Integrated Non-Invasive Cardiovascular Imaging

Description

Integrated cardiovascular imaging is the optimal use of multiple imaging modalities to obtain complementary information about cardiac diseases, to aid in diagnosis, determine aetiology and prognosis, with the ultimate objective of effectively guiding clinical decision making. Over the past few decades, advances in technology have contributed to the development of new imaging modalities and refinement of existing ones, leading to major improvements in the accuracy of diagnosing cardiovascular disease. While modality-centric expertise has been the primary driver of improvements in each modality, this has also contributed to imagers working in silos resulting with limited inter-modality coordination and collation of information relevant for patient care. This publication provides comprehensive guidance on the rationale and implementation of integrated cardiovascular imaging for practitioners. Chapter 1INTRODUCTION 1.1. Background 1.2. Objective 1.3. Scope 1.4. Structure Part IFUNDAMENTALS OF NON-INVASIVE CARDIAC IMAGING Chapter 2NUCLEAR CARDIOLOGY:SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY 2.1. Hardware 2.2 Software 2.3. Hybrid SPECT–CT imaging systems 2.3.1. Techniques 2.3.2. Types of stress used in GSPECT procedures 2.3.3. Acquisition and interpretation of images 2.3.4. Reporting 2.4. Safety 2.5. Key messages References to Chapter 2 Chapter 3NUCLEAR CARDIOLOGY:POSITRON EMISSION TOMOGRAPHY 3.1. Basic principles 3.1.1. Hardware 3.1.2. Software 3.2. Cardiac PET radiotracers 3.2.1. 82Ru 3.2.2. 13N ammonia 3.2.3. 15O water 3.2.4. Flurpiridaz 3.2.5. 18F-FDG 3.3. Imaging protocols 3.3.1. MPI and MBF quantification 3.3.2. Myocardial viability and sarcoid imaging 3.3.3. Coronary artery calcium scoring with PET–CT 3.3.4. Display of PET perfusion rest–stress and perfusion–metabolism images 3.3.5. Elements of a comprehensive cardiac PET report 3.4. Key messages References to Chapter 3 Chapter 4ECHOCARDIOGRAPHY 4.1. Physics of echocardiography 4.2. 2-D and 3-D echocardiography 4.3. Doppler echocardiography 4.3.1. Spectral Doppler imaging 4.3.2. Tissue Doppler imaging 4.4. Speckle tracking echocardiography 4.5. Transthoracic and transoesophageal echocardiography 4.6. 3-D echocardiography 4.7. Contrast echocardiography 4.8. Key messages References to Chapter 4 Chapter 5CARDIAC MAGNETIC RESONANCE IMAGING 5.1. Basics of magnetic resonance imaging 5.2. Cardiac magnetic resonance 5.3. Blood flow evaluation using CMR 5.4. 4-D flow cardiac magnetic resonance 5.5. Safety considerations 5.6. Key messages References to Chapter 5 Chapter 6CARDIAC COMPUTED TOMOGRAPHY 6.1. Basic principles 6.2. Computed tomography hardware and software 6.2.1. Minimum standards 6.2.2. Recent developments 6.2.3. Software for coronary computed tomography angiography 6.2.4. Software for determining the coronary artery calcium score 6.3. Techniques 6.3.1. Patient preparation 6.3.2. CCTA image acquisition 6.3.3. CCTA image analysis 6.4. Advanced CCT techniques 6.4.1. CACS image acquisition and reconstruction 6.4.2. CACS image analysis 6.4.3. Coronary artery calcification on non-dedicated imaging 6.4.4. Non-coronary cardiac imaging 6.5. Safety 6.5.1. Radiation dose parameters 6.5.2. Radiation dose of CCTA 6.5.3. Radiation dose risks 6.5.4. Iodinated contrast 6.5.5. Other medication 6.6. Key messages References to Chapter 6 Part IICLINICAL APPLICATIONS Chapter 7INTEGRATED NON-INVASIVE CARDIOVASCULAR IMAGING IN ROUTINE CLINICAL PRACTICE 7.1. Concept 7.2. Integrating the basics: ETT and echocardiography 7.2.1. Integrating with more advanced imaging using nuclear cardiology and computed tomography 7.2.2. Integrating basic modalities with other modalities 7.2.3. Key aspects for successful integration between modalities 7.3. Future of integrated cardiovascular imaging 7.4. Key messages References to Chapter 7 Chapter 8APPROPRIATE USE OF NON-INVASIVE CARDIAC IMAGING TECHNIQUES 8.1. Framework of appropriate imaging guidelines 8.2. Definition of appropriateness and application of guidelines 8.3. Future directions 8.4. Key messages References to Chapter 8 Chapter 9CURRENT EVIDENCE AND LESSONS LEARNED FROM RANDOMIZED TRIALS IN CARDIOVASCULAR IMAGING 9.1. Hierarchy of clinical research evidence in cardiovascular imaging 9.2. Evidentiary standards for quality cardiovascular imaging 9.3. Lessons learned from observational data: Examples in nuclear cardiology 9.4. Defining comparative effectiveness 9.5. Examples of controlled clinical trials 9.6. Examples of comparative effectiveness trials 9.7. Therapeutic risk reduction: Guiding therapeutic decision making 9.8. Assimilating evidence into evaluation algorithms 9.9. Key messages References to Chapter 9 Chapter 10STABLE CORONARY ARTERY DISEASE 10.1. Clinical presentation 10.2. Risk prediction models and pre-test probability 10.2.1. Advantages of prediction models 10.2.2. Disadvantages of prediction models 10.3. Role of basic investigations 10.4. Role of non-invasive imaging in clinical decision making 10.5. Imaging