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ESC Textbook of Cardiovascular Imaging - sample

Discover the ESC Textbook of Cardiovascular Imaging 2nd edition

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standard values in transthoracic and transoesophageal echocardiography 31 For wall thickness measurements to calculate left ventricular mass according to the Penn-convention and for left ventricular diameter measurements for calculation of the left ventricular ejection fraction according to the Teichholz equation, the myocardial borders will be labelled inner-edge-to-inner-edge without endo- and epicardium at the maximum peak of the R-wave of the electrocardiogram. In contrast, according to the American Society of Echocardiography convention, measurements of the left ventricular wall will be performed leading-edge-to-leading-edge at the beginning of the QRS complex. In Europe the measurements are normally performed inner-edge-to-inner-edge. Measurements were performed at a ventricular level between the transition of the papillary muscles to the chords. Left atrial diameter is measured at the time point of early diastole behind the aortic root. Aortic root diameter is measured inner-edge-to-inner-edge during mid-systole at the time interval of aortic valve separation. Right ventricular diameter is measured in the M-mode at the mitral valve level during end-diastole. Two-dimensional measurements Two-dimensional measurements of left atrial and left ventricular volumes and function are performed by planimetry of both cavities in the standardized apical 2- and 4-chamber view during diastole and systole using Simpson’s rule. Right atrial and ventricular size is conventionally determined by the longitudinal and transverse diameter of the right atrium and the right ventricular inflow tract in the standardized apical 4-chamber view. Right ventricular function is estimated by planimetry of the right ventricular inflow tract in the standardized apical 4-chamber view during diastole and systole for determination of right ventricular fractional area change. The diameter of the left ventricular outflow tract is normally measured in a standardized parasternal long-axis view due to a better spatial resolution than in the apical long-axis view. Inferior caval vein diameter is measured in the subcostal longitudinal view during expiration and inspiration. Pulsed spectral Doppler measurements Pulsed spectral Doppler measurements are performed using the spectra of the mitral valve inflow and the left ventricular outflow tract. In normal hearts the dimension of the left ventricular outflow tract is almost the same as the dimension of the aortic valve annulus. For the left ventricular inflow, maximum velocities of the E- and A-wave, the E/A-ratio and the deceleration time of the E-wave are measured. For estimation of diastolic function, the pulsed wave Doppler spectrum of the pulmonary vein flow is analysed for determination of the retrograde maximum A-wave velocity and the A-wave duration. Continuous wave Doppler measurements Continuous wave Doppler measurements are performed in all spectra documenting turbulences. This is especially important in valve pathologies. In normal hearts only the continuous wave Doppler spectrum of a mild tricuspid regurgitation is used for estimation of systolic pulmonary pressure. The maximum and mean velocities, as well as maximum and mean gradients calculated by the velocity time integrals, will be measured for the mitral valve inflow and left ventricular outflow tract or the flow through the aortic valve using the continuous wave Doppler spectra, if velocities are increased. Pulsed spectral tissue Doppler measurements Pulsed spectral tissue Doppler measurements are performed in the inferoseptal and lateral region of the mitral valve annulus to determine the velocity of E′ and the E/E′-ratio. Standard values for these measurements are given in Table 1.1. The standard digital acquisition for transthoracic and transoesophageal echocardiography is given in Table 1.2. Table 1.1 Echocardiographic parameters and standard values used to quantify cardiac dimensions and function Echocardiographic parameter Standard value Left ventricular wall thickness (M-mode/2D) 6–11 mm Left ventricular end-diastolic diameter (M-mode/2D) 39–59 mm 22–32 mm/m 2 25–33 mm/m Right ventricular wall thickness (M-mode/2D) < 5 mm Right ventricular diameter (M-mode/2D) < 25 mm Left ventricular end-diastolic volume (2D) 56–155 ml 35–75 ml/m 2 Left ventricular end-systolic volume (2D) 19–58 ml 12–30 ml/m 2 Left ventricular ejection fraction (2D) > 55% Left ventricular outflow tract diameter 18–31 mm Right ventricular outflow tract and aortic 17–23 mm annulus diameter Right ventricular base-to apex-length 71–79 mm Basal right ventricular diameter 20–28 mm Right ventricular diastolic area 11–28 cm 2 Right ventricular fractional area change 32–60% Left atrial diameter (M-mode/2D) 27–40 mm 15–23 mm/m 2 Left atrial volume (atrial end-diastole) (2D) 22–58 ml < 34 ml/m 2 Aortic root diameter (M-mode/2D) < 39 mm Right atrial minor axis diameter (2D) 29–45 mm 17–25 mm/m 2 Inferior caval vein diameter (2D) < 17 mm E/A-ratio > 1 Deceleration time < 200 ms A wave velocity of the pulmonary vein < 35 cm/s A wave duration < 120 ms E′-wave velocity > 8 cm/s E/E′-ratio < 8

Chapter 2 Nuclear cardiology (PET and SPECT)—basic principles Frank M. Bengel, Ornella Rimoldi, and Paolo G. Camici Contents Introduction 34 Technical aspects: physics and data analysis 34 SPECT 34 PET 36 Current imaging procedures and applications 38 SPECT 38 PET 39 Recent trends 42 PET MR 42 Conclusion 43 References 43 Introduction Radionuclide imaging of the heart is well established for the clinical diagnostic and prognostic workup of coronary artery disease. Myocardial perfusion single photon emission computed tomography (SPECT) has been the mainstay of cardiovascular radionuclide applications for decades and its usefulness is supported by a very large body of evidence [1]. Positron emission tomography (PET) is an advanced radionuclide technique that has also been available for decades. In contrast to SPECT, PET has long been considered mainly a research tool due to its methodological complexity. But owing to several recent developments, cardiac PET is now increasingly penetrating the clinical arena [2]. Nuclear cardiology techniques are considered robust, accurate, and reliable for clinical imaging of heart disease. Yet, in a continuous effort to minimize radiation burden and maximize comfort for patients on the one hand, while maximizing the available information for the referring physician on the other hand, nuclear imaging technology is progressing towards higher sensitivity and resolution [3], and novel, highly specific radiotracers are being introduced [4]. While the techniques will continue to play a key role for the assessment of myocardial perfusion, function, and viability, on-going novel developments are indicators of a steady evolution of nuclear cardiology towards characterization of molecular events at the tissue level. In the competitive environment of cardiovascular imaging, it is therefore expected that radionuclide imaging will take a central role in the implementation of molecular imaging techniques for more specific, personalized, preventive, and therapeutic decision-making. This chapter will outline the basic aspects of SPECT and PET as the two key nuclear cardiology techniques. Technical aspects of image acquisition will be discussed first. A brief overview on current application of radionuclide imaging procedures will then be given, and the chapter will be concluded by an outlook on novel developments of camera and tracer methodology. Technical aspects: physics and data analysis SPECT Myocardial SPECT imaging has typically been performed using a multi-detector gamma camera system, which rotates around the chest to obtain tomographic images of single emitted photons ( Fig. 2.1). Collimators are being used to balance detection sensitivity

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