Advances in cardiac computed tomography:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2009
|
| Schriftenreihe: | Cardiology clinics
27,4 |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV S., S. 555 - 682 Ill., graph. Darst. |
| ISBN: | 1437711987 9781437711981 |
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Datensatz im Suchindex
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| adam_text | Titel: Advances in cardiac computed tomography
Autor: Garcia, Mario J.
Jahr: 2009
Advances in Cardiac Computed Tomography
Contents
Foreword xjjj
Michael H. Crawford
Preface xv
Mario J. Garcia
Cardiac CT: Understanding and Adopting a New Diagnostic Modality 555
Mario J. Garcia
For many years, the holy grail in cardiac imaging was the noninvasive anatomic eval¬
uation of the coronary arteries. Although functional tests allow for the detection of
ischemia, they lack sufficient sensitivity and specificity to reliably exclude obstruc¬
tive coronary artery disease in many symptomatic patients, and have practically
no role in establishing the presence of non-obstructive disease in asymptomatic
subjects who may benefit from preventive interventions. The very short history of
cardiac CT has demonstrated rapid technological advances and the potential to
eliminate the need for invasive diagnostic testing in patients who have suspected
coronary artery disease. This article reviews the history of this modality, the princi¬
ples and challenges for its clinical implementation, and provides a preamble to
this special issue of Cardiology Clinics-
Diagnostic Accuracy of CT Coronary Angiography 563
Divya Kapoorand Randall C.Thompson
There is a rich and rapidly growing literature on the diagnostic utility of coronary CT
angiography (CTA) and its performance relative to other modalities such as stress
testing and invasive coronary angiography. Earlier studies of 16-slice coronary
CTA showed wide variability in sensitivity (30%-95%) and some variability in spec¬
ificity (86%-98%). With 40- and 64-slice coronary CTA, more of the chest is covered
with each spin of the gantry, the breath hold is shorter, and there are fewer uninter-
pretable segments than with 16-slice coronary CTA. The very high negative predic¬
tive value is especially helpful in ruling out coronary artery disease in patients who
have low to intermediate pretest likelihood of CAD.
The Prognostic Value of Cardiac Computed Tomographic Angiography 573
Fay Y. Lin, Suzanne E. Zentko, and James K. Min
With advancements in temporal and spatial resolution, CT has excellent diagnostic
characteristics for non-invasive evaluation of coronary artery disease in appropriate
patients. Nevertheless, clinical usefulness of diagnostic testing requires not only
high diagnostic accuracy but also risk stratification for patient management. Current
guidelines for risk stratification of patients with coronary artery disease rely primarily
upon functional testing; alternatively, anatomic risk stratification may also be per¬
formed with invasive coronary angiography. This article reviews current and emerg¬
ing concepts in the prognostic value of cardiac CT angiography.
Contents
Cardiac CT in the Emergency Department 587
Kavitha M. Chinnaiyan, Gilbert L. Raff, and James A. Goldstein
In the United States alone, nearly 6 million patients present annually to emergency
departments with complaints of chest pain suggestive of acute coronary ischemia.
Most of these patients have a non-negligible risk for acute coronary syndrome(s)
(ACS) and undergo extended observation and workup for an ischemic cause. Of
those admitted for extended observation, less than 30% of patients have true
ACS. In patients with a low to intermediate probability, cardiac CT performs well
in ruling out coronary artery disease, and American College of Cardiology and Amer¬
ican Heart Association guidelines deem this application to be appropriate. This
article reviews the application of CT for the evaluation of acute chest pain the emer¬
gency department.
Functional Versus Anatomic Imaging in Patients with Suspected Coronary
Artery Disease 597
Leslee J. Shaw and Daniel S. Berman
Patients with suspected or known coronary artery disease often require evaluation
by cardiac imaging tests. The purpose of these tests may vary according to each in¬
dividual patient, from establishing or ruling out obstructive coronary artery disease
as the cause of symptoms to determining the risk of future cardiac events and guid¬
ing the selection of medical therapy and revascularization. With the adoption of car¬
diac CT, most patients can have a complete evaluation noninvasively. The challenge
is to determine when anatomical evaluation of coronary artery disease or functional
evaluation of the burden of ischemia may be required. This article reviews the rela¬
tive value of anatomical versus functional imaging and their complementary role in
different clinical scenarios.
Cardiac CT in Asymptomatic Patients at Risk 605
Paolo Raggi
Atherosclerosis is a systemic process that can develop as early as the second or
third decade of life. A significant percentage of patients who experience acute cor¬
onary syndromes often have non-obstructive coronary artery disease and thus can¬
not be diagnosed by their symptoms or conventional functional stress testing. It has
been proposed that early detection of atherosclerosis would generate novel oppor¬
tunities for primary prevention through changes in lifestyle or even through drug ther¬
apy, especially in patients at high cardiovascular risk. Calcium scoring is a simple,
reproducible, and widely available test that has been extensively validated over
the past two decades. In this article, the utility of calcium scoring and the potential
application of CT coronary angiography in asymptomatic patients at risk are
reviewed.
