Multi-Slice and Dual-Source CT in Cardiac Imaging: Principles, Protocols, Indications, Outlook

by Ohnesorge, Bernd M.; Flohr, Thomas G.; Becker, Christoph R.; Knez, Andreas; Reiser, Maximilian, M.D.

• ISBN13: 9783540255239
• ISBN10: 3540255230
• Edition: 2nd
• Format: Hardcover
• Copyright: 2006-12-04
• Publisher: Springer Verlag

Summary

Cardiac diseases, and in particular coronary artery disease, are the leading cause of death and morbidity in industrialized countries. The development of non-invasive imaging techniques for the heart and the coronary arteries has been considered a key element in improving patient care. A breakthrough in cardiac imaging using CT occurred in 1998, with the introduction of multi-slice computed tomography (CT). Since then, amazing advances in performance have taken place with scanners that acquire up to 64 slices per rotation. This book discusses the state-of-the-art developments in multi-slice CT for cardiac imaging as well as those that can be anticipated in the future. It serves as a comprehensive work that covers all aspects of this technology, from the technical fundamentals and image evaluation all the way to clinical indications and protocol recommendations. This fully reworked second edition draws on the most recent clinical experience obtained with 16- and 64-slice CT scanners by world-leading experts from Europe and the United States. It also includes "hands-on" experience in the form of 10 representative clinical case studies, which are included on the accompanying CD. As a further highlight, the latest results of the very recently introduced dual-source CT, which may soon represent the CT technology of choice for cardiac applications, are presented. This book will not only convince the reader that multi-slice cardiac CT has arrived in clinical practice, it will also make a significant contribution to the education of radiologists, cardiologists, technologists, and physicists"whether newcomers, experienced users, or researchers.

