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The present book offers a bird's eye view of the clinical potential
of nuclear medical techniques (including nuclear and magnetic
resonance) in the practice of cardiology. It is based on 16 review
publications which cover the most important areas in clinical
cardiovascular nuclear medicine. The book has been grossly divided
into three sections: (1) Physiology, (2) Techniques, and (3)
Clinical Applications. The Physiology section deals with the
nuclear medicine background of myocardial perfusion, myocardial
metabolism, and cardiac function (Chapters 1, 2, and 3). The
Techniques sections discusses the planar techniques, in particular
for the perfusion tracer thallium-201, the Single Photon Emission
Computed Tomography (SPECT) technique, and the Positron Emission
Tomography (PET) technique (Chapters 4, 5 and 6). This section also
addresses the physical background of Magnetic Resonance Imaging
(MRI) (Chapter 7). The Clinical Applications section discusses the
value of nuclear cardiology for a variety of cardiac diseases from
detection ofmyocardial infarction to its merits for evaluating
cardiomyopathies (Chapters 8-14). Chapter 10 shortly addresses the
experimental and clinical value of Magnetic Resonance Spectroscopy
(MRS). Chapter 15 describes the latest developments in nuclear
cardiology with an emphasis on new cardiac imaging agents. Finally,
Chapter 16 presents the currently advocated Guidelines in Nuclear
Cardiology. The book will assist the clinical cardiologist, the
cardiology resident, the nuclear medicine physician, and the
radiologist in understanding the currently used cardiovascular
nuclear medicine techniques. It will broaden knowledge of the
nuclear cardiology techniques and will show the reader how
indispensable these techniques are in clinical cardiology practice.
This book consists of a total of 32 chapters subdivided into seven
Parts, being: Coronary quantitation by QCA and intracoronary
ultrasound (QCU), angiographic trials, progress in intravascular
ultrasound, magnetic resonance (MR) coronary and vascular imaging,
nuclear cardiovascular imaging, echocardiography, and cine and
spiral CT coronary imaging. In general, each Part begins with a
chapter that provides a broad overview of the advances in the field
described in that particular Part, as well as a view towards the
future. In the following chapters in such a Part, individual topics
are described in further detail by leading authorities. In this
way, the book should be of great interest to the more generalist'
reader as well as to the more specialist' reader. It has been quite
obvious for a long time that cardiovascular imaging is a field in
which quantitative analysis of the corresponding images is a must
for clinical research studies. One such example is the quantitative
coronary arteriography for the accurate assessment of vessel
morphology and their changes over time in interventional
cardiology. Particularly with the increasing use of
three-dimensional (3D) data as well as 4D ( 3D plus time ), it has
been quite clear that the amount of information is so large that
the conventional visual interpretation is not suitable anymore, and
otherwise would result in unacceptably high inter- and
intra-observer variabilities and underutilization of the data.
Fortunately, (semi)-automated analysis techniques preferably with
automated edge detection approaches begin to appear, thereby
providing a wealth of information with small systematic and random
errors. Therefore, What's New in Cardiovascular Imaging? will
assist the cardiologist, the radiologist, the nuclear medicine
physician, the image processing specialist, the physicist, the
basic scientist, and the fellow, who is in training for those
specialties, in understanding the most recent achievements in
cardiovascular imaging techniques and their impact on
cardiovascular medicine.
AMI E. ISKANDRIAN & ERNST E. VAN DER WALL The first edition of
this book was published in 1994. Since then important advances have
occurred in the field of myocardial viability. This, coupled with
increasing interest by the scientific community in the broader
issues of its relevance to patient care, suggested to us the need
to write the second edition. We are most fortunate to have the help
of a distinguished group of experts who have helped shape the
field; we appreciate their commitments and contributions. Almost
all chapters have been radically modified. Chapter 1 deals with
pathophysiology of myocardial hibernation and stunning; Chapter 2
with apoptosis; Chapter 3 with the role of positron emission
tomography; Chapters 4 and 5 with the role of single photon
emission computed tomography with thallium-201 and technetium
agents, respectively; Chapter 6 with the role of SPECT fatty acid
imaging; Chapter 7 with the role of SPECT FDG imaging; Chapter 8
with the role of cardiac catheterization angiography; Chapter 9
with the role of echocardiography; Chapter 10 with the role of
magnetic resonance imaging; and Chapter 11 with clinical
applications. Finally, Chapter 12 provides a short summary.
