CT evaluation of coronary artery disease / Paolo Pavone, Massimo Fioranelli, David A. Dowe.

Format:

Book

Author/Creator:

Pavone, P. (Paolo)

Contributor:

Fioranelli, Massimo.

Dowe, David A.

Standardized Title:

Malattia coronarica. English

Language:

English

Italian

Subjects (All):

Angiocardiography.

Heart--Radiography.

Heart.

Coronary heart disease--Diagnosis.

Coronary heart disease.

Coronary Artery Disease--diagnosis.

Coronary Angiography.

Medical Subjects:

Coronary Artery Disease--diagnosis.

Coronary Angiography.

Physical Description:

xii, 164 pages : illustrations (some color) ; 26 cm

Place of Publication:

Milan : Springer, 2009.

Summary:

Cardiovascular diseases are the leading cause of death in Western countries. In non-fatal cases, they are associated with a decreased quality of life as well as a substantial economic burden to society. Most sudden cardiac events are related to the complications of a non-stenosing marginal plaque. For this reason, the ability to properly identify the atherosclerotic plaque with a rapid, non-invasive technique is of utmost clinical interest in therapeutic planning. Coronary CT angiography produces high-quality images of the coronary arteries, in addition to defining their location and the extent of the atherosclerotic involvement. Proper knowledge of the equipment, adequate preparation of the patient, and accurate evaluation of the images are essential to obtaining a consistent clinical diagnosis in every case. With its clear and concise presentation of CT imaging of the coronary arteries, this volume provides general practitioners and cardiologists with a basic understanding of the technique. For radiologists with no direct experience in cardiac imaging, the book serves as an important source of information on coronary pathophysiology and anatomy.

Contents:

1 Clinical Anatomy of the Coronary Circulation / Massimo Fioranelli, Carlo Gonnella, Stefano Tonioni 1

Angiographic Anatomy of the Coronary circulation 2

Intramyocardial Vascularization and the Venous Circulation 6

Variability of the Coronary Artery circulation 7

Anomalous Coronary Arteries 9

Factors Determining Coronary Artery Size 10

2 Basic Techniques in the Acquisition of Cardiac Images with CT / Paolo Pavone 15

Technical Principles in the Acquisition of Cardiac Images by CT 15

From Conventional to Spiral CT 17

From Spiral to Multislice CT 18

Detector Number and Cardiac Imaging 20

Temporal Resolution in Cardiac Imaging 20

Types of Equipment and Their Clinical Uses in Cardiac Imaging 22

Other Factors That Improve the Image Quality of CT Technology 23

3 CT Examination of the Coronary Arteries / Paolo Pavone 25

Achieving Excellent Image Quality in CT of the Coronary Arteries 25

Patient Preparation 26

Informed Consent 26

Bradycardia 27

CT Angiography of the Coronary Arteries 28

Contrast-Agent Injection 28

Contrast-Agent Injection: Role of Resistance and Venous Anatomy 29

Contrast-Agent Injection: Flow Rate and Amount 31

Contrast Agents for Angiography of the Coronary Arteries: Characteristics and Concentrations 32

Optimizing the Imaging-Acquisition Window in CT Angiography of the Coronary Arteries 33

Cardiosynchronized Acquisition 33

4 Image Reconstruction / Paolo Pavone 37

Planimetric Techniques 38

Axial Images 38

Multi-Planar Reformatting 38

Reconstruction of the Curved Plane: Curved MPR 39

Clinical Use of Planimetric Techniques 42

Volumetric Techniques (Volume Rendering) 43

Orthogonal and Perspective Imaging 43

Volume Rendering of Human Anatomy 45

Color and Virtual Lighting 46

Clinical Use of Volume-Rendering Images 48

Virtual Endoscopy 50

5 Coronary Pathophysiology / Massimo Fioranelli, Chiara Lanzillo, Francesco Peverini 53

Coronary Flow Reserve 54

Coronary Stenosis: Definition and Evaluation in Coronary Artery Disease 54

The Limits of Coronary Angiography 56

6 The Atherosclerotic Plaque / Maddalena Piro, Sara Di Michele, Massimo Fioranelli 59

The Vulnerable Plaque: Biology and Histology 60

The Vulnerable Plaque: Local and Systemic Factors Contributing to Plaque Rupture 62