Table of Contents

Introduction	1	(22)
Bernd Ohnesorge
Basic Principles of CT Imaging	1	(2)
Established Imaging Modalities for Cardiac Imaging	3	(8)
Invasive Imaging	3	(5)
Non-invasive Imaging	8	(3)
Clinical Goals for CT in the Diagnosis of Cardiac and Thoracic Diseases	11	(3)
Coronary Artery Disease	11	(2)
Other Cardiac Diseases	13	(1)
Diseases of the Thoracic Vessels	14	(1)
The History and Evolution of CT in Cardiac Imaging	14	(9)
Principles and Applications of Electron-Beam CT	14	(3)
Cardiac Imaging with Conventional Mechanical CT	17	(3)
References	20	(3)
Cardiac and Cardiothoracic Anatomy in CT	23	(18)
Roman Fischbach
Topography	23	(1)
Standard Views	24	(6)
Coronary Arteries and Veins	30	(2)
Pericardium	32	(1)
Cardiac Chambers	33	(1)
Cardiac Valves	34	(1)
Great Vessels	35	(6)
References	39	(2)
Multi-slice CT Technology	41	(30)
Thomas Flohr
Bernd Ohnesorge
Evolution from 1 to 64 Slices	41	(4)
Principles of Multi-slice CT System Design	45	(7)
Multi-slice CT Acquisition and Reconstruction for Body Imaging	52	(19)
Definition of the Pitch	52	(1)
The Cone-Angle Problem in Multi-slice CT	53	(1)
Multi-slice Spiral Reconstruction Neglecting the Cone-Beam Geometry	54	(4)
Multi-slice Spiral Reconstruction with Cone-Beam Algorithms	58	(9)
References	67	(4)
Principles of Multi-slice Cardiac CT Imaging	71	(56)
Bernd Ohnesorge
Thomas Flohr
Basic Performance Requirements for CT Imaging of the Heart	71	(2)
CT Imaging with Optimized Temporal Resolution: The Principle of Half-Scan Reconstruction	73	(3)
Prospectively ECG-Triggered Multi-slice CT	76	(3)
Retrospectively ECG-Gated Multi-slice CT	79	(27)
Multi-slice Cardiac Spiral Reconstruction	81	(2)
ECG-Gated Multi-slice Spiral Acquisition	83	(5)
Segmented Cardiac Reconstruction Algorithms	88	(9)
Cardiac Cone-Beam Reconstruction Algorithms	97	(4)
ECG-Gated Spiral Scanning with Increased Volume Speed	101	(5)
Synchronization with the ECG and Cardiac Motion	106	(7)
ECG-Based Phase Selection	106	(2)
The Pros and Cons of ECG Gating and ECG Triggering	108	(2)
Alternative Cardiac-Motion Gating Approaches	110	(3)
Radiation Exposure Considerations	113	(14)
Principles of Radiation Dose Measurement in CT	113	(4)
Radiation Exposure for Selected Cardiac Examination Protocols	117	(2)
Exposure Reduction with ECG-Gated Tube-Current Modulation	119	(2)
Optimization for Different Patient Sizes	121	(2)
Optimization of Contrast-to-Noise Ratio	123	(1)
References	124	(3)
Clinical Examination Protocols with 4- to 64-Slice CT	127	(24)
Bernd Ohnesorge
Quantification of Coronary Artery Calcification	127	(6)
CT Angiography of the Cardiac Anatomy and Coronary Arteries	133	(8)
Cardiac Function Imaging	141	(3)
Cardiothoracic Examination Protocols	144	(7)
References	148	(3)
Image Visualization and Post-processing Techniques	151	(41)
Thomas Flohr
Bernd Ohnesorge
Trans-axial Image Slices	151	(2)
Multi-planar Reformation	153	(1)
Maximum-Intensity Projection	154	(3)
Volume-Rendering Technique	157	(5)
Vessel Segmentation and Vessel Analysis	162	(3)
Four-Dimensional Visualization and Functional Parameter Assessment	165	(4)
Myocardial Perfusion Evaluation	169	(2)
Quantification of Coronary Calcification	171	(8)
References	176	(3)
Clinical Indications
Current and Future Clinical Potential	179	(13)
Christoph Becker
Andreas Knez
Cardiac Multi-slice CT Technique	179	(1)
Coronary Calcium Screening	180	(2)
Coronary CT Angiography	182	(7)
Non-coronary Applications	189	(1)
References	190	(2)
Risk Assessment with Coronary Artery Calcium Screening	192	(13)
Roman Fischbach
Introduction	192	(1)
Methods of Coronary Artery Calcification Quantification	192	(3)
Multi-slice CT Examination Technique	195	(2)
Clinical Applications of Coronary Calcium Measurement	197	(3)
Further Clinical Applications of Calcium Scanning	200	(2)
Conclusion	202	(1)
References	203	(2)
Detection and Exclusion of Coronary Artery Stenosis	205
Koen Nieman
N. Mollet
F. Cademartiri
F. de Feyter
Introduction	205	(1)
Diagnostic Performance of 4-Slice CT	205	(1)
Diagnostic Performance of 16-Slice CT	206	(1)
Diagnostic Performance of 64-Slice CT	207	(1)
Image Processing and Analysis	208	(1)
Discussion	208	(4)
References	212
Assessment and Interpretation of Atherosclerotic Coronary Plaques	192	(32)
Stephan Achenbach
Clinical Background	214	(1)
