Integrated Cardiothoracic Imaging with Computed Tomography

Abstract

The respiratory and the cardiovascular systems are intimately connected. Because of the high degree of morphological and functional interaction, pathophysiological processes in one compartment are likely to induce adaptive changes in the other. Computed tomography (CT) plays a central role in the diagnostic work up of both thoracic and cardiac disorders. Historically, these two systems have been evaluated separately; however, CT technology has evolved remarkably over recent decades. Up-to-date advanced imaging strategies allow for a combined assessment of the cardiopulmonary unit. Besides improved techniques of electrocardiogram (ECG)-synchronization for obtaining both morphological and functional information, latest advances of dual-source CT (DSCT) have shown great promise for even more comprehensive integrated cardiothoracic imaging.

Keywords

chest imaging - heart disease - lung diseases - cardiopulmonary comorbidities - computed tomography angiography - dual-source computed tomography

• References

• 1 Han MK, McLaughlin VV, Criner GJ, Martinez FJ. Pulmonary diseases and the heart. Circulation 2007; 116 (25) 2992-3005
• 2 Loubeyre P, Angelie E, Grozel F, Abidi H, Minh VA. Spiral CT artifact that simulates aortic dissection: image reconstruction with use of 180 degrees and 360 degrees linear-interpolation algorithms. Radiology 1997; 205 (1) 153-157
• 3 Schoepf UJ, Helmberger T, Holzknecht N , et al. Segmental and subsegmental pulmonary arteries: evaluation with electron-beam versus spiral CT. Radiology 2000; 214 (2) 433-439
• 4 Boehm T, Willmann JK, Hilfiker PR , et al. Thin-section CT of the lung: does electrocardiographic triggering influence diagnosis?. Radiology 2003; 229 (2) 483-491
• 5 Montaudon M, Berger P, Blachère H, De Boucaud L, Latrabe V, Laurent F. Thin-section CT of the lung: influence of 0.5-s gantry rotation and ECG triggering on image quality. Eur Radiol 2001; 11 (9) 1681-1687
• 6 Ritchie CJ, Godwin JD, Crawford CR, Stanford W, Anno H, Kim Y. Minimum scan speeds for suppression of motion artifacts in CT. Radiology 1992; 185 (1) 37-42
• 7 Achenbach S, Ropers D, Holle J, Muschiol G, Daniel WG, Moshage W. In-plane coronary arterial motion velocity: measurement with electron-beam CT. Radiology 2000; 216 (2) 457-463
• 8 Wang Y, Watts R, Mitchell I , et al. Coronary MR angiography: selection of acquisition window of minimal cardiac motion with electrocardiography-triggered navigator cardiac motion prescanning—initial results. Radiology 2001; 218 (2) 580-585
• 9 Ohnesorge BM, Hofmann LK, Flohr TG, Schoepf UJ. CT for imaging coronary artery disease: defining the paradigm for its application. Int J Cardiovasc Imaging 2005; 21 (1) 85-104
• 10 Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U. Subsecond multi-slice computed tomography: basics and applications. Eur J Radiol 1999; 31 (2) 110-124
• 11 Schoepf UJ, Becker CR, Bruening RD , et al. Electrocardiographically gated thin-section CT of the lung. Radiology 1999; 212 (3) 649-654
• 12 Schoepf UJ, Holzknecht N, Helmberger TK , et al. Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 2002; 222 (2) 483-490
• 13 Remy-Jardin M, Tillie-Leblond I, Szapiro D , et al. CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value. Eur Radiol 2002; 12 (8) 1971-1978
• 14 Ohnesorge B, Flohr T, Becker C , et al. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 2000; 217 (2) 564-571
• 15 Flohr T, Ohnesorge B. Heart rate adaptive optimization of spatial and temporal resolution for electrocardiogram-gated multislice spiral CT of the heart. J Comput Assist Tomogr 2001; 25 (6) 907-923