Evaluation of Coronary Atherosclerotic Plaques 611
Christoph R. Beckerand Tobias Saam
In many patients, unheralded myocardial infarction associated with a mortality of ap¬
proximately 20% is the first manifestation of coronary artery disease. Approximately
40% of the population is considered to have a moderate midterm risk of 10% to
20%. Any of the stratification schemes suffers from a lack of accuracy to correctly
determine the risk, and uncertainty exists regarding how to treat individuals who
have been identified to be at intermediate risk. Other tools providing information
Contents
about the necessity to reassure or to treat these patients are warranted. Currently,
the assessment of the atherosclerotic plaque burden by CT may be able provide
valid information for this cohort. This article discusses the potential value and limita¬
tions of cardiac CT for evaluating coronary atherosclerotic plaque.
CT Applications in Electrophysiology 619
Subodh B. Joshi, Andrew R. Blum, Moussa Mansour, and Suhny Abbara
In recent years, extraordinary advances have been made in the management of car¬
diac arrhythmias. Increasingly complex procedures are being performed, and the
breadth of conditions for which invasive arrhythmia therapy is indicated continues
to grow. In addition to atrial and ventricular ablation procedures for treating arrhyth¬
mias, implantable defibrillators and biventricular pacemakers for cardiac resynchro-
nization therapy have made electrophysiology an important part of heart failure
management.
Evaluation of Cardiac Valves Using Multi-Detector CT 633
Juan Gaztanaga, Gonzalo Pizarro, and Javier Sanz
Cardiac CT is an accurate and reasonable alternative modality for valvular imaging. It
is used primarily for the evaluation of coronary artery disease; however, important
information regarding valvular anatomy and function can be derived from CT. Calci¬
fication is a common CT finding in various valvular abnormalities and carries impor¬
tant diagnostic and prognostic value. In addition, valvular morphology, stenosis, and
regurgitation also are detected on contrast enhanced scans, with good correlation
with trans-thoracic echocardiography and other techniques.
Left Ventricular Function, Myocardial Perf usion and Viability 645
Yasuyuki Kobayashi, Albert C. Lardo.Yasuo Nakajima, Joao A.C. Lima,
and Richard T. George
Cardiac computed tomography is now poised to revolutionize the practice of cardi¬
ology. Multi-detector row CT (MDCT) has the potential to evaluate cardiac function,
myocardial perfusion, and viability. These capabilities, combined with the robust
ability of MDCT to noninvasively image the coronary arteries, makes MDCT a com¬
prehensive tool for the evaluation of coronary artery disease and its anatomic and
physiologic impact on the myocardium. Recent technologic advances in MDCT
technology in regards to detector coverage, and spatial and temporal resolution
promise to improve the capabilities of cardiac CT in the assessment of cardiac func¬
tion, perfusion, and viability.
Recent Technologic Advances in Multi-Detector Row Cardiac CT 655
Sandra Simon Halliburton
Recent technical advances in multi-detector row CT have resulted in lower radi¬
ation dose, improved temporal and spatial resolution, decreased scan time, and
improved tissue differentiation. Lower radiation doses have resulted from the use
of pre-patient z collimators, the availability of thin-slice axial data acquisition, the
increased efficiency of ECG-based tube current modulation, and the implemen¬
tation of iterative reconstruction algorithms. Faster gantry rotation and the simul¬
taneous use of two x-ray sources have led to improvements in temporal
resolution, and gains in spatial resolution have been achieved through application
Contents
of the flying x-ray focal-spot technique in the z-direction. Shorter scan times
have resulted from the design of detector arrays with increasing numbers of de¬
tector rows and through the simultaneous use of two x-ray sources to allow
higher helical pitch. Some improvement in tissue differentiation has been
achieved with dual energy CT. This article discusses these recent technical ad¬
vances in detail.
Radiation Dose and Safety in Cardiac Computed Tomography 665
Thomas C. Gerber, Birgit Kantor, and Cynthia H. McCollough,
As a result of the changes in use of imaging procedures that rely on ionizing radia¬
tion, the collective dose has increased by over 700%, and the annual per-capita
dose by almost 600% in recent years. It is possible that this growing use may
have significant effects on public health. Although uncertainties exist related to
the accuracy of estimated radiation exposure and biologic risk, there are measures
that can be taken by the referring and the performing health care provider to reduce
the potential risks while maintaining diagnostic accuracy. This article reviews the ex¬
isting data regarding biologic hazards of radiation exposure associated with medical
diagnostic testing, the methodologies used to estimate radiation exposure and
dose, and the measures that can be taken to effectively reduce that exposure.
Index 679
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| spelling | Advances in cardiac computed tomography guest ed. Mario J. Garcia Philadelphia [u.a.] Saunders 2009 XV S., S. 555 - 682 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Cardiology clinics 27,4 Garcia, Mario J. (DE-588)13564562X edt Cardiology clinics 27,4 (DE-604)BV000008602 27,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024384448&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Advances in cardiac computed tomography Cardiology clinics |
| title | Advances in cardiac computed tomography |
| title_auth | Advances in cardiac computed tomography |
| title_exact_search | Advances in cardiac computed tomography |
| title_full | Advances in cardiac computed tomography guest ed. Mario J. Garcia |
| title_fullStr | Advances in cardiac computed tomography guest ed. Mario J. Garcia |
| title_full_unstemmed | Advances in cardiac computed tomography guest ed. Mario J. Garcia |
| title_short | Advances in cardiac computed tomography |
| title_sort | advances in cardiac computed tomography |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024384448&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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