2 Vessels Originating from the Contralateral Side, With an Interarterial Course;29
4.6.1;1.5.2.1 Right-Sided Left Coronary Artery;29
4.6.2;1.5.2.2 Left-Sided Right Coronary Artery;29
4.6.3;1.5.2.3 Congenital Coronary Anomalies Not Causing Myocardial Ischemia;32
4.7;References;33
5;2 Invasive Coronary Imaging;34
5.1;2.1 Conventional Catheterisation;34
5.1.1;2.1.1 The Development of Cardiac Catheterisation;34
5.1.1.1;2.1.1.1 Cardiac and Coronary Catheters;35
5.1.1.2;2.1.1.2 Cardiac Catheterisation Laboratories;36
5.1.1.3;2.1.1.3 Radiation Safety and Exposure;36
5.1.1.4;2.1.1.4 Coronary Contrast Injection;37
5.1.1.5;2.1.1.5 Views for Coronary Angiography;37
5.1.1.6;2.1.1.6 Quantifi cation of Coronary Angiography;37
5.1.2;2.1.2 Normal Coronary Anatomy;38
5.1.3;2.1.3 Arterial Dominance;38
5.1.3.1;2.1.3.1 Normal Variants;38
5.1.3.2;2.1.3.2 Muscle Bridge;38
5.1.3.3;2.1.3.3 Coronary Artery Anomalies Presenting in the Adult;39
5.1.4;2.1.4 Coronary Abnormalities Presenting in Infancy and Childhood;39
5.1.4.1;2.1.4.1 Coronary Fistulae;39
5.1.5;2.1.5 Risks of Coronary Angiography;40
5.1.5.1;2.1.5.1 Selection of Patients for Coronary Angiography;40
5.1.5.2;2.1.5.2 Development of Coronary Revascularisation;41
5.1.6;2.1.6 Percutaneous Coronary Intervention;41
5.1.6.1;2.1.6.1 Concomitant Pharmacological Therapy;45
5.1.6.2;2.1.6.2 Long-Term Outcome;46
5.1.6.3;2.1.6.3 Comparison with Bypass Surgery;47
5.1.6.4;2.1.6.4 Percutaneous Coronary Intervention Versus Conservative Therapy;47
5.1.7;2.1.7 Alternative Strategies to the First Line Use of Coronary Angiography;47
5.1.8;References;47
5.2;2.2 Quantitative Coronary Arteriography;50
5.2.1;2.2.1 Introduction;50
5.2.2;2.2.2 Analog or Digital Image Acquisition and Analysis;52
5.2.3;2.2.3 Brief History of Quantitative Coronary Arteriography;52
5.2.4;2.2.4 Basic Principles of Quantitative Coronary Arteriography;53
5.2.4.1;2.2.4.1 Basic Principles of Automated Contour Detection;53
5.2.4.2;2.2.4.2 Calibration Procedure;55
5.2.4.3;2.2.4.3 Coronary Segment Analysis;55
5.2.4.4;2.2.4.4 The Flagging Procedure;56
5.2.4.5;2.2.4.5 Complex Vessel Morphology;58
5.2.4.6;2.2.4.6 Densitometry;59
5.2.4.7;2.2.4.7 Standardized QCA Methodology for Assessing Brachytherapy Trials;60
5.2.4.8;2.2.4.8 Standardized QCA Methodology for Drug-Eluting Stent Analyses;60
5.2.4.8.1;2.2.4.8.1 Definition and Assessment of the Segments Based on Markers or Physical Landmarks ;60
5.2.4.8.2;2.2.4.8.2 Definition and Assessment of the Segments Based on Biologically Relevant Landmarks ;61
5.2.4.8.3;2.2.4.8.3 Definition and Assessment of the “Normal” Segment ;62
5.2.4.8.4;2.2.4.8.4 Definition and Assessment of the Related Parts ;62
5.2.4.8.5;2.2.4.8.5 Data Collection and Reporting for Drug-Eluting Stent Trials;63
5.2.4.9;2.2.4.9 Ostial Analysis;63
5.2.4.10;2.2.4.10 Bifurcation Analysis;65
5.2.5;2.2.5 Guidelines;66
5.2.5.1;2.2.5.1 Guidelines for Catheter Calibration;66
5.2.5.2;2.2.5.2 Guidelines for QCA Acquisition Procedures;67
5.2.6;2.2.6 QCA Validation;68
