Table Of ContentI
Contents
MEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A. L. Baert, Leuven
M. Knauth, Göttingen
K. Sartor, Heidelberg
III
Contents
M. Rémy-Jardin · J. Rémy
(Eds.)
Integrated
Cardiothoracic
Imaging
with MDCT
With Contributions by
J. Aldrich · H. Alkadhi · C. R. Becker · L. Bonomo · K. Boroto · L. Boussel · E. Bouvier
F. Cademartiri · C. Camus · P. Camus · A. Caulo · T. Couvreur · P. Douek · M. Dupont
B. Elicker · J.-B. Faivre · J. Feignoux · D. Fleischmann · T. Flohr · P. Foucher
D. Gamondès · B. Ghaye · A. B. Gorgos · A.-L. Hachulla · X. Hamoir · D. M. Hansell
J. Kirsch · E. Klotz · L. La Grutta · J.–P. Laissy · A. R. Larici · F. Laurent · M. C. C. Lin
G. Macis · E. Maffei · F. Maggi · B. Marincek · J. R. Mayo · L. Menchini · N. R. Mollet
M. Montaudon · B. Ohnesorge · A. A. Palumbo · V. Pansini · F. Pontana
M. Prokop · S. D. Qanadli · J. Rémy · M. Rémy-Jardin · D. Revel · E. Rizzo · A. Rutten
J.–L. Sablayrolles · P. Stolzmann · M. L. Storto · N. Sverzellati · N. Tacelli
J. M. Trautenaere · C. S. White · S. M. Yoo
Foreword by
A. L. Baert
With 247 Figures in 487 Separate Illustrations, 102 in Color and 37 Tables
123
IV
Contents
Martine Rémy-Jardin, MD, PhD
Professor, Department of Radiology
C.H.R.U. de Lille
Hôpital Calmette
Boulevard du Prof. J. Leclercq
59037 Lille Cédex
France
Jacques Rémy, MD
Professor, Department of Radiology
C.H.R.U. de Lille
Hôpital Calmette
Boulevard du Prof. J. Leclercq
59037 Lille Cédex
France
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors:
A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Knauth · M. Molls · C. Nieder · K. Sartor
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
ISBN 978-3-540-72386-8 e-ISBN 978-3-540-72387-5
DOI 10.1007 / 978-3-540-72387-5
Medical Radiology · Diagnostic Imaging and Radiation Oncology ISSN 0942-5373
Library of Congress Control Number: 2008924374
(cid:2) 2009, Springer-Verlag Berlin Heidelberg
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V
Contents
Foreword
This remarkable book explores yet another frontier of multidetector CT imaging,
namely the widespread application of this high-performance radiological technique in
the screening for cardiac and coronary artery lesions among the large group of patients
at risk who undergo MDCT owing to respiratory symptoms.
The volume convincingly demonstrates the exciting new role which both general
and chest radiologists can play in this medical fi eld, as well as the many new potentially
medically relevant applications of MDCT in daily radiological practice.
The editors are internationally renowned for their pioneering efforts in defi ning the
role and scope of high resolution CT and MDCT for the study of the lung. They have
published numerous articles and several highly successful handbooks on this topic. In
addition, they have been able to involve many leading experts in the fi eld as individual
contributing authors to this volume.
Here, they brilliantly describe and illustrate how the fast scanning techniques and
ultrahigh temporal resolution offered by state-of-the-art MDCT techniques can detect
and characterise the numerous interaction processes that occur between two vital chest
organs: the heart and the lungs.
I would like to congratulate both the editors and the authors for this outstanding
volume, which is an excellent and timely addition to this book series.
I can highly recommend this handbook not only to all radiologists involved in chest
imaging, but also to cardiologists, cardiac surgeons, pneumologists and lung surgeons
as an indispensable guide for the optimal diagnostic and therapeutic management of
their patients.
I am convinced that this work will rapidly fi nd well deserved recognition and suc-
cess among our readership.
