Cardiovascular CT and MR Imaging: From Technique to Clinical Interpretation

372 Pages·2013·22.813 MB·English

by  Michele Anzidei, Guendalina Menichini, Carlo Catalano (auth.), Carlo Catalano, Michele Anzidei, Alessandro Napoli (eds.)

Carlo Catalano
Michele Anzidei
Alessandro Napoli
Editors
Cardiovascular CT
and MR Imaging
From Technique
to Clinical Interpretation
123
Cardiovascular CT and MR Imaging
Carlo Catalano
Michele Anzidei
Alessandro Napoli
(Editors)
Cardiovascular CT
and MR Imaging
From Technique to Clinical Interpretation
123
Carlo Catalano
Michele Anzidei
Alessandro Napoli
Department of Radiological Sciences
Umberto I Hospital
“Sapienza” University of Rome
Rome, Italy
ISBN 978-88-470-2867-8 ISBN 978-88-470-2868-5 (eBook)
DOI 10.1007/978-88-470-2868-5
Library of Congress Control Number: 2012952473
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Foreword
For those who, like me, have begun working in vascular radiology, particularly with
invasive diagnostic methods, it is satisfying today to experience the once unthinkable
diagnostic possibilities of CT and MRI in cardiovascular diseases, and we are aware
that technological progress is making and will continue to provide more results in the
future.
Satisfaction is found in two factors, one personal and one general. The personal
factor concerns the way in which my young colleagues have brilliantly contributed to
this advancement in cardiovascular diagnosis, increasing and refining their expertise
thanks to the experience of Carlo Catalano, who coordinated the work, and enriching
it with the knowledge they gained from him before beginning to work in the sector;
this was developed at the University of L’Aquila with the first suitable CT and MRI
installations, in their early stages, for angiographic cardiovascular acquisition. The
general factor is the observation that technological progress, in terms of the speed and
quality of both acquisition and reconstruction software, has made it possible for ra-
diologists to study coronary circulation, which, until the advent of new imaging te-
chnologies had been sparsely and indirectly accessible.
It is therefore with great delight and pride that I present this work, edited by Carlo
Catalano, which in 17 chapters summarizes, albeit comprehensively, examination te-
chniques, the treatment and processing of images, their reconstructions by angiogra-
phic types, and the resulting diagnostic picture in the main pathological conditions in
various cardiovascular districts.
Rome, December 2012 Prof. Roberto Passariello
Department of Radiological Sciences
Umberto I Hospital
“Sapienza” University of Rome
Rome, Italy
V
Preface
The development of diagnostic imaging techniques in recent years, especially computed
tomography and magnetic resonance, has enabled them to be applied to areas that until
a few years ago were unthinkable. In particular, specific applications have become pos-
sible that enable us to overcome the need for invasive examinations for purely diagno-
stic purposes. Among these, vascular imaging is probably the most important.
The extension of efficient equipment throughout Italy makes it possible to carry
out high-quality vascular studies in the field of clinical radiology, enabling very de-
tailed definitions of the anatomy and pathological conditions.
The acquisition of high-quality images, however, requires the use of accurate and
specific acquisition protocols for both computed tomography and magnetic resonance.
At the same time it is essential to pay appropriate attention to the administration of
both iodinated and paramagnetic contrast media. Protocols for each clinical application
are carefully reported in this book, using the same format throughout, so that readers
can easily find them and apply them to their own daily activities.
Particular attention has been paid to iconography and the correct methods for do-
cumenting examinations. In fact, a fundamental aspect of each vascular diagnostic
examination is the reconstruction of images on post-processing stations, with increa-
singly sophisticated two- and three-dimensional techniques, in order that examinations
can be understood by clinical colleagues.
I would like to thank those who have worked on this book with enthusiasm and
dedication – young interns, specialists, postgraduates and research assistants.
Finally, I and my two co-authors, Alessandro Napoli and Michele Anzidei, would
like to dedicate this work to Prof. Roberto Passariello, who taught radiology me and
many other Italians.