5.2.6.1;2.2.6.1 Plexiglass Phantom Studies;68
5.2.6.2;2.2.6.2 In Vivo Plexiglass Plugs;69
5.2.6.3;2.2.6.3 Inter- and Intra-observer and Short- and Medium-term Variabilities;69
5.2.6.4;2.2.6.4 Inter-laboratory Variability;69
5.2.7;2.2.7 Applications of QCA: Off -Line and On-Line;70
5.2.8;2.2.8 Future QCA Directions;71
5.2.9;2.2.9 In Conclusion;72
5.2.10;References;72
5.3;2.3 Clinical Intracoronary Ultrasound;75
5.3.1;2.3.1 Introduction;75
5.3.2;2.3.2 Intracoronary Ultrasound Catheters;75
5.3.3;2.3.3 Intracoronary Imaging of the Normal Coronary Artery ;79
5.3.4;2.3.4 Intracoronary Ultrasound of Coronary Atherosclerosis;81
5.3.5;2.3.5 IVUS and Vulnerable Plaque;88
5.3.6;2.3.6 IVUS for In-Stent Restenosis;90
5.3.7;2.3.7 IVUS for Intermediate Lesions;91
5.3.8;2.3.8 IVUS and Transplant Coronary Artery Disease ;92
5.3.9;2.3.9 Limitations of Intracoronary Ultrasound;92
5.3.10;2.3.10 Conclusion;95
5.3.11;References;95
5.4;2.4 Quantitative Coronary Ultrasound (QCU);98
5.4.1;2.4.1 Introduction;98
5.4.2;2.4.2 ICUS Image Acquisition;98
5.4.2.1;2.4.2.1 Interventional Laboratory “Hardware” Set-Up;99
5.4.2.2;2.4.2.2 Image Acquisition;99
5.4.3;2.4.3 Quantitative Analysis;100
5.4.3.1;2.4.3.1 QCU Developments;101
5.4.4;2.4.4 Limitations;103
5.4.5;2.4.5 Future Developments;104
5.4.6;2.4.6 Conclusion;104
5.4.7;References;104
6;3 Non-Invasive Coronary Imaging;106
6.1;3.1 Multi-Detector Row Computed Tomography – Technical Principles, New System Concepts, and Clinical Applications;106
6.1.1;3.1.1 Introduction;106
6.1.2;3.1.2 Technical Principles of ECG-Synchronized Cardiac Scanning with MDCT;108
6.1.2.1;3.1.2.1 Technology Overview;108
6.1.2.2;3.1.2.2 ECG-Triggered Sequential MDCT Scanning and Image Reconstruction;111
6.1.2.3;3.1.2.3 ECG-Gated Spiral MDCT Scanning and Image Reconstruction;112
6.1.2.4;3.1.2.4 Evaluation of Spatial Resolution;115
6.1.2.5;3.1.2.5 Evaluation of Temporal Resolution;116
6.1.3;3.1.3 New System Concepts;117
6.1.3.1;3.1.3.1 CT Systems with Area Detectors;117
6.1.3.2;3.1.3.2 Dual Source CT (DSCT);119
6.1.4;3.1.4 Clinical Applications;123
6.1.4.1;3.1.4.1 Quantification of Coronary Artery Calcification ;123
6.1.4.2;3.1.4.2 CT Angiography of the Coronary Arteries;123
6.1.4.3;3.1.4.3 Detection of Coronary Artery Stenosis;127
6.1.4.4;3.1.4.4 Evaluation of Atherosclerotic Plaque;129
6.1.4.5;3.1.4.5 Evaluation of Cardiac Function;130
6.1.4.6;3.1.4.6 Cardio-thoracic Examinations;131
6.1.5;3.1.5 Advanced Image Post-Processing;132
6.1.6;References;137
6.2;3.2 Developments in MR Coronary Angiography;142
6.2.1;3.2.1 Technical Development;143
6.2.2;3.2.2 Pulse Sequences and K-space Trajectories;144
6.2.3;3.2.3 Image Contrast;145
6.2.4;3.2.4 Flow Quantification;147
6.2.4.1;3.2.4.1 Coronary Wall Imaging;147
6.2.5;3.2.6 Clinical Results;148
6.2.6;3.2.7 Future Developments;149
6.2.7;References;152
6.3;3.3 Clinical Implementation of Coronary Imaging;155
6.3.1;3.3.1 Introduction;155
6.3.2;3.3.2 Patient Preparation for Non-invasive Coronary Angiography with CT;155
6.3.3;3.3.3 Contrast Media Administration;156
