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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3752_Библиотеки_им_академика_М_И_Перельмана
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Matthew J. Budo
Jerold S. Shinbane
Editors
Cardiac CT Imaging
Diagnosis of
Cardiovascular Disease
Third Edition
123
Cardiac CT Imaging
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Matthew J. Budoff • Jerold S. Shinbane
Editors
Cardiac CT Imaging
Diagnosis of Cardiovascular Disease
Third Edition
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Editors
Matthew J. Budoff
Division of Cardiology
Harbor-UCLA Medical Center
Torrance , CA
USA
Jerold S. Shinbane
Keck School of Medicine
University of Southern California
Los Angeles , CA
USA
Additional material to this book can be downloaded from http://extras.springer.com .
ISBN 978-3-319-28217-6 ISBN 978-3-319-28219-0 (eBook)
DOI 10.1007/978-3-319-28219-0
Library of Congress Control Number: 2016934867
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
express or implied, with respect to the material contained herein or for any errors or omissions that may have been
made.
Printed on acid-free paper
Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com)
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v
Cardiac CT has fi nally come of age. After nearly 30 years of development and growth,
tomographic X-ray is being embraced by cardiologists as a useful imaging technology. Thirty
years ago, Doug Boyd envisioned a unique CT scanner that would have suffi cient temporal
resolution to permit motion-artifact-free images of the heart. In the late 1970s, I had the good
fortune to work closely with Dr. Boyd, Marty Lipton, and Bob Herkens who had the vision to
recognize the potential of CT imaging for the diagnosis of heart disease. In the early 1980s,
when electron beam CT became available, others, including Mel Marcus (deceased), John
Rumberger, Arthur Agatston, and Dave King (deceased), were instrumental in making clinical
cardiologists aware of the potential of cardiac CT.
In 1985, several investigators recognized the potential of cardiac CT for identifying and
quantifying coronary artery calcium. Now, 20 years later, there is wide recognition of the value
of coronary calcium quantifi cation for the prediction of future coronary events in asymptomatic
people. It has been a long and arduous road, but fi nally, wide-spread screening may signifi cantly
reduce the 150,000 sudden deaths and 300,000 myocardial infarctions that occur each year in
the United States as the fi rst symptom of heart disease
In the late 1970s, it was thought that a 2.4-s scan time was very fast CT scanning. With the
development of electron beam technology, scan times of 50 ms became possible, giving rise to
terms such as fast CT, ultrafast CT, and RACAT (rapid acquisition computed axial tomography).
Now, with the development of multidetector scanners capable of 64, 128, 256, and beyond
simultaneous slices, spatial resolution is approaching that of conventional cineangiography,
and the holy grail, noninvasive coronary arteriography, appears attainable.
In this book, Drs. Matthew Budoff and Jerold Shinbane, preeminent leaders in the fi eld of
cardiac CT, have described the many and varied uses of the technology in the diagnosis of
cardiovascular disease. The book clearly documents that cardiac CT has not only arrived but
has become a very valuable and potent diagnostic tool.
Bruce H. Brundage , MD, MACC
Heart Institute of the Cascades, Bend , OR , USA
UCLA School of Medicine , Los Angeles, CA, USA
Foreword to the Second Edition
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vii
It is a testament to the intellect and diligence of the physician-scientists and engineers involved
in the fi eld of cardiovascular computed tomography that a third edition of this text is necessary
in so short a time since this fi eld was created. Our fi rst cardiac CT angiogram was performed
in January 1995, over 20 years ago. The trials and tribulations that we faced over the introduction
of this modality are reminiscent of a quote by the philosopher Arthur Schopenhauer:
All truth passes through three stages.
First, it is ridiculed.
Second, it is violently opposed.
Third, it is accepted as being self-evident.
Cardiovascular CT has now matured into a fi rmly established subspecialty of radiology and
cardiovascular medicine with a multidisciplinary society with 4000 members, a board examination, dedicated journals, numerous scientifi c statements from leading national societies, focused
national and international meetings, and clear education and training pathways. The foundation
has been provided by a sound medical literature, which continues to grow at an astounding pace.
We hope that research maintains the same forward momentum fueled by the intellectual curiosity and passion to increase the understanding of the cardiovascular system and improve patient
care. As we look ahead, we also continue to look back and acknowledge our debt to the pioneers
of this technology who dedicated their careers to forwarding this discipline, who persevered the
ridicule and violent opposition, and may or may not be enjoying the current acceptance and
utilization in this “self-evident” era of cardiac CT.
Cardiovascular CT has become a powerful risk stratifying tool for the early detection of
atherosclerosis, used as a calcium score to identify asymptomatic persons at risk of CVD. It
has also developed into the de facto noninvasive angiogram, a measure of coronary stenosis, a
substitute for coronary angiography or noninvasive exercise testing in certain clinical situations, and a powerful tool to image the heart for congenital heart disease, trans-aortic valve
procedures, perfusion imaging, and coronary anomalies. There has been a paradigm shift in its
role related to cardiovascular therapies, with progress from pre- and postprocedure assessment
to use in the actual guidance of a variety of invasive procedures.
Advances in CT scanners, imaging techniques, postprocessing workstations, and
interpretation for diagnostic and therapeutic applications have now made the fi eld relevant to
the entire spectrum of physicians who diagnose and treat cardiovascular disease. As such, a
thorough knowledge of cardiovascular CT is required for the thoughtful and individualized
application in patient care. We hope that this text will provide the substrate for a detailed
understanding of the art and science of this technology.
Torrance, CA, USA Matthew J. Budoff , MD
Jerold S. Shinbane , MD, FACC, FHRS, FSCCT
Pref ace
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ix
Part I Overview
1 Computed Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Matthew J. Budoff
2 Cardiovascular Computed Tomography: Current and Future
Scanning System Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Rine Nakanishi , Wm. Guy Weigold , and Matthew J. Budoff
3 Radiation Dosimetry and CT Dose Reduction Techniques . . . . . . . . . . . . . . . . . . . 33
Kai H. Lee
4 Orientation and Approach to Cardiovascular Images . . . . . . . . . . . . . . . . . . . . . . 47
Jerold S. Shinbane and Antreas Hindoyan
Part II Cardiac CT
5 Assessment of Cardiovascular Calcium: Interpretation,
Prognostic Value, and Relationship to Lipids and Other
Cardiovascular Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Harvey S. Hecht
6 Natural History and Impact of Interventions on CAC . . . . . . . . . . . . . . . . . . . . . 121
Paolo Raggi
7 Methodology for CCTA Image Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Mathew J. Budoff , Jerold S. Shinbane , and Songshao Mao
8 Post-processing and Reconstruction Techniques
for the Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Swaminatha V. Gurudevan
9 Coronary CT Angiography: Native Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Stephan Achenbach
10 Coronary CT Angiography After Revascularization . . . . . . . . . . . . . . . . . . . . . . 179
Joachim Eckert , Marco Schmidt , Thomas Voigtländer , and Axel Schmermund
Part III CT Angiography Assessment for Cardiac Pathology
11 Assessment of Cardiac Structure and Function by Computed
Tomography Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
John A. Rumberger
12 Cardiovascular CT for Perfusion and Delayed Contrast
Enhancement Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Ravi K. Sharma , Ilan Gottlieb , and João A. C. Lima
Contents
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