• 16 Flohr T, Prokop M, Becker C , et al. A retrospectively ECG-gated multislice spiral CT scan and reconstruction technique with suppression of heart pulsation artifacts for cardio-thoracic imaging with extended volume coverage. Eur Radiol 2002; 12 (6) 1497-1503
• 17 Jakobs TF, Becker CR, Wintersperger BJ , et al. CT angiography of the coronary arteries with a 16-row spiral tomograph. Effect of spatial resolution on image quality. Radiologe 2002; 42 (9) 733-738
• 18 Flohr T, Ohnesorge B, Bruder H , et al. Image reconstruction and performance evaluation for ECG-gated spiral scanning with a 16-slice CT system. Med Phys 2003; 30 (10) 2650-2662
• 19 Coche E, Vlassenbroek A, Roelants V , et al. Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography. Eur Radiol 2005; 15 (7) 1432-1440
• 20 Delhaye D, Remy-Jardin M, Teisseire A , et al. MDCT of right ventricular function: comparison of right ventricular ejection fraction estimation and equilibrium radionuclide ventriculography, part 1. AJR Am J Roentgenol 2006; 187 (6) 1597-1604
• 21 Coche E, Verschuren F, Kefer J. Acute coronary artery occlusion revealed by ECG-gated 16-slice CT scan of the whole chest. Eur Heart J 2005; 26 (20) 2098
• 22 White CS, Kuo D, Kelemen M , et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation?. AJR Am J Roentgenol 2005; 185 (2) 533-540
• 23 Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J. When, why, and how to examine the heart during thoracic CT: Part 2, clinical applications. AJR Am J Roentgenol 2006; 186 (2) 333-341
• 24 Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J. When, why, and how to examine the heart during thoracic CT: Part 1, basic principles. AJR Am J Roentgenol 2006; 186: 324-32
• 25 Salem R, Remy-Jardin M, Delhaye D , et al. Integrated cardio-thoracic imaging with ECG-Gated 64-slice multidetector-row CT: initial findings in 133 patients. Eur Radiol 2006; 16 (9) 1973-1981
• 26 Johnson TR, Nikolaou K, Wintersperger BJ , et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol 2007; 188 (1) 76-82
• 27 Choi SI, George RT, Schuleri KH, Chun EJ, Lima JA, Lardo AC. Recent developments in wide-detector cardiac computed tomography. Int J Cardiovasc Imaging 2009; 25 (Suppl. 01) 23-29
• 28 Flohr TG, McCollough CH, Bruder H , et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 2006; 16 (2) 256-268
• 29 Flohr TG, Leng S, Yu L , et al. Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution: image reconstruction and assessment of image quality. Med Phys 2009; 36 (12) 5641-5653
• 30 Flohr TG, Bruder H, Stierstorfer K, Petersilka M, Schmidt B, McCollough CH. Image reconstruction and image quality evaluation for a dual source CT scanner. Med Phys 2008; 35 (12) 5882-5897
• 31 Johnson TR, Nikolaou K, Becker A , et al. Dual-source CT for chest pain assessment. Eur Radiol 2008; 18 (4) 773-780
• 32 Lell M, Hinkmann F, Anders K , et al. High-pitch electrocardiogram-triggered computed tomography of the chest: initial results. Invest Radiol 2009; 44 (11) 728-733
• 33 Scharf M, Bink R, May MS , et al. High-pitch thoracic CT with simultaneous assessment of coronary arteries: effect of heart rate and heart rate variability on image quality and diagnostic accuracy. JACC Cardiovasc Imaging 2011; 4 (6) 602-609
• 34 Tacelli N, Remy-Jardin M, Flohr T , et al. Dual-source chest CT angiography with high temporal resolution and high pitch modes: evaluation of image quality in 140 patients. Eur Radiol 2010; 20 (5) 1188-1196
