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2 Developments in Cardiovascular Medicine VOLUME 171

3 ADVANCESIN IMAGING TECHNIQUES IN ISCHEMIC HEART DISEASE edited by ERNST E. VAN DER W ALL Department ofcardiology, University Hospital Leiden, Leiden, The Netherlands THOMAS H. MARWICK Department ofcardiology, Cleveland Clinic Foundation, Cleveland, U.SA. and JOHAN H.C. REIBER Department of Diagnostic Radiology, University Hospital Leiden, Leiden, The Netherlands ISIIIII SPRINGER -SCIENCE+BUSINESS MEDIA, B.V.

4 A c.i.p. Catalogue record for this book is available from the Library of Congress. CIP DATA ROYAL UBRARY. TIlE HAGUE Advancc:s ed. : E.E. van der WaU. Th.H. Muwlck.. I.H.C. Reiber. - Leiden 80erhuve Commissie voor Postaeadcmisch Onderwijs in de Geneeskunde. Rijksuruverslleu Lc:lden. (Boerhaave 'u<sus. ISSN ). Symposium georgaruscerd doar Dc:panmems of Cardiology, and DiagnoSlic: Radiologyand Nuclear Medicine of the Uruversny Hospltal Leiden en Cleveland Cliruc International Cemer. zaletdag 19 augustus Met lit. opg. ISBN ISBN (ebook ) DOI / Trefw.: hanzlektcn; beeidverwerlt:ende diagnostick. ISBN Printed on acid-free paper Ali Rights Reserved ~ 1995 Springer Science+Business Media Dordrecht Originally pubiished by Kluwer Academic Publishers in 1995 Softcover reprint of the hardcover 1 st edition 1995 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permis sion from the copyright owner.

5 We gratefully acknowledge the financial support of: Byk Nederland B. V. Amersham Nederland B. V. Bristol-Myers Squibb Philips Medical Systems Siemens Medical Engineering Sonotron B. V.

6 Contents List of Contributors Preface IX xiii Current Status of Myocardial Perfusion Scintigraphy E.E. van der Wall Use of Positron Emission Tomography for the Diagnosis and Evaluation of Ischemic Heart Disease Th.H. Marwick 17 Magnetic Resonance Coronary Angiography P.M.T. Pattynama and A. de Roos 31 Noninvasive Imaging of Coronary Artery Anomalies. Present Angiographic Criteria and Role of Additional Techniques, Especially Fast Gradient Echo Magnetic Resonance Imaging H. W. Vliegen, J. Doornbos, 1. W. Jukema, M.A. Bekedam, A. de Roos and E.E. van der Wall 47 Left Ventricular Function by Stress MR Imaging. Animal Studies using Dobutamine J. Baan and P.M. T. Pattynama 59 Spectroscopy of the Human Heart: Techniques, Limitations and Opportunities P.R. Luyten 71 Current Status of Stress Echocardiography for the Diagnosis of Myocardial Ischemia and Viability Th.H. Marwick 83 Contrast Ultrasound for Assessment of Myocardial Perfusion: Promise and Pitfalls J.D. Thomas 101

7 viii Contents Intravascular Ultrasound. Possibilities of Image Enhancement by Signal Processing N. Born, W. Li, A.F. W. van der Steen, CL. de Korte, E.J. Gussenhoven, C von Birgelen and C T. Lancee 113 Clinical Aspects of Intravascular Ultrasound E.M. Tuzcu 127 Evolution of Quantitative Coronary Arteriography J.H.C Reiber, L.R. Schiemanck, P.M.J. van der Zwet, G. Koning, B. Goedhart, J.J. Gerbrands, M.J. Schalij and A. V.G. Bruschke 139 Index 153

8 List of contributors J. Baan M.A. Bekedam C. von Birge/en Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Dr. Molenwaterplein 40, 3015 GD Rotterdam, N. Born Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, A. V. G. Bruschke J. Doornbos J.J. Gerbrands Information Theory group, Delft University of Technology, P.O. Box 5, 2600 AA, Delft, B. Goedhart E.J. Gussenhoven Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, ix

9 x List of contributors J. W. Jukema G. Koning c.l. de Korte Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, C.T. Lancee Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, w. Li Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, P.R. Luyten Philips Medical Systems, MR Clinical Science, P.O. Box 10000, 5680 DA, Best, Th.H. Marwick Department of Cardiology, Cleveland Clinic International Center, 9500 Euclid Avenue, Cleveland 44195, U.S.A. P.M. T. Pattynama 1. H. C. Reiber