Rome, December 2012 Prof. Carlo Catalano
VII
Contents
1 CT-Angiography.......................................................................................... 1
Michele Anzidei, Guendalina Menichini, and Carlo Catalano
1.1 Examination Technique...................................................................... 1
Volumetric Acquisition....................................................................... 1
Scan Parameters............................................................................. 3
Acquisition Parameters.................................................................. 4
Reconstruction Parameters............................................................. 4
Signal-to-Noise Ratio..................................................................... 6
1.2 Contrast Medium Administration....................................................... 7
Contraindications to the Use of Contrast Medium............................. 9
Administration Strategy...................................................................... 9
Contrast Medium Volume................................................................... 11
Saline Solution.................................................................................... 11
tCMT and the Additive Model............................................................ 12
Iodine Delivery Rate........................................................................... 14
Factors that Influence Vascular Enhancement.................................... 14
Body Mass Index............................................................................ 14
Cardiac Ejection Fraction............................................................... 15
Contrast Medium Administration Rate.......................................... 16
Contrast Medium Volume............................................................... 16
Iodine Concentration of the Contrast Medium (mgl/ml)............... 17
kVp................................................................................................. 17
Timing............................................................................................ 17
1.3 Dosimetric Considerations.................................................................. 19
1.4 Artifacts.............................................................................................. 19
2 MR-Angiography........................................................................................ 21
Michele Anzidei, Guendalina Menichini, and Carlo Catalano
2.1 Equipment........................................................................................... 21
2.2 Contraindications................................................................................ 21
Absolute Contraindications................................................................ 21
Relative Contraindications.................................................................. 22
Limiting Contraindications................................................................. 22
2.3 Flow Phenomena................................................................................. 22
Flow-Void Effect................................................................................. 22
In-Flow Effect..................................................................................... 23
IX
X Contents
Phase Shift Effect................................................................................ 25
Image Acquisition Techniques............................................................ 25
Non-Contrast MRA Techniques ........................................................ 26
Dark-Blood Sequences................................................................... 26
Bright-Blood Sequences................................................................. 27
ToF Sequences................................................................................ 27
Phase-Contrast Sequences.............................................................. 29
MRA Techniques with Contrast Media Administration (CE-MRA).. 30
Gradient-Echo Sequences.............................................................. 32
Determinants of Signal Intensity.................................................... 33
Contrast Media Administration...................................................... 33
Timing Evaluation Techniques....................................................... 35
K-Space Sampling Strategies ............................................................. 35
Parallel Imaging............................................................................. 37
Time-Resolved Imaging................................................................. 37
Contraindications to the Use of Contrast Medium............................. 37
2.4 Factors Determining the Quality of Images........................................ 38
Temporal and Spatial Resolution........................................................ 38
SNR..................................................................................................... 38
3 Post-Processing............................................................................................ 41
Pietro Sedati, Fulvio Zaccagna, and Carlo Augusto Mallio
3.1 Planar Reconstructions....................................................................... 43
3.2 Advanced Post-Processing Techniques............................................... 44
MPR.................................................................................................... 44
CPR..................................................................................................... 45
Multi-Path CPR................................................................................... 47
MIP..................................................................................................... 47
MinIP.................................................................................................. 50
VR....................................................................................................... 52
What Is the Best Method of Visualization?........................................ 53
4 Plaque Imaging............................................................................................ 55
Ilaria Iacucci, Luca Saba, and Michele Anzidei
4.1 Vessel Wall Anatomy.......................................................................... 55
4.2 Biomechanical Characteristics and Physiology
of the Blood Stream............................................................................ 55
Laminar Flow...................................................................................... 55
Turbulent Flow.................................................................................... 56
4.3 Mechanisms Modifying Atherosclerotic Plaque................................. 56
4.4 High-Resolution MR Imaging............................................................ 57
MR Imaging Protocol......................................................................... 58
4.5 Qualitative Assessment of Plaque Components.................................. 58
Calcifications ..................................................................................... 60
Intraplaque Hemorrhage..................................................................... 60
Fibrous Cap......................................................................................... 60
4.6 CT Plaque Imaging............................................................................. 60
Contents XI
4.7 Clinical Characteristics of Atherosclerotic Plaque............................. 64
Stable Plaque...................................................................................... 64
Unstable Plaque.................................................................................. 67
Vascular Remodeling.......................................................................... 69
5 Intracranial Circulation............................................................................. 71
