Table Of Content(cid:37)(cid:66)(cid:87)(cid:74)(cid:69)(cid:1)(cid:34)(cid:15)(cid:1)(cid:37)(cid:80)(cid:88)(cid:70)
(cid:46)(cid:66)(cid:84)(cid:84)(cid:74)(cid:78)(cid:80)(cid:1)(cid:39)(cid:74)(cid:80)(cid:83)(cid:66)(cid:79)(cid:70)(cid:77)(cid:77)(cid:74)(cid:1)
Editors
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Imaging
(cid:36)(cid:80)(cid:83)(cid:80)(cid:79)(cid:66)(cid:83)(cid:90)(cid:1)(cid:34)(cid:83)(cid:85)(cid:70)(cid:83)(cid:74)(cid:70)(cid:84)
Second edition
In collaboration with
Roberto Leo
With a collection
of clinical cases
123
Imaging Coronary Arteries
David A. Dowe
Massimo Fioranelli
Paolo Pavone
Editors
Imaging
Coronary Arteries
Second edition
In collaboration with
Roberto Leo
With a collection
of clinical cases
Springer
Editors
David A. Dowe
Coronary CTA Program Director
Atlantic Medical Imaging
Galloway, NJ, USA
Massimo Fioranelli
Head of Heart Center
Casa di Cura Mater Dei
Rome, Italy
Scientific Director of the
Centro Studi in Scienze della Vita
“Guglielmo Marconi” University
Rome, Italy
Paolo Pavone
Radiology Department
Casa di Cura Mater Dei
Rome, Italy
ISBN 978-88-470-2681-0 ISBN 978-88-470-2682-7 (eBook)
DOI 10.1007/978-88-470-2682-7
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Preface to the Second Edition
Coronary artery disease (CAD) is one of the leading causes of death in de-
veloped countries, yet for many years the prediction of clinical events has been
reliant upon methods with substantial drawbacks. Non-invasive, indirect ex-
aminations such as Framingham risk factors, thorough clinical examination,
EKG and the treadmill test yield valid information but certainly do not pro-
vide a safe and complete assessment of the presence of CAD. Even nuclear
medicine techniques provide only indirect information on the presence of dis-
ease and are not always specific. On the other hand, direct imaging of the coro-
nary arteries using selective coronary angiography, possible since the 1960s,
is an invasive procedure that is not well tolerated by patients; this remains true
despite progress in catheter and guidewire design and the development of
stenting procedures that allow diagnosis and therapy within the same clinical
setting.
Coronary CT angiography has been proposed relatively recently as an al-
ternative to selective coronary angiography. Progress in equipment design has
transformed what was originally a research tool into a reliable, clinically ac-
cepted procedure that is easy to perform. The widely debated issue of X-ray
dose has now been partially solved as we have moved from an absolutely un-
acceptable dose of 25-30 mSv to a routine dose of 3-5 mSv or even 1 mSv.
Furthermore, a reduction in the acquisition time has permitted the contrast
medium dose to be consistently lowered from 120-150 ml to 40-50 ml. Ac-
ceptance of coronary CT angiography continues to grow, although there is still
no consensus on its role as a non-invasive diagnostic test in intermediate risk
patients.
Looking beyond coronary CT angiography, magnetic resonance angiog-
raphy (MRA) of the coronary arteries has been the subject of considerable
clinical research but has not yet entered general clinical practice despite ad-
vances on various fronts. A further significant advance is the use of techniques
that allow imaging of the coronary arterial walls during selective coronary an-
giography (intravascular ultrasound, IVUS, and optical coherence tomogra-
phy, OCT); this approach is improving our understanding of CAD and pro-
viding better evidence of the type of vascular wall involvement.
This new edition of Imaging Coronary Arteries fully reflects the latest ad-
vances in coronary CT angiography and includes extensively revised or en-
tirely new chapters on IVUS, catheter angiography and OCT as well as dis-
cussion of the role of nuclear imaging and MRA. A further very significant
V
VI Preface to the Second Edition
new feature is the inclusion of 74 clinical cases that will serve to illustrate the
wide range of clinical cases encountered in daily practice and to demonstrate
the utmost importance of correlation of clinical and imaging findings.
The editors would like to express their gratitude to all who have been in-
volved in the preparation of this edition, which will without doubt be of great
interest to radiologists, cardiologists, CT technologists and others. Special
thanks are due to Dr. Marco Rengo, Dr. Carlo Nicola De Cecco, Dr. Davide
Bellini, Dr. Damiano Caruso and Dr. Marco Maria Maceroni for their support
in the preparation of the updated chapters 2, 3, 4, 8 and 9.
November 2012 David A. Dowe
Massimo Fioranelli
Paolo Pavone
Preface to the First Edition
Coronary CT angiography (CTA) is rapidly changing the patient-care algo-
rithms used to detect coronary artery disease, as well as the approach we take
in risk-factor assessment and in the triage of patients. The rapid adoption of
coronary CTA into clinical practice has been fueled by significant yearly ad-
vances in CT technology, which have improved the spatial and temporal res-
olution of this technique while simultaneously decreasing radiation exposure.