Leuven Albert L. Baert
VII
Contents
Preface
Since its introduction into medical imaging practice in the 1980s, the major technologi-
cal revolution of the scanner has focused mainly on temporal resolution. Indeed, on
this basis, is it possible to classify equipment into two groups: scanners which control
physiological motion and those which are subjected to physiological motion. Techni-
cal innovations have lead to an elaboration of this classifi cation. Cardiac synchronisa-
tion is becoming an increasingly high-performance procedure, with ever less radiation
exposure. Even without the use of the latter, accelerating rotation times controls motion
in the slice plane and acquisition volume ever better. These physiological movements
are caused by beats induced by the heart and vessels (which are quadri-dimensional)
and, depending on patient condition, by oesophageal peristalsis, poorly controlled
coughing, involuntary Valsalva maneuver as contrast material passes into the system,
or disrupted control of apnea at full lung capacity. All anatomical structures of the
thorax and their possible lesions are thus subjected to shifts. It has been shown that
detection, analysis and quantifi cation are improved by the suppression of all paracar-
diac motion artefacts. It can also be shown that all paracardiac gains are the result of
“cardiac arrest” during acquisition. One example demonstrates this accurately: dou-
ble-source technology offers temporal resolution of 83 ms without cardiac gating. It is
able to acquire the entire thoracic level in 3 s, as well as the proximal coronary arteries
in diastole if the cardiac frequency is at 75 bpm.
Only total immbolisation of structures and lesions suppresses motion artefacts which
can have an effect not only on spatial resolution, but also on contrast resolution since
shifted structures will be under-sampled. The results of this progress have an impact
on CT practices. While thoracic imaging and cardiac imaging are two distinct special-
ties, the thoracic radiologist of today can no longer neglect examination of the heart
and coronaries as he used to with earlier generations of equipment. Thus technology
has opened an era of “cardiothoracic imaging” which prompts the thoracic radiologist
to take a keen interest in cardiopulmonary interactions, while the cardiac radiologist
needs to extend his fi eld of analysis. These interactions are manifold: embryologic,
anatomic, mechanical, physiological, physiopathological, and therapeutic. The time
has come for these two specialties, thoracic imaging and cardiac imaging, to integrate
the inseparable part of what was previously the domain of another specialist in their
own activities.
This book is a trial of integrated cardiothoracic imaging in which a number of fi elds
are addressed in order to alert the reader to the scale of the task, without, however,
attempting to be exhaustive. The modest objective of the book is to attract the reader’s
VIII
Preface
attention to the cardiac effect of pulmonary vascular disease, the cardiovascular
comorbidities of COPD and the cardiovascular causes and effects of their acute
exacerbation, the cardiorespiratory tropism of sarcoidosis or scleroderma, as
well as the management of equivocal symptoms which can be of either cardiac
or respiratory origin.
The reader may fi nd overlaps between chapters. These are certainly redun-
dant if they express converging opinions while, in contrast, interesting if they
express confl icting opinions resulting from the author’s own experience and
demonstrate that the use of imaging at the boundary between heart and lungs
has not yet found its balance.
The reader may also encounter chapters lacking suffi cient detail, such as
the study of the cardio-pericardiac extent of neighbouring diseases (media-
stinal, bronchopulmonary, pleural or even sub-diaphragmatic), or of therapeu-
tic interactions between heart and lungs, a review of which alone would have
merited a book of this size.
We would like to express our profound gratitude to all the authors who con-
tributed to this book, which represents a collective work of pioneers who have
just opened the door to a new specialty.