10 List of contributors xi A. de Roos M.J. Schali} L.R. Schiemanck A.F. W. van der Steen Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, J. Thomas Department of Cardiology, Cleveland Clinic International Center, 9500 Euclid A venue, Cleveland 44195, U.S.A. E.M. Tuzcu Department of Cardiology, Cleveland Clinic International Center, 9500 Euclid A venue, Cleveland 44195, U.S.A. H. W. Vliegen E. E. van der Wall P.M.J. van der Zwet

11 Preface 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 angiography 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. For instance, intravascular ultrasound permits the early detection of coronary artery disease, magnetic resonance angiography can presently be used for screening of disease, nuclear imaging techniques using positron emission tomography may well be applied for evaluation of the functional and metabolic consequences of coronary artery lesions, and quantitative coronary angiography allows the assessment of successful interventional therapy. Advances in Imaging Techniques in Ischemic Heart Disease is a bibliographical 'image' of a Symposium, held on August 19, 1995, in Leiden. At this Symposium all major advances in cardiac imaging techniques in ischemic heart disease were addressed varying from intravascular ultrasound to positron emission tomography, and from magnetic resonance coronary angiography to quantitative contrast coronary angiography. In addition, major attainments in conventional imaging approaches were discussed such as new tracers for myocardial perfusion imaging, developments in contrast and stress echocardiography, and stress magnetic resonance imaging. Finally, the value of tbe various cardiac imaging techniques was highlighted in order to emphasize their important role in assessing the effects of interventional therapy such as early reperfusion xiii

12 xiv Preface and lipid lowering drugs. Based on the presentations of all speakers, this book consists of a compilation of manuscripts related to each of these specific topics. Herewith we like to acknowledge all individuals, societies, and institutions who have had a substantial contribution to our Symposium and therefore to the appearance of Advances in Imaging Techniques in Ischemic Heart Disease. First of all, we believe that the Symposium was unique because of three factors; 1) the Symposium was a joint venture between Leiden University Hospital and Cleveland Clinic International Center, 2) the Symposium was an international Boerhaave Course which has by nature a longstanding reputation, and 3) the Symposium included the prestigious Einthoven Lecture, this year presented by Rene G. Favoloro, Buenos Aires, Argentina. We express our gratitude to all authors and co-authors for making great efforts in preparing their superb up-to-date chapters at short-term. The authors are all excellent investigators in one or more fields of cardiac imaging and they have stimulated progress in cardiac imaging with the aim to improve patient care. We like to acknowledge our sponsors i.e. the Netherlands Society of Cardiology (NVVC), the Interuniversity Cardiology Institute of (ICIN), the Einthoven Foundation, the Cleveland Clinic Foundation (CCF), and Cleveland Clinic International Center (CCIC). We like to thank the Departments of Cardiology (Head Prof.dr. A.V.G. Bruschke), Radiology (Head Prof.dr. A.E. van Voorthuisen) and Nuclear Medicine (Head Prof.dr. E.K.J. Pauwels) of the Leiden University for their support in organizing the Symposium. In part, this book may also be considered as a mark of honour to Prof.dr. A.V.G. Bruschke who at the time of the Symposium has been head of the Department of Cardiology for a period of exactly 10 years as he moved from the St. Antonius Hospital (Nieuwegein, The Netherlands) to Leiden University in August We are very grateful to Dr. M. Razavi (Cleveland Clinic International Center) who as a Course Director, together with Prof. Bruschke, took the initiative to this joint Symposium and laid the basis for an excellent bilateral program. We are very much indebted to Mrs A.E.H. Zitter and Mr J.J.L. Muller (Boerhaave Committee, Leiden, The Netherlands) who superbly assisted us in organizing the Symposium. We like to acknowledge Mrs N. Dekker (Kluwer Academic Publis!1ers, Dordrecht, The Netherlands) and Mr J. Schoones (Leiden University Medical Library) who, together with Mrs A.E.H. Zitter, put a lot of effort in editing, preparing, and completing Advances in Imaging Techniques in Ischemic Heart Disease. Lastly, the appearance of this book would not have been possible without a generous grant from Byk Nederland B.V. (Zwanenburg, The Netherlands).

13 Preface xv We hope that this book will assist the cardiologist, the radiologist, the nuclear medicine physician, physicists, basic scientists, and the fellows who are in training for those specialties, in understanding the most recent achievements in cardiac imaging techniques in ischemic heart disease. The Editors Ernst E. van der Wall, Thomas H. Mmwick, lohan H. C. Reiber