Table Of ContentSecond Edition
Cardiac CT Made Easy
An Introduction to Cardiovascular
Multidetector Computed Tomography
Second Edition
Cardiac CT Made Easy
An Introduction to Cardiovascular
Multidetector Computed Tomography
Edited by
Paul Schoenhagen
, MD
Cleveland Clinic, Cleveland, Ohio, USA
Carl J. Schultz
, MD
Erasmus Medical Center, Rotterdam, The Netherlands
Royal Perth Hospital and School of Medicine and Pharmacology
University of Western Australia, Perth, Western Australia
Sandra S. Halliburton
, MD
Cleveland Clinic, Cleveland, Ohio, USA
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2014 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20140108
International Standard Book Number-13: 978-1-4822-1423-9 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been
made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or
liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed
in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions
of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care
professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge
of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of
the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently
verified. The reader is strongly urged to consult the drug companies’ printed instructions, and their websites, before adminis-
tering any of the drugs recommended in this book. This book does not indicate whether a particular treatment is appropriate
or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own
professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace
the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish
in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may
rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any
form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming,
and recording, or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copy-
right.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400.
CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have
been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identifica-
tion and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Contents
Foreword ix
Contributors xi
Part 1 Basics of Multidetector Computed
Tomography (MDCT)
1. Introduction to cardiovascular MDCT imaging 3
2. CT perspective of normal cardiovascular anatomy 7
2.1 Cardiac chambers 7
2.2 Central venous and pulmonary venous return 8
2.3 Pulmonary artery 10
2.4 Aorta 11
2.4.1 Aortic root 11
2.4.2 Aorta 18
2.5 Coronary arteries 19
2.6 Extracardiac structures: lungs and mediastinum 20
3. Technical aspects of multi-detector row computed tomography 29
3.1 Data acquisition 29
3.1.1 Current CT systems 29
3.1.2 ECG referencing 30
v
vi Contents
3.1.3 Acquisition mode 31
3.1.4 Tube current modulation 32
3.1.5 Special image reconstruction techniques to improve
temporal resolution 32
3.1.6 Radiation exposure 34
3.1.7 Contrast media 34
3.1.8 Control of heart rate: beta-blocker 37
3.1.9 Control of vessel tone: nitroglycerine 37
3.1.10 Imaging protocols 37
3.2 Image reformation and interpretation 37
3.2.1 Axial CT images 38
3.2.2 Image artifacts 45
Part 2 Clinical Cardiovascular Applications
4. Cardiac chambers and myocardial disease 53
4.1 Cardiomyopathies 54
4.1.1 Non-ischemic cardiomyopathies 54
4.1.2 Ischemic cardiomyopathy 65
4.2 Other cardiac and myocardial conditions 67
4.2.1 Myocarditis 67
4.2.2 Non-ischemic atrial and ventricular aneurysms and
diverticula 69
4.2.3 Atrial and ventricular thrombus formation 70
4.2.4 Lipomatous hypertrophy 71
5. Pericardial disease 85
6. Valvular heart disease 103
7. CT planning and guidance for transcatheter interventions 123
8. Coronary arterial and venous disease 141
8.1 Coronary artery disease 145
8.1.1 Atherosclerotic coronary artery disease 145
8.2 Myocardial stress/rest perfusion 164
8.2.1 Static and dynamic CT perfusion imaging 164
8.2.2 Artifacts in CT myocardial perfusion imaging 166
Contents vii
8.2.3 CT myocardial perfusion protocols 166
8.2.4 Interpretation of CT myocardial perfusion studies 172
8.2.5 Systematic evaluation of perfusion 173
8.2.6 Quantitation of perfusion findings 175
8.3 Coronary veins and coronary sinus 182
8.3.1 Other applications 185
9. Pulmonary circulation 197
9.1 Pulmonary artery 197
9.2 Pulmonary veins 197
10. Aortic disease 205
10.1 Acute aortic syndromes 205
10.1.1 Definition 205
10.1.2 Morphologic classification 207
10.1.3 Location and extent 209
10.1.4 Diagnostic consideration 210
10.1.5 Differential diagnosis (triple rule-out) 212
10.1.6 Therapeutic implications 213
10.2 Aortic aneurysmal disease 215
10.3 Endovascular stent graft 216
10.4 Aortic surgery 218
10.5 Non-aortic pre-operative imaging 219
10.6 Other conditions 220
11. Peripheral artery disease 277
11.1 Lower-extremity CT angiography 277
12. Cardiac masses 283
13. Adult congenital heart disease 297
13.1 Cardiac chambers and myocardium 297
13.2 Pericardial disease 299
13.3 Valvular heart disease 299
13.4 Coronary arteries 301
13.5 Coronary veins and coronary sinus 304
13.6 Pulmonary veins 305
viii Contents
13.7 Aortic disease 305
13.8 Arteriovenous shunt defects 317
References 323
List of Videos 357
Index 361
Foreword
Computed tomography has established itself as a novel diagnostic technique for car-
diovascular disease. The constant improvements in temporal and spatial resolution
of computed tomography systems permit increasingly stable imaging of the rapidly
moving heart, and as a result of these improvements the number of clinical indi-
cations for cardiac computed tomography is increasing. Indications have expanded
from prevention (where coronary calcium imaging is complemented by advanced
analysis of plaque morphology and composition) to modern interventional treatment
of cardiac disease; for example, detailed computed tomographic imaging is one of the
major contributors to the success of transcatheter aortic valve implantation (TAVI).
Based on the tremendous developments that we have witnessed in recent years, it
can be expected that computed tomography will continue to expand its role in the
work-up and management of cardiovascular disease, and everyone involved in the
diagnosis and treatment of heart disease should take advantage of these new imaging
capabilities.
Cardiac computed tomography requires specialist knowledge. Cardiologists need
to familiarize themselves with computed tomography technology, image interpreta-
tion tools, typical findings and artifacts, while radiologists need deeper insight in
cardiac anatomy, function, and pathophysiology than ever before. The second edition
of Cardiac CT Made Easy is therefore published just at the right time. Along with
the basic information everyone should know, and new and recent techniques, the
applications of cardiac computed tomography are thoroughly explained and put in
a clinical context. With a clear structure, well-written text, and a large number of
impressive illustrations, this book will be a very useful resource for all those new to
the field, and a trustworthy reference for those who have been involved for a while
but would like to update their knowledge or are looking for a resource to turn to for
very specific questions.
ix