algorithms based on clinical presentation 10.5.1. Investigation of suspected stable coronary artery disease 10.5.2. Important considerations when choosing a diagnostic test 10.5.3. Pre-operative risk assessment prior to non-cardiac surgery 10.5.4. Incidental identification of CAD on imaging performed for other reasons 10.6. Conclusion 10.7. Key messages References to Chapter 10 Chapter 11ACUTE CORONARY SYNDROMES 11.1. Definition of acute coronary syndrome 11.2. Pathophysiology of acute coronary syndrome 11.3. Role of non-invasive imaging in acute coronary syndrome 11.4. Clinical utility of non-invasive imaging in acute coronary syndrome 11.4.1. Echocardiography 11.4.2. Coronary computed tomography angiography 11.4.3. Cardiac magnetic resonance imaging 11.4.4. Radionuclide imaging: SPECT and PET 11.5. Case based approach to imaging in acute coronary syndromes 11.5.1. Suspected ACS: Case 1 11.5.2. Suspected ACS: Case 2 11.5.3. NSTE-ACS: Case 3 11.5.4. STE-ACS: Case 4 11.5.5. STE-ACS: Case 5 11.6. Myocardial infarction with non-obstructive coronary arteries 11.7. Key messages References to Chapter 11 Chapter 12HEART FAILURE 12.1. Global and regional left ventricular function 12.2. Left ventricular size and shape 12.3. Myocardial morphology and function 12.4. Myocardial ischaemia or viability 12.5. Left atrium and right ventricle 12.6. Valve disease 12.7. Key messages References to Chapter 12 Chapter 13CARDIOMYOPATHIES 13.1. Hypertrophic cardiomyopathy 13.2. Dilated cardiomyopathy 13.3. Restrictive cardiomyopathy 13.4. Specific cardiomyopathies 13.4.1. Cardiac amyloidosis 13.4.2. Cardiac sarcoidosis 13.4.3. Anderson–Fabry disease 13.5. Classification of cardiomyopathies according to left ventricular systolic or diastolic dysfunction 13.6. Key messages References to Chapter 13 Chapter 14PERICARDIAL DISEASES 14.1. Acute pericarditis 14.1.1. Definition and clinical presentation 14.1.2. Imaging algorithms and modalities for acute pericarditis based on clinical presentation 14.2. Cardiac tamponade 14.2.1. Cardiac computed tomography 14.2.2. Cardiac magnetic resonance 14.3. Constrictive pericarditis 14.3.1. Definition and clinical presentation 14.3.2. Imaging modalities for constrictive pericarditis 14.4. Key messages References to Chapter 14 Chapter 15PRIMARY VALVE DISEASES 15.1. Causes of valve disease 15.2. Signs, symptoms and diagnosis of valvular heart disease 15.3. Classification of the severity of primary valvular pathologies 15.4. Pre-operative imaging evaluations in patients with rheumatic mitral stenosis 15.5. Role of CMR imaging in patients with primary valve disease 15.6. Assessment of coronary anatomy in patients with primary valvular heart disease prior to surgical interventions 15.7. Follow-up of patients with prosthetic valves 15.8. Role of imaging in planning percutaneous interventions for aortic stenosis 15.9. Role of nuclear cardiology in patients with primary valve disease 15.10. Follow-up and treatment of patients with advanced valvular heart disease 15.11. Case presentation 15.12. Key messages References to Chapter 15 Chapter 16CARDIO-ONCOLOGY 16.1. Definition 16.2. Clinical presentations 16.2.1. Asymptomatic left ventricular dysfunction 16.2.2. Heart failure 16.2.3. Vascular disease 16.2.4. Pericardial disease 16.2.5. Valvular complications 16.3. Imaging algorithms based on clinical presentation 16.4. Selection of an imaging modality 16.5. Echocardiography 16.6. Nuclear imaging 16.7. Cardiac magnetic resonance imaging 16.8. Key messages References to Chapter 16 Chapter 17ADULT CONGENITAL HEART DISEASE 17.1. Guidelines 17.2. Clinical presentation 17.3. Imaging modalities 17.4. Specific disease entities 17.4.1. Atrial septal defect 17.4.2. Ventricular septal defect 17.4.3. Atrioventricular septal defect 17.4.4. Patent ductus arteriosus 17.4.5. Left sided heart obstructive lesions (aortic valve disease, coarctation of aorta) 17.4.6. Right ventricular outflow tract obstruction (pulmonary stenosis) 17.4.7. Coronary artery abnormalities 17.4.8. Pulmonary hypertension and Eisenmenger’s syndrome 17.4.9. Tetralogy of Fallot 17.4.10. Dextrotransposition of the great arteries 17.4.11. Congenitally corrected transposition of the great arteries 17.4.12. Ebstein’s anomaly 17.4.13. Single ventricle diseases 17.5. Key messages References to Chapter 17 Chapter 18ENDOCARDITIS 18.1. Epidemiology and clinical presentation 18.2. Diagnostic imaging 18.3. Echocardiography 18.4. Multislice gated cardiac computed tomography 18.5. Cardiac magnetic resonance 18.6. Nuclear molecular and functional imaging 18.6.1. 18F-FDG PET–CT 18.6.2. SPECT–CT with labelled leukocytes 18.6.3. Imaging algorithms based on clinical presentation 18.7. Key messages References to Chapter 18 Bibliography to Chapter 18 Chapter 19IMAGING CORONARY ATHEROSCLEROSIS WITH COMPUTED TOMOGRAPHY AND POSITRON EMISSION TOMOGRAPHY 19.1. Molecular imaging 19.2. Plaque features on CCTA that predict outcome and myocardial ischaemia 19.3. Key messages References to Chapter 19 ABBREVIATIONS CONTRIBUTORS TO DRAFTING AND REVIEW