6.3.4;3.3.4 Image Post-Processing Technique;157
6.3.5;3.3.5 Diagnosis of Coronary Artery Disease;158
6.3.6;3.3.6 Indications for CT Coronary Angiography;159
6.3.7;3.3.7 Coronary Morphology and Myocardial Function;161
6.3.8;3.3.8 Evaluation of Coronary Artery Bypass Grafts;161
6.3.9;3.3.9 Evaluation of Coronary Artery Stents;161
6.3.10;3.3.10 Plaque Detection;163
6.3.11;3.3.11 Radiation Dose;163
6.3.12;3.3.12 Conclusion;164
6.3.13;References;165
6.4;3.4 MDCT in Acute Coronary Syndrome;170
6.4.1;3.4.1 Introduction;170
6.4.2;3.4.2 Pathogenesis;171
6.4.3;3.4.3 Risk Stratification;172
6.4.4;3.4.4 Calcium Scoring in Patients with ACS;173
6.4.5;3.4.5 CTA for the Diagnosis of ACS;174
6.4.6;3.4.6 CTA for the Differential Diagnosis in ACS;175
6.4.7;3.4.7 Current Recommendations and Guidelines;176
6.4.8;3.4.8 Conclusion;176
6.4.9;References;177
6.5;3.5 Coronary CT Angiography Guidance for Percutaneous Transluminal Angioplasty;179
6.5.1;3.5.1 General Principles;179
6.5.2;3.5.2 CTA Protocol for PCI Guidance of Complex CA Lesions;181
6.5.2.1;3.5.2.1Coronary Angiography;181
6.5.2.2;3.5.2.2 Protocol of Coronary CTA;182
6.5.2.3;3.5.2.3 Post Processing;182
6.5.2.4;3.5.2.4 Integration of CAG and CT Data in the Cath Lab;185
6.5.3;3.5.3 CT Guidance of Chronic Total Occlusion;185
6.5.4;3.5.4 CT Guidance of Coronary Ostia;186
6.5.5;3.5.5 CT Guidance of Bifurcation Lesions;187
6.5.5.1;3.5.5.1 The Limits of Coronary Angiography;187
6.5.5.2;3.5.5.2 Example of a Lesion on the Main Branch and the LAD/LCX Bifurcation;190
6.5.5.2.1;3.5.5.2.1 CAG and CTA Assessment Prior to the Procedure;190
6.5.5.2.2;3.5.5.2.2 Performance of the Procedure;192
6.5.5.2.3;3.5.5.2.3 Results;192
6.5.6;3.5.6 Conclusion;193
6.5.7;References;193
6.6;3.6 Use of Multidetector Computed Tomography for the Assessment of Acute Chest Pain: Guidelines of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology;194
6.6.1;3.6.1 Preamble;194
6.6.2;3.6.2 How to Manage Chest Pain: The Emergency Department Perspective;195
6.6.2.1;3.6.2.1 Acute Coronary Syndrome;196
6.6.2.2;3.6.2.2 Pulmonary Embolism;197
6.6.2.3;3.6.2.3 Acute Aortic Syndromes;197
6.6.2.4;3.6.2.4 Alternative Diagnoses;198
6.6.3;3.6.3 Triple Rule-Out;199
6.6.4;3.6.4 CT Protocol;199
6.6.4.1;3.6.4.1 Scanner Technology;199
6.6.4.2;3.6.4.2 Preparation for the CT Scan;199
6.6.4.3;3.6.4.3 Calcium Scoring;200
6.6.4.4;3.6.4.4 CTA Protocol;201
6.6.4.5;3.6.4.5 Dedicated CTA;201
6.6.4.6;3.6.4.6 Global Assessment (Triple Rule-Out);202
6.6.5;3.6.5 Imaging Evaluation and Post Processing;202
6.6.6;3.6.6 Physician Requirements;203
6.6.7;3.6.7 Future Directions;203
6.6.8;3.6.8 Summary;204
6.6.9;References;204
7;4 Non-Invasive Measurement of Coronary Atherosclerosis;207
7.1;4.1 Pathophysiology of Coronary Atherosclerosis and Calcification;207
7.1.1;4.1.1 Normal Artery Histology and Cell Function;207
7.1.2;4.1.2 Endothelial Dysfunction and the Pathogenesis of Atherosclerotic Plaques;208
7.1.3;4.1.3 Calcification of Plaques;209
7.1.4;4.1.4 Calcification and Plaque Rupture;210