• 35 Remy-Jardin M, Faivre JB, Santangelo T, Tacelli N, Remy J. Imaging the heart-lung relationships during a chest computed tomography examination: is electrocardiographic gating the only option?. J Thorac Imaging 2010; 25 (3) 239-246
• 36 Hein PA, Romano VC, Lembcke A, May J, Rogalla P. Initial experience with a chest pain protocol using 320-slice volume MDCT. Eur Radiol 2009; 19 (5) 1148-1155
• 37 Durmus T, Rogalla P, Lembcke A, Mühler MR, Hamm B, Hein PA. Low-dose triple-rule-out using 320-row-detector volume MDCT—less contrast medium and lower radiation exposure. Eur Radiol 2011; 21 (7) 1416-1423
• 38 Sommer WH, Schenzle JC, Becker CR , et al. Saving dose in triple-rule-out computed tomography examination using a high-pitch dual spiral technique. Invest Radiol 2010; 45 (2) 64-71
• 39 d'Agostino AG, Remy-Jardin M, Khalil C , et al. Low-dose ECG-gated 64-slices helical CT angiography of the chest: evaluation of image quality in 105 patients. Eur Radiol 2006; 16 (10) 2137-2146
• 40 de Malherbe M, Duhamel A, Tacelli N , et al. Ultrafast imaging of the entire chest without ECG synchronisation or beta-blockade: to what extent can we analyse the coronary arteries?. Insights Imaging 2012; 3 (1) 73-79
• 41 Au DH. Use of beta blockers in patients with COPD. Thorax 2008; 63 (4) 296-298
• 42 Jacobs PC, Gondrie MJ, Mali WP , et al. Unrequested information from routine diagnostic chest CT predicts future cardiovascular events. Eur Radiol 2011; 21 (8) 1577-1585
• 43 Shriki JE, Shinbane J, Lee C , et al. Incidental myocardial infarct on conventional nongated CT: a review of the spectrum of findings with gated CT and cardiac MRI correlation. AJR Am J Roentgenol 2012; 198 (3) 496-504
• 44 Rodríguez-Granillo GA, Rosales MA, Degrossi E, Rodriguez AE. Signal density of left ventricular myocardial segments and impact of beam hardening artifact: implications for myocardial perfusion assessment by multidetector CT coronary angiography. Int J Cardiovasc Imaging 2010; 26 (3) 345-354
• 45 Bischoff B, Bamberg F, Marcus R , et al. Optimal timing for first-pass stress CT myocardial perfusion imaging. Int J Cardiovasc Imaging 2013; 29 (2) 435-442
• 46 Bamberg F, Becker A, Schwarz F , et al. Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 2011; 260 (3) 689-698
• 47 Bamberg F, Hinkel R, Schwarz F , et al. Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. Invest Radiol 2012; 47 (1) 71-77
• 48 Ruzsics B. Integrative computed tomography imaging of ischemic heart disease. J Thorac Imaging 2010; 25 (3) 231-238
• 49 Weininger M, Schoepf UJ, Ramachandra A , et al. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results. Eur J Radiol 2012; 81 (12) 3703-3710
• 50 Lim KC, Chai P, Teo LS. Incidental cardiac abnormalities on non-electrocardiogram-gated multi-detector computed tomography imaging of the thorax and abdomen. Singapore Med J 2011; 52 (12) 906-912 , quiz 913
• 51 Lee SH, Seo JB, Kang JW, Chae EJ, Park SH, Lim TH. Incidental cardiac and pericardial abnormalities on chest CT. J Thorac Imaging 2008; 23 (3) 216-226
• 52 Scherer A, Choy G, Kröpil P, Lanzman RS, Mödder U, Abbara S. Cardiac Pathologies Incidentally Detected with Non-Gated Chest CT. Rofo 2009; 181 (12) 1127-1134
• 53 Bogaert J, Centonze M, Vanneste R, Francone M. Cardiac and pericardial abnormalities on chest computed tomography: what can we see?. Radiol Med (Torino) 2010; 115 (2) 175-190
• 54 Richardson P, McKenna W, Bristow M , et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 1996; 93 (5) 841-842
• 55 Quarta G, Sado DM, Moon JC. Cardiomyopathies: focus on cardiovascular magnetic resonance. Br J Radiol 2011; 84 (Spec No 3): S296-S305