Clinical Concepts	215	(1)
Visualization of Coronary Atherosclerotic Plaques	215	(1)
Visualization of Non-calcified Plaques by Multi-slice CT	215	(4)
Perspective	219	(2)
References	221	(3)
Coronary CT Angiography in Patients with Chest Pain	224	(8)
Axel Kuttner
Stephen Schroder
Clinical Background	224	(1)
Methods and Protocols	225	(1)
Results in a Representative Patient Population	226	(2)
Discussion	228	(2)
References	230	(2)
Evaluation of Coronary Artery Bypass Grafts	232	(7)
Axel Kuttner
Andreas Kopp
Clinical Background	232	(1)
Protocol to Assess Graft Patency and Native Vessels with Multi-slice CT	233	(2)
Results in a Representative Patient Population	235	(2)
Conclusion	237	(1)
References	238	(1)
Patency Control of Coronary Stents	239	(6)
Koen Nieman
N. Mollet
F. Candemartiry
F. de Feyter
Introduction	239	(1)
CT Imaging Characteristics of Stents	239	(1)
Post-processing and Analysis	240	(1)
In Vivo Coronary Stent Imaging	241	(1)
Conclusion	242	(2)
References	244	(1)
Evaluation of the Coronary Anomaly, Fistula, Aneurysm, and Dissection	245	(13)
Steffen Frohner
Introduction	245	(1)
Anomalies of the Coronary Arteries	245	(1)
Coronary Artery Fistulas	246	(5)
Myocardial Bridges	251	(3)
Coronary Aneurysms	254	(1)
Coronary Dissection	254	(2)
Coronary Vasculitis	256	(1)
Conclusion	256	(1)
References	256	(2)
Diagnosis of Congenital Heart Disease in Adults and Children	258	(8)
Jean-Francois Paul
Introduction	258	(1)
Technical Aspects and Imaging Protocols	258	(3)
Clinical Indications	261	(2)
Improvements with 64-Slice CT	263	(1)
Conclusion	263	(2)
References	265	(1)
Evaluation of Ventricular Function Parameters	266	(15)
Kai Uwe Jurgens
Roman Fischbach
Introduction	266	(1)
Determination of Cardiac Function Parameters with Multi-slice CT	267	(2)
Data Acquisition and Image Reconstruction	269	(1)
Image Analysis	270	(1)
Limitations	270	(2)
Clinical Considerations	272	(5)
Summary and Outlook	277	(2)
References	279	(2)
Imaging and Diagnosis of Cardiac Valves	281	(9)
Jurgen Willmann
Introduction	281	(1)
Technical Considerations	281	(1)
Valvular Morphology	282	(1)
Valvular Disease	283	(2)
Limitations	285	(1)
Conclusion	286	(1)
References	286	(4)
Visualization of Cardiac Tumors and Masses	290	(6)
Bernd Wintersperger
Introduction	288	(2)
Imaging Techniques	290	(1)
Epidemiology of Cardiac Masses and Clinical Application of CT	290	(3)
Conclusion	293	(2)
References	295	(1)
Imaging of the Pulmonary Veins in Patients with Atrial Fibrillation	296	(11)
Michael Poon
C. Learra
Introduction	296	(1)
Pharmacological Treatment Options	297	(1)
Non-pharmacological Treatment of Atrial Fibrillation: Catheter Ablation	298	(1)
The Role of Imaging in the Era of Catheter Ablation of the Pulmonary Veins	299	(1)
Multi-slice CT Imaging of the Pulmonary Veins and Left Atrium	299	(3)
The Role of Multi-slice CT in Catheter Ablation of Afib	302	(1)
Conclusions	303	(2)
References	305	(2)
Potential of Myocardial Perfusion and Viability Studies	307	(10)
Konstantin Nikolaou
Bernd Wintersperger
Introduction	307	(1)
Principles of Myocardial Perfusion Assessment	307	(1)
Technical Considerations of Multi-slice CT	308	(1)
Study Data on Myocardial Perfusion Imaging Using Multi-slice CT	308	(2)
Assessment of Myocardial Viability with Multi-Slice CT	310	(3)
Conclusion	313	(2)
References	315	(2)
Cardiothoracic Multi-Slice CT in the Emergency Department	317	(10)
Uwe-Joseph Schopf
ECG-Gated Multi-Slice CT Scanning of the Chest	317	(3)
Patients with Equivocal Chest Pain in the Emergency Department	320	(1)
64-Slice CT as a Triage Tool in the Emergency Department	320	(4)
References	324	(3)
Future Technical Developments in Cardiac CT	327	(32)
Bernd Ohnesorge
Limitations and Pitfalls with Today's Multi-slice CT	327	(5)
Temporal Resolution	327	(1)
Volume Coverage	328	(1)
Spatial Resolution and Signal-to-Noise Ratio	329	(2)
Radiation Exposure	331	(1)
A Future for Electron-Beam CT?	332	(2)
Future Possibilities with Area Detector CT	334	(1)
New Frontiers with Dual-Source CT	335	(24)
Dual-Source CT: System Concept and Design	338	(1)
Dual-Source CT: Cardiac Scanning Principles and Techniques	339	(3)
Dual-Source CT: System Performance Evaluation	342	(5)
Dual-Source CT: Clinical Scan Protocols and Preliminary Clinical Results	347	(10)
References	357	(2)
Subject Index	359