Myocardial viability has become one of the most important issues in
clinical cardiology. In particular, absence or presence of
viability may be decisive in patient management, and the decision
to perform angioplasty (PTCA) or bypass surgery (CABG) is
frequently based on the accurate assessment of viability. Although
echocardiography and conventional nuclear medicine techniques may
provide valuable information on viability, positron emission
tomography (PET) is currently considered to be the gold standard
for the assessment of myocardial viability. The simultaneous
evaluation of myocardial metabolism and perfusion allows precise
delineation and accurate quantification of residual myocardial
viability in affected regions. In addition, accurate quantification
of myocardial perfusion alone may provide insight into the basic
mechanisms of syndrome X and may assist in the appropriate
clarification of this clinically complicated, but frequently
occurring phenomenon. Besides that, cardiac PET may deepen our
insight into metabolism and perfusion of cardiac muscle disease,
particularly in hypertrophic cardiomyopathy. Furthermore, receptor
imaging studies with PET will become important as the study of
cardiac neurohumoral regulation in heart failure has gained in
interest. Cardiac Positron Emission Tomography: Viability,
Perfusion, Receptors and Cardiomyopathy describes the most recent
developments in cardiac PET as these are related to myocardial
viability and myocardial perfusion studies of syndrome X. The value
of PET for receptor imaging and cardiac muscle disease is also
discussed. For cardiologists, nuclear medicine physicians,
radiochemists, physiologists, technicians and basic researchers
interested in understanding the most recent achievements in
cardiovascular PET.
In recent years there have been major advances in the fields of
cardiovascular nuclear medicine and cardiac magnetic resonance
imaging. In nuclear cardiology more adequate tomographic systems
have been designed for routine cardiac use, as well as new or
improved quantitative analytic software packages both for planar
and tomographic studies implemented on modern state-of-the-art
workstations. In addition, artificial intelligence techniques are
being applied to these images in attempts to interpret the nuclear
studies in a more objective and reproducible manner. Various new
radiotracers have been developed, such as antimyosin, labeled
isonitriles, metabolic compounds, etc. Furthermore, alternative
stress testing with dipyridamole and dobutamine has received much
attention in clinical cardiac practice. Magnetic resonance imaging
is a relative newcomer in cardiology and has already shown its
merits, not only for anatomical information but increasingly for
the functional aspects of cardiac performance. This book covers
almost every aspect of quantitative cardiovascular nuclear medicine
and magnetic resonance imaging. It will assist the nuclear medicine
physician, the radiologist, the physicist/image processing
specialist and the clinical cardiologist in understanding the
nuclear medicine techniques used in cardiovascular medicine, and in
increasing our knowledge of cardiac magnetic resonance imaging.
It is with pleasure that I write this foreword for the book
"Magnetic Resonance Imaging in Coronary Artery Disease", edited by
Dr. van der Wall and Dr. de Roos. I am pleased for two reasons.
Firstly, as chairman of the Scientific Board of the Interuniversity
Cardiology Institute of the Netherlands (ICIN), because ever since
the technique became available for use in medicine and biology our
Institute has tried and succeeded to promote the introduction and
dev- opment of magnetic resonance imaging in cardiology in the
Netherlands. ICIN was the first cardiological institute on the
European continent to purchase its own nuclear magnetic resonance
spectroscope for the study of myocardial metabolism. Secondly,
because I have always been infatuated with this noninvasive
technique that can produce cardiac images without ionic radiation
and at the same time allows for the study of myocardial metabolism
as well. And even more so because nuclear magnetic resonance
imaging in medicine is one of the shining examples of medical
progress as a result of breakthrough discoveries in physics and
chemistry.