7.1.5;References;211
7.2;4.2 Detection and Quantification of Coronary Calcification;213
7.2.1;4.2.1 Introduction;213
7.2.2;4.2.2 Fluoroscopy;213
7.2.3;4.2.3 Conventional Computed Tomography;215
7.2.4;4.2.4 Electron-Beam Computed Tomography;216
7.2.5;4.2.5 Multidetector Computed Tomography;219
7.2.6;4.2.6 Intravascular Ultrasound;220
7.2.7;4.2.7 Magnetic Resonance Imaging;221
7.2.8;References;221
7.3;4.3 Measuring Coronary Calcium;224
7.3.1;4.3.1 Introduction;224
7.3.2;4.3.2 Scoring Algorithms;224
7.3.3;4.3.3 Calcium Scoring In Vivo;225
7.3.4;4.3.4 Calcium Scoring In Vitro;227
7.3.5;4.3.5 Combining In Vivo and In Vitro;231
7.3.6;4.3.6 Implications;232
7.3.7;4.3.7 Conclusion;232
7.3.8;References;232
7.4;4.4 Coronary Calcium as an Indicator of Coronary Artery Disease;235
7.4.1;4.4.1 Coronary Calcium as an Indicator of Atherosclerosis;235
7.4.2;4.4.2 Coronary Calcium – Prediction of Coronary Heart Disease Events;236
7.4.3;4.4.3 Progression of Coronary Calcium;238
7.4.4;4.4.4 Guidelines for and Practical Use of Coronary Calcium Assessment;241
7.4.5;References;243
7.5;4.5 Epidemiology of Coronary Calcification;246
7.5.1;4.5.1 The Prevalence of Coronary Calcification;246
7.5.2;4.5.2 Cardiovascular Risk Factors and Coronary Calcification;247
7.5.3;4.5.3 Ethnic Diff erences in Coronary Calcification ;252
7.5.4;4.5.4 Coronary Calcification and Risk of Manifest Atherosclerotic Disease;252
7.5.5;4.5.5 Coronary Calcification and Measures of Extracoronary Atherosclerosis ;256
7.5.6;4.5.6 Progression and Regression of Coronary Calcification;257
7.5.7;References;260
7.6;4.6 Coronary Artery Calcium Screening: Current Status and Recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging;265
7.6.1;4.6.1 Introduction;266
7.6.2;4.6.2 Coronary Artery Calcium as a Predictor of Cardiac Events;266
7.6.3;4.6.3 CAC as an Indicator of Coronary Artery Luminal Stenosis;267
7.6.4;4.6.4 Clinical Comparison of MDCT and EBT for Coronary Artery Calcium Score Measurement;267
7.6.5;4.6.5 Review of Current Guidelines on Coronary Artery Calcification;267
7.6.5.1;4.6.5.1 Risk Assessment in Asymptomatic Persons;267
7.6.5.2;4.6.5.2 The Focus of Current Guidelines on CAC Scoring;268
7.6.6;4.6.6 Indications for CAC Scoring in Asymptomatic Individuals;269
7.6.7;4.6.7 Atherosclerotic Disease Quantification in Patients with Chest Pain ;270
7.6.7.1;4.6.7.1 Implications for Therapy;271
7.6.7.2;4.6.7.2 Limitations;271
7.6.7.3;4.6.7.3 Summary;271
7.6.8;4.6.8 Race and Calcium Score;271
7.6.9;4.6.9 The Value of Coronary Artery Calcium in the Elderly Population;272
7.6.10;4.6.10 Summary;273
7.6.11;4.6.11 Diabetes Mellitus and Coronary Artery Calcium;273
7.6.12;4.6.12 Summary;274
7.6.13;4.6.13 Renal Failure and Coronary Artery Calcium;274
7.6.14;4.6.14 Summary;275
7.6.15;4.6.15 The Value of the ZERO Calcium Score – Asymptomatic Patients;275
7.6.16;4.6.16 The Value of ZERO Calcium Score – Symptomatic Patients;277
7.6.16.1;4.6.16.1 Calcium Score and Prediction of Obstructive Coronary Artery Disease on Angiography;277
