Computed tomography of the coronary arteries

217 Pages·2008·19.2 MB·English

by  De Feyter, Pim J., Krestin, Gabriel P

COMPUTED TOMOGRAPHY OF THE
CORONARY
ARTERIES

COMPUTED TOMOGRAPHY OF THE
CORONARY
ARTERIES
EDITORS
Pim J de Feyter MD
Gabriel Ρ Krestin MD
CO-EDITORS
Filippo Cademartiri MD
Nico R Mollet MD
Koen Nieman MD
Departments of Cardiology and Radiology
University Hospital Rotterdam
The Netherlands
Taylor & Francis
Taylor & Francis Group
LONDON AND NEW YORK
A MARTIN DUNITZ BOOK
© 2005 Taylor & Francis, an imprint of the Taylor & Francis Group
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Contents
Preface vii
Acknowledgments viii
1. Basic principles 1
2. Image post-processing 27
3. Coronary imaging: normal coronary anatomy 47
4. Coronary pathology relevant to coronary imaging 53
5. Coronary stenosis 59
6. Coronary plaque imaging 79
7. Coronary calcification 89
8. Chronic total occlusion 99
9. Assessment of coronary stents 103
10. Coronary artery anomalies in the adult 111
11. Assessment of collateral circulation 119
12. Coronary bypass graft imaging 121
13. Cardiac masses, intracardiac thrombi and pericardial abnormalities 127
14. The emergency department 133
15. The great thoracic vessels 139
16. Non-cardiac findings on cardiac computed tomography 147
17. Assessment of left ventricular function 153
18. Artifacts 157
19. Contrast enhancement in coronary angiography 179
20. The future 187
References 195
Selected reading 201
Index 203
V

Preface
Fast electron-beam computed tomography (CT) was for correct clinical application and interpretation of the
first introduced as a tool for non-invasive identification CT coronary images.
of coronary findings in the early 1990s. Since then, However, many cardiologists and radiologists are not
significant advances in X-ray CT technology have acquainted with CT coronary imaging. This has inspired
occurred, the most notable being the recent introduc- the compilation of this book: Computed Tomography of the
tion of fast spiral CT coronary imaging. Coronary Arteries. It is the culmination of the collabo-
Non-invasive coronary imaging using spiral CT has rative efforts of both cardiologists and radiologists who
emerged as a diagnostic tool that permits assessment of have drawn up a practical CT text explaining the basic
the coronary lumen and coronary plaques. We think principles and applications of CT through the use of
that reliable non-invasive coronary imaging will revolu- numerous illustrations and tables, while at the same
tionize our current diagnosis and management of time avoiding the complicated technical details of CT
asymptomatic high-risk individuals and symptomatic imaging. The results of CT coronary imaging would not
patients with known or unknown coronary artery dis- have been possible without the faithful and friendly
ease. CT coronary imaging is now already entering a cooperation between cardiologists and radiologists in
phase of clinical acceptance and the rapid anticipated our institution.
technical advances foster great hopes that non-invasive We hope this book will serve its goal as a concise,
CT coronary imaging will become an alternative to con- quick reference for the understanding and interpretation
ventional diagnostic coronary angiography. A solid of CT coronary imaging.
understanding of the basic principles of CT is essential
Pim J de Feyter
Gabriel Ρ Krestin
October 2004
Vii
Acknowledgments
The editors wish to express their gratitude to the many thanks to Martin Lister, Karen Kennedy and Hannah
individuals employed in both the radiology and cardiol- Watson.
ogy departments of the Erasmus MC, Rotterdam. We would also like to thank Marcel Dijkshoorn,
Computed Tomography of the Coronary Arteries is a reflec- Berend Koudstaal and Ralf Raaijmakers for their assis-
tion of the efforts of many individuals and without their tance in patient preparation, data acquisition and post-
help this book would not have been possible. processing.
This book would not have become a reality without Finally, we would like to thank Denise Vrouenraets
the much appreciated skilful help of the members of the for her excellent secretarial assistance, enthusiasm and
staff of Taylor & Francis Medical Books, with special encouragement.
Viii
C H A P T ER 1
Basic principles
Cardiac imaging is currently one of the most rapidly absence of rotating parts. In 1990 the first spiral CT
advancing fields in clinical cardiology. Continuing tech- scanners, which provided continuous data acquisition
nical innovations are expanding the applicability and while the patient passed through the scanner, were
usefulness of non-invasive imaging modalities such as introduced, and in 1998 the first multislice spiral CT
ultrasound, nuclear imaging, positron emission tomo- scanners appeared, which allowed simultaneous acquisi-
graphy, magnetic resonance imaging and, most recently, tion of several slices per gantry rotation. These high-
computed tomography (CT). While CT has been an resolution volumetric scanners resulted in the
essential imaging tool in general medicine, for a long development of advanced three-dimensional image pro-
time it was regarded to be unsuitable for the imaging of cessing. The significantly shorter scan time of (multi-
fast-moving organs. However, current multislice spiral slice) spiral CT scanners improved angiographic
CT scanners, with rapid gantry rotation, are able to pro- applications of CT and, because of the accelerated
vide detailed and motion-free imaging of the heart and gantry rotation and improved temporal resolution of
coronary arteries. It is undeniable that spiral CT has these latest generation scanners, contrast-enhanced
entered the arena of non-invasive cardiac imaging, and electrocardiogram (ECG) synchronized cardiovascular
while its exact role in the clinical setting still needs to be imaging has become a reality.
determined, an increase in the number of cardiac spiral
CT examinations is anticipated by both cardiologists
and radiologists. COMPUTED TOMOGRAPHY BASICS
The process of CT, which includes CT coronary angio-
COMPUTED TOMOGRAPHY graphy, involves the following steps: data acquisition,
image reconstruction, post-processing, evaluation,
Computed tomography is one of the many applications reporting and communication (Figure 1.1).
of X-ray radiation. The technique was developed in the
early 1970s by Godfrey N. Hounsfield, and together
with Dr Allan MacLeod Cormack, who contributed Data acquisition
mathematical solutions, he received the Nobel Prize in
Medicine for his work in 1979. These first computed Data acquisition refers to the collection of X-ray trans-
axial tomography (CAT) scanners required days to scan, mission measurements through the patient. It requires
and hours to reconstruct a single image of the head. an X-ray source which produces a collimated X-ray
Technical advancement led to faster imaging and recon- beam in the shape of a fan. When an X-ray beam passes
struction, whole-body scanners, improved image quality through an object some of the photons are absorbed or
and dynamic imaging protocols. In the interest of car- scattered. The reduction of X-ray transmission, which is
called attenuation, depends on the atomic composition
diovascular imaging, electron-beam CT was developed
and density of the traversed tissues and the energy of the
in the mid-1980s, which is a non-mechanical CT scan-
photons. After passing through a section of the patient
ner with a high temporal resolution owing to the
1