In the past few years it has become clear that left ventricular
dysfunction, even of severe degree, may be reversible after
coronary revascularization in some patients. As a result,
myocardial viability has captured the imagination of researchers
and clinicians seeking to unravel the cellular and subcellular
mechanisms and define appropriate diagnostic modalities. These
diagnostic modalities include: cardiac catheterization,
positron-emission tomography, magnetic resonance imaging,
two-dimensional echocardiography and single-photon imaging. This
book, for the first time, brings together a diverse array of
information in a comprehensive and concise fashion using a template
of ten chapters written by experts in the field. It will be
required reading for cardiologists, radiologists, nuclear medicine
specialists, cardiac surgeons, anesthesiologists, internists and
basic researchers and their trainees who are involved in the
management of patients with coronary artery disease in whom
myocardial viability is a clinically relevant issue.
In recent years there have been tremendous advances in cardiac
imaging techniques covering the complete spectrum from
echocardiography, nuclear cardiology, magnetic resonance imaging to
contrast angiography. With respect to these noninvasive and
invasive cardiac imaging modalities, marked technological
developments have allowed the cardiologist to visualize the
myocardium in a far more refined manner than conventional imaging
was capable of. Echocardiography has extended its domain with
intravascular ultrasound, cardiovascular nuclear imaging has added
positron emission tomography to its line of research, magnetic
resonance imaging has been broadened with magnetic resonance
angiography and spectroscopy, and finally contrast angiograp hy has
widened its scope with excellent quantitation programs. For all
these imaging modalities it is true that the application of
dedicated quantitative analytic software packages enables the
evaluation of the imaging studies in a more accurate, reliable, and
reproducible manner. It goes without saying that these extensions
and achievements have resulted in improved diagnostics and
subsequently in improved patient care. Particularly in patients
with ischemic heart disease, major progress has been made to detect
coronary artery disease in an early phase of the disease process,
to follow the atherosclerotic changes in the coronary arteries, to
establish the functional and metabolic consequences of the luminal
obstructions, and to accurately assess the results of
interventional therapy.
The importance of left ventricular hypertrophy in cardiovascular
disease has gained wide recognition. Left ventricular hypertrophy
is a highly important risk factor associated with major
cardiovascular events, including symptomatic heart failure,
particularly in patients with systemic hypertension. Over the past
years much has been learned about the genetics, molecular
background, prevalence, incidence and prognosis of left ventricular
hypertrophy. A variety of noninvasive methods has emerged for
detecting left ventricular hypertrophy and the assessment of
reversal of hypertrophy. Yet, a lot of controversy remains about
the connotations and clinical implications of left ventricular
hypertrophy. For instance, in the athlete's heart left ventricular
hypertrophy may constitute a physiological adaptation to pressure
overload, which normalizes following discontinuation of strenuous
physical activity. On the other hand, in particular in patients
with hypertension, left ventricular hypertrophy denotes a serious
prognosis in the course of hypertension. In these patients left
ventricular hypertrophy should be regarded as a grave prognostic
sign rather than an innocent compensatory phenomenon. The
distinction between physiologic and pathophysiologic left
ventricular hypertrophy has been the basis for this book.
Since the introduction of myocardial perfusion imaging and
radionuclide angiography in the mid-seventies, cardiovascular
nuclear medicine has undergone an explosive growth. The use of
nuclear cardiology techniques has become one of the cornerstones of
the noninvasive assessment of coronary artery disease. In the past
15 years major steps have been made from visual analysis to
quantitative analysis, from planar imaging to tomographic imaging,
from detection of disease to prognosis, and from separate
evaluations of perfusion, metabolism, and function to an integrated
assessment of myocardial viability. In recent years many more
advances have been made in cardiovascular nuclear imaging, such as
the development of new imaging agents, reevaluation of existing
procedures, and new clinical applications. This book describes the
most recent developments in nuclear cardiology and also addresses
new contrast agents in MRI. What's New in Cardiac Imaging will
assist the clinical cardiologist, the cardiology fellow, the
nuclear medicine physician, and the radiologist in understanding
the most recent achievements in clinical cardiovascular nuclear
imaging.
