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Broad scope, visual aids on DVD enhance cardiac CT text
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Cardiac CT is a growing field of diagnostic imaging. Although most clinicians are familiar with the use of CT for calcium scoring and angiography, the technology can be reliably used for a variety of other indications. Author Ethan J. Halpern, MD, and colleagues have expanded Clinical Cardiac CT: Anatomy and Function, Second Edition, and compiled a practical 425-page text that is well-illustrated and supplemented with a DVD. The text serves as both an introduction and a review of clinically relevant applications of cardiac CT.
Covering the basics
The text opens with a chapter on practical information on how to conduct a cardiac CT scan. Recommendations are provided on contrast dosing, as well as how to adequately medicate to reduce patient heart rates and address patients with contrast allergies. Further, the authors discuss the advantages and disadvantages of using nitroglycerin routinely for coronary imaging. The text is lacking in discussion of aggressive radiation dose reduction strategies, including 100 kV imaging, which many centers use for standard image acquisition, and the authors do not extensively address different CT equipment or software manufacturers.
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A thorough discussion of basic coronary anatomy, including an entire chapter on coronary anomalies, is also provided. The authors wisely use images to demonstrate the myriad variations in coronary anatomy, rather than try to describe them in the text. Indeed, these chapters on anatomy, and the text in general, are supplemented by extensive illustrations, both in the text and on the included DVD.
Calcium scoring
Calcium scoring and coronary analysis are introduced with an overview of the pathophysiology of atherosclerosis, and this is helpful for understanding how the process can then be imaged using CT technology. The discussion of the prognostic value of calcium scoring, however, would benefit from inclusion of the most recent long-term data, now out to 10 years. The morphology of plaque types and how to distinguish them using cardiac CT is well outlined and reinforces the concept of the “vulnerable” plaque, which is clinically important. Cardiac CT is capable of providing excellent and reproducible analysis of valve morphology and ventricular function, as the authors describe. Although exposure to radiation limits the regular use of CT for this indication, the text provides a reasonable review of these functions.
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Courtesy of: Thieme Medical Publishers |
CT for stenting and bypass grafts
Most clinicians do not find CT useful in assessing patency of previously placed coronary stents, but this is an area of growing interest, and the authors provide guidance on how to image stents. Another area of increasing clinical interest is the imaging of CABGs. The authors said the cardiac CT has unique ability to accurately describe the course of prior grafts for surgeons who are planning repeat sternotomy procedures. They omit, however, information on how to adjust scan protocols and windows to achieve optimal imaging and contrast opacification of bypass grafts. Later in the text, the authors illustrate how planning of other procedures, such as left atrial ablation, can be assisted using cardiac CT. Three-dimensional reconstructions are provided to demonstrate this, although the discussion does not include a review of how CT images can be fused with other modalities such as electrophysiological mapping.
Cognitive defects, surgical repairs
Several new chapters of material have been added to this second edition. In reviewing congenital disease in the adult, some of the material is duplicative from earlier chapters on coronary anomalies. This chapter provides informative images and text covering prior surgical repairs that may be encountered in imaging the adult with congenital heart disease. Although high heart rates frequently limit CT imaging of infants and children with congenital disease, newer scanners capable of high heart rate imaging are increasingly being used for this indication, which is not discussed in this text. The thoracic aorta, sometimes forgotten by those focused on cardiac findings, is included in every CT scan of the chest. As such, the authors now devote a full chapter to aortic pathology, which is important for clinicians to be familiar with. The authors conclude with a review of areas of ongoing research and clinical interest. These new frontiers of cardiac CT include hybrid perfusion imaging and the “triple rule out” scan. Absent from these chapters is mention of the use of iodinated contrast to achieve perfusion imaging using cardiac CT alone.
Conclusion
Overall, this text provides a succinct review of cardiac CT for clinicians interested in becoming more familiar with this technology. Although not intended as the definitive text for the field, it is an excellent introduction or review for trainees and those preparing for board examinations. It should hold appeal to a broad range of disciplines, as well; suitable for radiologists, cardiologists and cardiothoracic surgeons. Illustrations in the text and video content included on the DVD enhance the value of the text and facilitate understanding of the material. The references are appropriate and provide the reader with resources for further review as they desire. Areas that are lacking optimal discussion or review of the literature are primarily limited by the time lag inherent to the nature of book publishing and can easily be remedied in future editions.
Reviewer David E. Winchester, MD, is a cardiologist at the University of Florida in Gainesville. Text author Ethan J. Halpern, MD, is a radiologist at Thomas Jefferson University in Philadelphia.
Disclosure: Dr. Winchester reports no relevant financial disclosures.
Added Note: "Dr. Halpern has suggested that [Winchester's] review of his excellent text, 'Cardiac CT: Anatomy and Function,' did not appreciate material on dose reduction (pages 34-39), bypass grafts (pages 25-26), fusion imaging (page 285) and perfusion imaging (pages 401-405). Due to space limitations, my consideration of these topics was not clear. My intention was to indicate topics not discussed in sufficient detail for a clinician to implement them into practice. I regret any implication that the text was devoid of these topics and would again recommend the text as a succinct and practical review of clinical applications of cardiac CT."