The growing utilization of coronary CTA has created a need for compre-
hensive didactic texts that explain the numerous applications of this new tech-
nology with respect to the pathophysiology of coronary artery disease, while
also providing information on the approach to patients who have undergone
previous bypass surgery or percutaneous coronary intervention. I believe this
book accomplishes both of these goals, and does so in a reader-friendly for-
mat. The image quality of the many figures that accompany each chapter is
excellent and reflects the use of state of the art technology. The techniques
described for plaque detection and characterization represent the current think-
ing pervasive in the coronary CTA community. The comprehensive reference
list at the end of the book offers the reader a wealth of resources for further
study.
There is no doubt that this book will be popular with radiologists, cardi-
ologists, CT technologists and anyone else seeking to acquire a comprehen-
sive understanding of coronary artery disease and its depiction using coro-
nary CTA.
Galloway, October 2008 David A. Dowe, MD
VII
Contents
1 Clinical Anatomy of the Coronary Circulation . . . . . . . . . . . 1
Massimo Fioranelli, Carlo Gonnella, Stefano Tonioni,
Fabrizio D’Errico and Mariantonietta Carbone
2 Basic Techniques in the Acquisition of Cardiac Images
with CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Paolo Pavone
3 CT Examination of the Coronary Arteries . . . . . . . . . . . . . . . 21
Paolo Pavone
4 Image Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Paolo Pavone
5 Coronary Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mara Piccoli, Serafino Orazi, Giovanna Giubilato
and Massimo Fioranelli
6 Clinical Classification of Coronary Artery Disease:
Who Should Be Treated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Damien Casagrande, Jean-Jacques Goy, Mario Togni,
Jean Christophe Stauffer and Stéphane Cook
7 Intravascular Ultrasound: From Gray-Scale
to Virtual Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Giuseppe M. Sangiorgi, Luigi Politi, Chiara Leuzzi,
Luigi Mattioli, Fabiana Rollini and Massimo Fioranelli
8 Identification and Characterization of the Atherosclerotic
Plaque Using Coronary CT Angiography . . . . . . . . . . . . . . . . 63
Paolo Pavone, David A. Dowe and Roberto Leo
9 Coronary CT Angiography: Evaluation of Stenosis
and Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Paolo Pavone and Roberto Leo
IX
X Contents
10 Current Strategies in Cardiac Surgery . . . . . . . . . . . . . . . . . . 85
Andrea Montalto and Francesco Musumeci
11 Coronary CT Angiography: Evaluation of Coronary
Artery Bypass Grafts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Carlo Nicola De Cecco, Gorka Bastarrika and Marco Rengo
12 Coronary Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Enrica Mariano, Giuseppe M. Sangiorgi and Massimo Fioranelli
13 CT Angiography of Coronary Stents . . . . . . . . . . . . . . . . . . . . 115
Gorka Bastarrika, Carlo Nicola De Cecco and U. Joseph Schoepf
14 X-Ray Exposure in Coronary CT Angiography . . . . . . . . . . . 131
Paolo Pavone and Roberto Leo
15 Optical Coherence Tomography in the Cathlab . . . . . . . . . . . 137
Francesco Prati and Luca Di Vito
16 Triple Rule Out: the Use of Cardiac CT
in the Emergency Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Giulio Speciale and Vincenzo Pasceri
17 Contraindications to Coronary CT Angiography . . . . . . . . . . 153
David A. Dowe
18 Prognostic Value of Coronary CT . . . . . . . . . . . . . . . . . . . . . . 157
Bruno Pironi, Antonio Lucifero and Massimo Fioranelli
19 Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
David A. Dowe, Paolo Pavone and Massimo Fioranelli
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Contributors
Gorka BastarrikaCardiothoracic Imaging Division, Department of Medical
Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
Mariantonietta CarboneInterventional Cardiovascular Unit, San Carlo Hos-
pital, Rome, Italy
Damien Casagrande Cardiology Service, Hôpital Cantonal, Fribourg,
Switzerland
Stéphane Cook Cardiology Service, Hôpital Cantonal, Fribourg, Switzerland
Carlo Nicola De CeccoDepartment of Radiological Sciences, Oncology and
Pathology, University of Rome “La Sapienza” Polo Pontino, Latina, Italy
Fabrizio D’Errico Interventional Cardiovascular Unit, San Carlo Hospital,
Rome, Italy
Luca Di VitoCLI Foundation, Centro per la Lotta contro l’Infarto, Rome,
Italy
David A. DoweCoronary CTA Program Director, Atlantic Medical Imaging,
Galloway, NJ, USA
Massimo FioranelliHead of Heart Center, Casa di Cura Mater Dei, Rome,
Italy. Scientific Director of the Centro Studi in Scienze della Vita,
“Guglielmo Marconi” University, Rome, Italy
Giovanna GiubilatoHeart Center, Casa di Cura Mater Dei, Rome, Italy
Carlo Gonnella Cardiology Department, “San Carlo di Nancy” Hospital,
Rome, Italy
Jean-Jacques GoyCardiology Service, Hôpital Cantonal, Fribourg, Switzer-
land
Roberto Leo Internal Medicine, University of Rome Tor Vergata, Rome, Italy
Chiara Leuzzi Interventional Cardiology, Policlinico Universitario, Modena,
Italy
Antonio Lucifero Heart Center, Casa di Cura Mater Dei, Rome, Italy
Enrica MarianoInterventional Cardiology Unit, “Tor Vergata” University,
Rome, Italy
XI