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Advanced Imaging in Coronary Artery Disease - PET, SPECT, MRI, IVUS, EBCT (Paperback, Softcover reprint of the original 1st ed. 1998)
Ernst E. van der Wall, P.K. Blanksma, M.G. Niemeyer, Willem Vaalburg, Harry J. G. M. Crijns
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R1,592
Discovery Miles 15 920
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Ships in 10 - 15 working days
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In Advanced Imaging in Coronary Artery Disease, the role of several
imaging techniques in diagnosing atherosclerosis, assessment of
myocardial ischemia, myocardial viability, and heart failure are
broadly discussed. The issues derived from cardiac PET are
presented in relation to the conventional techniques, such as
echocardiography, SPECT and MRI. In addition, newer imaging
techniques such as intracoronary ultrasound, electron beam computed
tomography, and Raman spectroscopy are given wide attention. The
effects of drug treatment, such as anti-ischemic and lipid-lowering
drugs, are also evaluated. This book will assist clinical
cardiologists, nuclear medicine physicians, fellows in cardiology
and nuclear medicine, radiochemists, basic research fellows, and
technicians, in understanding the new advances in clinical cardiac
PET.
F.J.Th. WACKERS Metabolic imaging: The future of cardiovascular
nuclear imaging? Since cardiovascular nuclear imaging emerged as a
new subspecialty in the mid-1970s, the field has gone through an
explosive growth. Radionuclide techniques became readily recognized
as important new diagnostic aids in the armamentarium of the
clinical cardiologist. Initially, cardiovascular nuclear imaging
focused on static myocardial imaging using either thallium-201 or
technetium-99m-pyrophosphate for diagnosing acute myocardial
infarction. Shortly thereafter, multigated equilibrium radionuclide
angiocardiography became the most widely used noninvasive method
for assessing cardiac function. Furthermore, attention and clinical
application shifted towards the use of radionuclide techniques in
conjunction with exercise testing, either with thallium-20 1
myocardial perfusion imaging or technetium-99m left ventricular
function studies. The future of cardiovascular nuclear imaging
appeared exciting and promising. However, around 1980 pessimists
predicted the premature demise of cardiovascular nuclear imaging
with the introduction of digital subtraction angiography and
nuclear magnetic resonance imaging. These doomsayers have been
proven wrong: in 1985 cardiovascular nuclear imaging is thriving
and, in many centers, even expanding. Although digital substraction
angiography and magnetic resonance imaging provided exquisite
anatomic detail, for practical evaluation of patients with ischemic
heart disease - in the Coronary Care Unit or exercise laboratory -
nuclear techniques appeared to be more practical.
Based on a number of collaborative efforts between basic
researchers and clinicians from different institutions in Leiden,
this book covers the initial and promising results of these
efforts. The role of the endothelium, especially of the coronary
intravascular species is a relatively new and fascinating
development in the diagnosis and treatment of cardiac disease.
Three major aspects of endothelial function receive attention in
this volume: its regulatory role in myocardial function, evidence
for which is gradually forthcoming, with possible great
implications for disease states such as volume overload and failure
its role in the calcium metabolism of vascular smooth muscle cells
and the effects of calcium antagonists and the endothelial
dysfunction generated by coronary angioplasty and its possible
restoration by cholesterol reduction. The topic of imaging
atherosclerotic lesions in the coronary arteries is discussed with
the emphasis on advanced methods: single photon emission computed
tomography (SPECT), positron emission tomography (PET), and
magnetic resonance imaging techniques. A wholly new development is
the characterization of the atherosclerotic lesion by Raman
spectroscopy using a laser beam to illuminate the vascular wall.
Various aspects of inflammation related to the pathogenesis of
acute coronary syndromes, in particular unstable angina, are
illuminated, as well as the role of blood-borne substances as risk
factors for atherosclerosis. Transgenic mice carrying the gene for
human APOE*3 Leiden are being used successfully to study the
environmental and genetic factors that influence the remnant
lipoprotein metabolism. Possibilities for gene therapy to treat
atherosclerosis in the clinic are being investigated in animal
models. Finally, as the book is based on 50 years of Cardiology in
Leiden, the history of its development up to the present day is the
topic of a separate chapter. This book is intended for
cardiologists, internal medicine specialists, nuclear medicine
specialists, thoracic surgeons, cardiovascular radiologists and
basic scientists in the field of the cardiovascular system.
In the past, coronary arteriography was the only modality available
to provide high quality images of the coronary anatomy.