Lille Martine Rémy-Jardin
Jacques Rémy
IX
Contents
Contents
Part I : Technological Approach to Cardiothoracic Imaging. . . . . . . 1
1 From Sixteen Slices to Nowadays – Cardiothoracic Imaging with CT
Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Cardiac Gating
Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 23
3 Cardiothoracic Image Postprocessing
Thomas Flohr and Bernd Ohnesorge . . . . . . . . . . . . . . . . . . . . . . . . . 37
4 Contrast Medium Utilization
Dominik Fleischmann and Margaret C. C. Lin . . . . . . . . . . . . . . . . . . . 53
5 Dose Reduction in Chest CT
John R. Mayo and John Aldrich. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
6 Acquisition Protocols
Jacques Kirsch, Michaël Dupont, and Xavier Hamoir . . . . . . . . . . . . . . 79
Part II: Anatomical and Physiological Approach to
Cardiothoracic Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
7 Cardiac and Coronary Artery Anatomy and Physiology
Jean-Louis Sablayrolles, Erik Bouvier, Jean Marc Trautenaere,
and Jacques Feignoux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Part III: Heart-Lung Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
8 Physiological Interactions
Francois Laurent and Michel Montaudon . . . . . . . . . . . . . . . . . . . . . 109
9 Drug-Induced Respiratory Disease in Cardiac Patients
Philippe Camus, Clio Camus, and Pascal Foucher. . . . . . . . . . . . . . . . . 131
X
Contents
Part IV: Medical Applications of Integrated Cardiothoracic Imaging
Cardiac Complications of Thoracic Disorders . . . . . . . . . . . . . . . . . . . . . . . . 159
10 Diseases of the Pulmonary Circulation
Martine Rémy-Jardin, Andrei-Bodgan Gorgos, Vittorio Pansini,
Jean-Baptiste Faivre, and Jacques Rémy. . . . . . . . . . . . . . . . . . . . . . . 161
11 COPD and Cardiac Comorbidities
Jacques Rémy, Anne-Lise Hachulla, and Jean-Baptiste Faivre . . . . . . . . 175
12 Immunologic Lung Diseases
Delphine Gamondès and Didier Revel . . . . . . . . . . . . . . . . . . . . . . . . 197
13 Sleep-Related Hypoventilation/Hypoxemic Syndromes (SRHH)
Jacques Rémy and Nunzia Tacelli . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Thoracic Consequences of Cardiac Diseases. . . . . . . . . . . . . . . . . . . . . . . . . 207
14 Imaging Findings Associated with Left-Sided Cardiac Dysfunction
Nicola Sverzellati and David M. Hansell . . . . . . . . . . . . . . . . . . . . . 209
MDCT Management of Ambiguous Symptoms . . . . . . . . . . . . . . . . . . . . . . . 219
15 Evaluation of Chest Pain, Hemoptysis and Dyspnea
Seung Min Yoo and Charles S. White . . . . . . . . . . . . . . . . . . . . . . . . . 221
Evaluation of Asymptomatic Cardiac Diseases . . . . . . . . . . . . . . . . . . . . . . . 239
16 Lesions of Proximal Coronary Arteries
Filippo Cademartiri, Ludovico La Grutta, Anselmo Alessandro Palumbo,
Erica Maffei, and Nico R. Mollet . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
17 Myocardial Infarction
Christoph R. Becker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
18 Aortic Bicuspidia, Silent Ductus Arterious
Salah D. Qanadli and Elena Rizzo. . . . . . . . . . . . . . . . . . . . . . . . . . . 257
19 Cardiac Calcifi cations
Annemarieke Rutten and Mathias Prokop . . . . . . . . . . . . . . . . . . . . . 269
XI
Contents
20 Left Superior Vena Cava
Thierry Couvreur and Benoît Ghaye. . . . . . . . . . . . . . . . . . . . . . . . . 289
21 Partial Anomalous Venous Return
Benoît Ghaye and Thierry Couvreur. . . . . . . . . . . . . . . . . . . . . . . . . 307
22 Pulmonary Valvular Stenosis
Jacques Rémy and Kahimano Boroto . . . . . . . . . . . . . . . . . . . . . . . . . 325
23 Right-to-Left Shunts
Loic Boussel, Philippe Douek, and Brett Elicker . . . . . . . . . . . . . . . . . 327
Diseases of the Pericardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
24 MDCT: Evaluation of Congenital and Acquired Diseases of the Pericardium
Paul Stolzmann, Borut Marincek, and Hatem Alkadhi. . . . . . . . . . . . . 341
Diseases of the Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
25 Lung Perfusion
Ernst Klotz, Jacques Rémy, François Pontana, Jean-Baptiste Faivre,
Vittorio Pansini, and Martine Remy-Jardin . . . . . . . . . . . . . . . . . . . . 363
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
26 Pulmonary Embolism from Cardiac Origin
Lorenzo Bonomo, Anna Rita Larici, Fabio Maggi, Laura Menchini,
Andrea Caulo, and Maria Luigia Storto . . . . . . . . . . . . . . . . . . . . . . 381
27 Pectus Excavatum and the Heart
Lorenzo Bonomo, Guiseppe Macis, and Andrea Caulo . . . . . . . . . . . . . . 397
28 Thoracic Surgery and Asymptomatic Coronary Artery Disease
Jean-Pierre Laissy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
29 Diseases Developing Coronaro-Bronchial Anastomoses
Jean-Pierre Laissy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