Eytan Raz, Emanuele Tinelli, Ferdinando D’Ambrosio, and Francesca Caramia
5.1 Anatomy and Anatomical Variants..................................................... 71
Anterior Circulation............................................................................ 71
Posterior Circulation........................................................................... 72
Circle of Willis.................................................................................... 74
Venous System Anatomy.................................................................... 74
5.2 CTA and MRA Technique.................................................................. 75
5.3 Brain Aneurysms................................................................................ 76
5.4 Vascular Malformations...................................................................... 81
5.4.1 Arteriovenous Malformation.............................................................. 81
5.4.2 Dural Arteriovenous Fistula................................................................ 83
5.4.3 Sinus Pericranii................................................................................... 83
5.4.4 Capillary Telangiectasia...................................................................... 85
5.4.5 Developmental Venous Anomaly........................................................ 86
5.4.6 Cavernous Malformation.................................................................... 86
5.5 Atherosclerosis................................................................................... 87
5.6 Vasculitis............................................................................................. 89
5.7 Intracranial Venous Thrombosis......................................................... 90
6 Carotid Arteries........................................................................................... 93
Beatrice Cavallo Marincola, Eugenio Marotta, and Michele Anzidei
6.1 Anatomy and Anatomical Variants..................................................... 93
6.2 CTA Technique................................................................................... 95
Patient Preparation.............................................................................. 95
Acquisition Technique........................................................................ 96
6.3 MRA Technique.................................................................................. 96
Patient Preparation.............................................................................. 96
Image Acquisition............................................................................... 96
ToF Sequences................................................................................ 96
Phase Contrast Sequences.............................................................. 97
3D Gradient-Echo Sequences........................................................ 98
Time-Resolved Sequences............................................................. 99
High-Resolution Sequences (Steady-State Sequences)................. 99
6.4 Atherosclerotic Disease...................................................................... 100
6.5 Carotid Aneurysm and Pseudo-Aneurysm.......................................... 108
6.6 Arteriovenous Fistulas........................................................................ 109
6.7 Carotid Fibrodysplasia........................................................................ 110
6.8 Eagle Syndrome.................................................................................. 111
6.9 Carotid Dissection.............................................................................. 112
6.10 Carotid Paraganglioma....................................................................... 112
6.11 Vertebral Arteries................................................................................ 114
XII Contents
7 Thoracic Aorta............................................................................................ 117
Nicola Galea, Iacopo Carbone, Matteo Mangia, Ilaria Iampieri,
and Riccardo Rosati
7.1 Anatomy and Anatomical Variants..................................................... 117
7.2 CTA Technique................................................................................... 119
Patient Preparation.............................................................................. 119
Image Acquisition Protocol................................................................ 119
Cardio-Synchronization...................................................................... 119
7.3 MRA Technique.................................................................................. 121
Patient Preparation.............................................................................. 121
Image Acquisition............................................................................... 121
Black-Blood 2D ECG-Gated Turbo Spin Echo (TSE) T1-
and T2-Weighted Sequences.......................................................... 121
ECG-Gated Phase Contrast Sequence............................................ 121
True FISP Sequences ECG-Gated (Balanced Steady-State Free
Precession or bssFP)...................................................................... 122
3D GRE T1-Weighted Sequence........................................................ 124
Time-Resolved Sequence............................................................... 125
7.4 Congenital Aortic Malformations....................................................... 126
Arch Anomalies.................................................................................. 126
7.5 Acute Aortic Syndromes..................................................................... 129
Aortic Dissection................................................................................ 130
Intramural Hematoma......................................................................... 134
Penetrating Ulcer................................................................................ 136
Aortic Injury from Blunt Trauma................................................... 138
7.6 Aneurysmal Disease........................................................................... 139
Mycotic Aneurysms............................................................................ 142
7.7 Post-Surgery Imaging......................................................................... 142
Aortic Endoprosthesis.................................................................... 142
Endoleak............................................................................................. 143
Other Complications........................................................................... 145
Infection of the Endoprosthesis.......................................................... 145
Surgical Prosthesis.............................................................................. 148
Aortic Valve Replacement.................................................................. 148
Aortic Prosthesis................................................................................. 149
Aortic Root Replacement .................................................................. 149
Origin of Epiaortic Vessels................................................................. 149
Combined Intervention....................................................................... 149
Dehiscence of the Anastomosis.......................................................... 151
Surgical Treatment for Aortic Coarctation.......................................... 152
7.8 Aortic Valvulopathy............................................................................ 153
Aortic Valve Stenosis.......................................................................... 153
Aortic Valve Insufficiency.................................................................. 156
7.9 Inherited Disorders of Connective Tissue: Marfan Syndrome,
Ehler-Danlos Syndrome...................................................................... 156