7 Intravascular Ultrasound: From Gray-Scale to Virtual Histology / Fabrizio Clement, Giuseppe M. Sangiorgi 67

From Gray-Scale to Color-Coded IVUS: The Virtual-Histology Revolution 68

Lesion Classification Using IVUS-VH 71

IVUS-VH Console and Image Interpretation: Tips and Tricks 73

8 Identification and Characterization of the Atherosclerotic Plaque Using Coronary CT Angiography / Paolo Pavone, David A. Dowe 75

Normal Vascular Wall 75

Identification of Atherosclerotic Plaques in Coronary CT Angiography 76

CT Density Values and Plaque Characterization: Fibrolipidic and Calcific Plaques 76

Atherosclerotic Plaque and Disease Evolution 78

Diagnostic Evaluation of Coronary Disease During Medical Therapy 83

9 Coronary CT Angiography: Evaluation of Stenosis and Occlusion / Paolo Pavone, Roberto Leo 85

Non-Significant Moderate Stenosis 86

Calcified Plaques: Problems in Defining Vascular Stenosis 87

Significant Stenosis 89

Remodeling 93

Occlusion of the Coronary Arteries and the Development of Collateral Circulation 94

Evaluation of Coronary-Artery Stenosis: A Review of the Literature 97

Saving Lives 97

10 Current Strategies in Cardiac Surgery / Paolo Sordini 103

Standard Grafting Techniques 103

Results 106

11 Coronary CT Angiography: Evaluation of Coronary Artery Bypass Grafts / Marcello de Santis, Paolo Pavone 107

Pre-Operative CT Evaluation 107

Post-Operative Evaluation of CABG 108

CT Evaluation of CABG: Technique 109

CT Evaluation of CABG: Results 109

12 Coronary Stents / Enric Mariano, Giuseppe M. Sangiorgi 113

Types of Stents 114

Mechanism of Stent Expansion 115

Materials 116

Raw Material 116

Fabrication Methods 116

Geometry 118

Closed Cell 118

Open Cell 118

Coatings 119

Additions 119

Radio-Opacity Enhancements 119

Drugs 119

Impact of Stent Design on Clinical Outcome 121

Acute Outcome 121

Long-Term Outcome 122

Stent Coating 122

Drug Elution 123

Bioabsorbable and Biocompatible Stents 124

Polymer-Free Solutions 126

Biodegradable Platforms 126

Tyrosine-Derived Polycarbonate 127

Magnesium Alloy 127

13 CT Angiography of Coronary Stents / Marcello De Santis, Paolo Pavone 129

14 X-ray Exposure in Coronary CT Angiography / Paolo Pavone 133

Damage from Ionizing Radiation 133

X-ray Dose During CT 134

Techniques for Limiting X-ray Exposure in Coronary CT Angiography 134

X-ray Exposure and Patient Age 136

15 Use of MSCT Scanning in the Emergency-Room Evaluation of Patients with Chest Pain / Giulio Speciale, Vincenzo Pasceri 139

Causes of Acute Chest Pain 140

Multislice CT Scanning in Acute Chest Pain 142

The "Triple Rule Out" Protocol 144

16 Current Recommendations for Coronary CT Angiography / Massimo Fioranelli, Francesca Sbandi 147

Technical Considerations 148

Evaluation of Coronary Stenoses in Patients at Low or Intermediate Risk of Cardiovascular Disease 148

Evaluation of Coronary-Artery Bypass Patency 149

Other Frequent Uses of Coronary CT Angiography 150

Contraindications to Coronary CT Angiography 150

Future Directions in Non-invasive Coronary Artery Imaging with Coronary CT Angiography 150

17 Prognostic Value of Coronary CT / Massimo Fioranelli, Antonio Lucifero 153.

Notes:

"Originally published as 'Malattia coronarica: fisiopatologia e diagnostica non invasiva con TC' ... Springer-Verlag Italia 2008."--T.p. verso.

Includes bibliographical references (pages [157]-[165]).

ISBN:

8847011256

9788847011250

9788847011267

8847011264

OCLC:

298178930