7.6.17;4.6.17 Summary;277
7.6.17.1;4.6.17.1 The Value of Zero Calcium Score to Rule Out CAD in Symptomatic Patients: Comparison to Treadmill Stress Testing and Nuclear Stress Tests;278
7.6.17.2;4.6.17.2 The Value of Zero Calcium Score inPatients Presenting with Acute Chest Pain to the Emergency Department;278
7.6.18;4.6.18 Calcium Score Progression: Interpretation;279
7.6.19;4.6.19 Serial Testing Paradigm;279
7.6.20;4.6.20 Reproducibility of CAC CT and Its Determinants ;279
7.6.20.1;4.6.20.1 Clinical Thresholds of Coronary Artery Calcium Progression;280
7.6.21;4.6.21 Clinical Interpretation of Changes in Coronary Artery Calcium;281
7.6.21.1;4.6.21.1 Rates of Coronary Artery Calcium Progression and Its Determinants;281
7.6.21.2;4.6.21.2 Results of Randomized Clinical Trials on Effect of Statin Therapy on Coronary Artery Calcium Progression ;282
7.6.22;4.6.22 Cardiovascular Prognosis Related to Coronary Artery Calcium Progression;283
7.6.23;4.6.23 Summary;284
7.6.24;4.6.24 Standardization of the Calcium Score Measured Using Different CT Systems ;284
7.6.25;4.6.25 Infl uence of Scoring Parameter Settings of Underlying Software Algorithms on Calcium Scoring;286
7.6.26;4.6.26 Radiation Exposure;287
7.6.27;4.6.27 Conclusions;288
7.6.28;References;288
8;5 Multi-Dimensional Computed Cardiac Visualization;294
8.1;5.1 Introduction;294
8.2;5.2 Visualization Techniques;295
8.2.1;5.2.1 Two-Dimensional Slice Viewing;295
8.2.1.1;5.2.1.1 Native Multi-planar Reformation;295
8.2.1.2;5.2.1.2 Oblique Multi-planar Reformation;296
8.2.1.3;5.2.1.3 Curved Multi-planar Reformation;296
8.2.1.4;5.2.1.4 Stretched Multi-planar Reformation;296
8.2.2;5.2.2 Maximum Intensity Projection;299
8.2.3;5.2.3 Thin Slab Maximum Intensity Projection;301
8.2.4;5.2.4 Surface Rendering;301
8.2.5;5.2.5 Volume Rendering;302
8.3;5.3 Intra-coronary Visualization;306
8.4;5.4 Visualization of Four-Dimensional Data;308
8.5;5.5 Clinical Applications;309
8.5.1;5.5.1 Coronary Calcification;309
8.5.2;5.5.2 Coronary Anatomy;309
8.5.3;5.5.3 Coronary Stenosis and Atherosclerotic Plaque;310
8.5.4;5.5.4 Coronary Stent Evaluation;314
8.5.5;5.5.5 Cardiac Function;316
8.5.6;5.5.6 Myocardial Perfusion and Late-Enhancement Analysis;317
8.5.7;5.5.7 Combined Analysis of Coronary Arteries and Myocardium;318
8.6;5.6 Artifacts and Pitfalls;319
8.6.1;5.6.1 Technique-Related Problems;319
8.6.2;5.6.2 User-Related Problems;323
8.6.2.1;5.6.2.1 Missegmentation;323
8.6.2.2;5.6.2.2 Improper Choice of Techniques;323
8.6.2.3;5.6.6.3 Misplacement of Selection Tools;323
8.7;5.7 Conclusion;323
8.8;5.8 Digital Storage and Distribution;324
8.9;5.9 History of Cardiac X-Ray Management;324
8.10;5.10 Standardized File Formats;325
8.10.1;5.10.1 DICOM Extensions for Cardiology Data;325
8.10.2;5.10.2 Image Compression;326
8.10.3;5.10.3 Matrix Size Reduction;327
8.10.4;5.10.4 Data Size Reduction;327
8.11;5.11 PACS Development;328
8.12;5.12 Conclusion;330
8.13;References;330
9;Subject Index;336
10;List of Contributors;345