Quantitative coronary arteriography (QCA) was developed,
implemented, validated and extensively applied to obtain accurate
and reproducible data about coronary morphology and the functional
significance of coronary obstructions. Over the last few years
extensive basic technological research supported by clinical
investigations has created competing modalities to visualize
coronary morphology and the associated perfusion of the myocardial
muscle. Currently, the following modalities are available: X-ray
coronary arteriography, intracoronary ultrasound, contrast- and
stress-echocardiography, angioscopy, nuclear cardiology, magnetic
resonance imaging, and cine and spiral CT imaging. For all these
imaging modalities, the application of dedicated quantitative
analytical software packages enables the evaluation of the imaging
studies in a more accurate, reliable, and reproducible manner.
These extensions and achievements have resulted in improved
diagnostics and subsequently in improved patient care. Particularly
in patients with ischaemic heart disease, major progress has been
made to detect coronary artery disease in an early phase of the
disease process, to follow the atherosclerotic changes in the
coronary arteries, to establish the functional and metabolic
consequences of the luminal obstructions, and accurately to assess
the results of interventional therapy. Aside from all these
high-tech developments in cardiac imaging techniques, the
transition from the analogue to the digital world has been going on
for some time now. For the future, it has been predicted that the
CD-R will be the exchange medium for cardiac images and DICOM-3 the
standard file format. This has been a major achievement in the
field of standardization activities. Since these developments will
have a major impact on the way images will be stored, reviewed and
exchanged in the near future, an important part of this book has
been dedicated to DICOM and the filmless catheterization
laboratory. Cardiovascular Imaging will assist cardiologists,
radiologists, nuclear medicine physicians, image processing
specialists, physicists, basic scientists, and fellows in training
for these specialties to understand the most recent achievements in
cardiac imaging techniques and their impact on cardiovascular
medicine.
AMI E. ISKANDRIAN & ERNST E. VAN DER WALL The first edition of
this book was published in 1994. Since then important advances have
occurred in the field of myocardial viability. This, coupled with
increasing interest by the scientific community in the broader
issues of its relevance to patient care, suggested to us the need
to write the second edition. We are most fortunate to have the help
of a distinguished group of experts who have helped shape the
field; we appreciate their commitments and contributions. Almost
all chapters have been radically modified. Chapter 1 deals with
pathophysiology of myocardial hibernation and stunning; Chapter 2
with apoptosis; Chapter 3 with the role of positron emission
tomography; Chapters 4 and 5 with the role of single photon
emission computed tomography with thallium-201 and technetium
agents, respectively; Chapter 6 with the role of SPECT fatty acid
imaging; Chapter 7 with the role of SPECT FDG imaging; Chapter 8
with the role of cardiac catheterization angiography; Chapter 9
with the role of echocardiography; Chapter 10 with the role of
magnetic resonance imaging; and Chapter 11 with clinical
applications. Finally, Chapter 12 provides a short summary.
The importance of left ventricular hypertrophy (LVH) in
cardiovascular disease has gained wide recognition. LVH is a highly
important risk factor associated with major cardiovascular events,
including symptomatic heart failure, particularly in patients with
systemic hypertension. In recent years much has been learned about
the genetics, molecular background, prevalence, incidence and
prognosis of LVH. A variety of noninvasive methods has emerged for
detecting LVH and the assessment of reversal of hypertrophy, yet a
lot of controversy remains about the connotations and clinical
implications of LVH. For instance, in the athlete's heart LVH may
constitute a physiological adaptation to pressure overload, which
normalizes following discontinuation of strenuous physical
activity. On the other hand, in particular in patients with
hypertension, LVH denotes a serious prognosis in the course of
hypertension. In these patients LVH should be regarded as a grave
prognostic sign rather than an innocent compensatory phenomenon.
The distinction between physiologic and pathophysiologic LVH is the
basis for this book. Left Ventricular Hypertrophy - Physiology
versus Pathology is a bibliographical reflection of a Boerhaave
Symposium held on April 9, 1999, in Leiden, The Netherlands. At
this symposium the major issues in dealing with LVH were discussed,
including etiology, genetics, detection, and therapy. In
particular, the book includes novel detection methods for LVH such
as magnetic resonance imaging and spectroscopy. Furthermore, much
attention was paid to the molecular and genetic approach of LVH.