• 56 Doğan H, Kroft LJ, Huisman MV, van der Geest RJ, de Roos A. Right ventricular function in patients with acute pulmonary embolism: analysis with electrocardiography-synchronized multi-detector row CT. Radiology 2007; 242 (1) 78-84
• 57 van der Bijl N, Klok FA, Huisman MV , et al. Measurement of right and left ventricular function by ECG-synchronized CT scanning in patients with acute pulmonary embolism: usefulness for predicting short-term outcome. Chest 2011; 140 (4) 1008-1015
• 58 Lu MT, Cai T, Ersoy H , et al. Comparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism. Int J Cardiovasc Imaging 2009; 25 (1) 101-107
• 59 Liu M, Ma Z, Guo X, Zhang H, Yang Y, Wang C. Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction. Eur J Radiol 2011; 80 (3) e462-e469
• 60 Eriksson B, Lindberg A, Müllerova H, Rönmark E, Lundbäck B. Association of heart diseases with COPD and restrictive lung function—results from a population survey. Respir Med 2013; 107 (1) 98-106
• 61 Kauczor HU, Wielpütz MO, Owsijewitsch M, Ley-Zaporozhan J. Computed tomographic imaging of the airways in COPD and asthma. J Thorac Imaging 2011; 26 (4) 290-300
• 62 Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: Role of comorbidities. Eur Respir J 2006; 28 (6) 1245-1257
• 63 Abroug F, Ouanes-Besbes L, Nciri N , et al. Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease: diagnostic performance of cardiac biomarkers. Am J Respir Crit Care Med 2006; 174 (9) 990-996
• 64 Rutten FH, Cramer MJ, Grobbee DE , et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005; 26 (18) 1887-1894
• 65 Apostolovic S, Jankovic-Tomasevic R, Salinger-Martinovic S , et al. Frequency and significance of unrecognized chronic obstructive pulmonary disease in elderly patients with stable heart failure. Aging Clin Exp Res 2011; 23 (5-6) 337-342
• 66 Rennard SI. Clinical approach to patients with chronic obstructive pulmonary disease and cardiovascular disease. Proc Am Thorac Soc 2005; 2 (1) 94-100
• 67 O'Donnell DE, Parker CM. COPD exacerbations. 3: Pathophysiology. Thorax 2006; 61 (4) 354-361
• 68 Weitzenblum E, Chaouat A, Canuet M, Kessler R. Pulmonary hypertension in chronic obstructive pulmonary disease and interstitial lung diseases. Semin Respir Crit Care Med 2009; 30 (4) 458-470
• 69 Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 2005; 127 (6) 1898-1903
• 70 Kang DK, Thilo C, Schoepf UJ , et al. CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 2011; 4 (8) 841-849
• 71 Klima UP, Lee MY, Guerrero JL, Laraia PJ, Levine RA, Vlahakes GJ. Determinants of maximal right ventricular function: role of septal shift. J Thorac Cardiovasc Surg 2002; 123 (1) 72-80
• 72 Soliman A, Shanoudy H, Liu J, Russell DC, Jarmukli NF. Increased prevalence of patent foramen ovale in patients with severe chronic obstructive pulmonary disease. J Am Soc Echocardiogr 1999; 12 (2) 99-105
• 73 Revel MP, Faivre JB, Letourneau T , et al. Patent foramen ovale: detection with nongated multidetector CT. Radiology 2008; 249 (1) 338-345
• 74 Jörgensen K, Müller MF, Nel J, Upton RN, Houltz E, Ricksten SE. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest 2007; 131 (4) 1050-1057
• 75 Watz H, Waschki B, Meyer T , et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest 2010; 138 (1) 32-38
• 76 Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 1998; 113 (3) 576-583
• 77 Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005; 127 (6) 1952-1959
• 78 Alhaj EK, Alhaj NE, Bergmann SR , et al. Coronary artery calcification and emphysema. Can J Cardiol 2008; 24 (5) 369-372
• 79 Agusti A. Thomas a. Neff lecture. Chronic obstructive pulmonary disease: a systemic disease. Proc Am Thorac Soc 2006; 3 (6) 478-481