This book will assist clinical cardiologists, fellows in
cardiology, general internists, radiologists, cardiothoracic
surgeons, biochemists, physiologists, pharmacologists, and basic
research fellows in understanding the most recent insights in the
background of physiologic versus pathologic LVH.
Since the introduction of myocardial perfusion imaging and
radionuclide angiography in the mid-seventies, cardiovascular
nuclear medicine has undergone an explosive growth. The use of
nuclear cardiology techniques has become one of the cornerstones of
the noninvasive assessment of coronary artery disease. In the past
15 years major steps have been made from visual analysis to
quantitative analysis, from planar imaging to tomographic imaging,
from detection of disease to prognosis, and from separate
evaluations of perfusion, metabolism, and function to an integrated
assessment of myocardial viability. In recent years many more
advances have been made in cardiovascular nuclear imaging, such as
the development of new imaging agents, reevaluation of existing
procedures, and new clinical applications. This book describes the
most recent developments in nuclear cardiology and also addresses
new contrast agents in MRI. What's New in Cardiac Imaging will
assist the clinical cardiologist, the cardiology fellow, the
nuclear medicine physician, and the radiologist in understanding
the most recent achievements in clinical cardiovascular nuclear
imaging.
It has been clear for a long time that cardiovascular imaging is a
field in which quantitative analysis of the corresponding images is
a must for clinical research studies. One such example is the
quantitative coronary arteriography for the accurate assessment of
vessel morphology and their changes over time in interventional
cardiology. Particularly with the increasing use of
three-dimensional (3D) data as well as 4D (3D plus time), it has
been clear that the amount of information is so large that the
conventional visual interpretation is not suitable anymore, and
otherwise would result in unacceptably high inter- and
intra-observer variabilities and under-utilization of the data.
Fortunately, (semi)-automated analysis techniques, preferably with
automated edge detection approaches, begin to appear, thereby
providing a wealth of information with small systematic and random
errors. This text should assist the cardiologist, the radiologist,
the nuclear medicine physician, the image processing specialist,
the physicist, the basic scientist, and the fellow training for
those specialties, in understanding the most recent achievements in
cardiovascular imaging techniques and their impact on
cardiovascular medicine. This text consists of a total of 32
chapters subdivided into seven Parts.
In the past, coronary arteriography was the only modality available
to provide high quality images of the coronary anatomy.
Quantitative coronary arteriography (QCA) was developed,
implemented, validated and extensively applied to obtain accurate
and reproducible data about coronary morphology and the functional
significance of coronary obstructions. Over the last few years
extensive basic technological research supported by clinical
investigations has created competing modalities to visualize
coronary morphology and the associated perfusion of the myocardial
muscle. Currently, the following modalities are available: X-ray
coronary arteriography, intracoronary ultrasound, contrast- and
stress-echocardiography, angioscopy, nuclear cardiology, magnetic
resonance imaging, and cine and spiral CT imaging. For all these
imaging modalities, the application of dedicated quantitative
analytical software packages enables the evaluation of the imaging
studies in a more accurate, reliable, and reproducible manner.
These extensions and achievements have resulted in improved
diagnostics and subsequently in improved patient care. Particularly
in patients with ischaemic heart disease, major progress has been
made to detect coronary artery disease in an early phase of the
disease process, to follow the atherosclerotic changes in the
coronary arteries, to establish the functional and metabolic
consequences of the luminal obstructions, and accurately to assess
the results of interventional therapy. Aside from all these
high-tech developments in cardiac imaging techniques, the
transition from the analogue to the digital world has been going on
for some time now. For the future, it has been predicted that the
CD-R will be the exchange medium for cardiac images and DICOM-3 the
standard file format. This has been a major achievement in the
field of standardization activities. Since these developments will
have a major impact on the way images will be stored, reviewed and
exchanged in the near future, an important part of this book has
been dedicated to DICOM and the filmless catheterization
laboratory. Cardiovascular Imaging will assist cardiologists,
radiologists, nuclear medicine physicians, image processing
specialists, physicists, basic scientists, and fellows in training
for these specialties to understand the most recent achievements in
cardiac imaging techniques and their impact on cardiovascular
medicine.
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