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作者:蔡依橙
作者(外文):I-Chen Tsai
論文名稱:以多切面電腦斷層推進心血管疾病診斷疆界
論文名稱(外文):Advancing the diagnostic frontier of cardiovascular diseases with MDCT
指導教授:傅雲慶
指導教授(外文):Yun-Ching Fu
學位類別:博士
系所名稱:臨床醫學研究所
學號:49624004
出版年:100
畢業學年度:99
語文別:英文
論文頁數:255
中文關鍵詞:電腦斷層心血管疾病心臟動脈先天性心臟病靜脈
外文關鍵詞:computed tomographycardiovascular diseaseheartarterycongenital heart diseasevein
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多切面電腦斷層的快速進展,使得心血管疾病的診斷有了新的可能,我們使用新近取得的40切面、60切面以及256切面機種,在四大領域嘗試拓展心血管疾病的診斷疆界,分別是:先天性心臟病、全心臟評估、心臟內植入物與血管電腦斷層四大部分。在先天性心臟病方面,我們首先證明了多切面電腦斷層對於複雜先天性心臟病的診斷準確率為98%,接著進一步證明其對近端冠狀動脈的偵測率達100%,並將相關檢查技巧與流程以回顧文章方式整理出版。有關全心臟評估,我們首先確認我們自己的機器能取得97.9%的冠狀動脈狹窄偵測準確度,接著配合心肌運動與活性的評估,作成「全心臟評估」的診斷技術並成功診斷許多心臟疾病。此觀念逐漸被學界接受後,我們更進一步領導制訂亞洲適應症指引,以推廣臨床應用。心臟內植入物方面,我們確認了多切面電腦斷層診斷合成瓣膜疾患的準確度為100%,廣泛診斷各種疾病,並將相關技術延伸至安普拉茲關閉器的評估。在血管電腦斷層方面,則是發展了實用的顯影劑注射技巧:「顯影劑涵蓋時間(contrast-covering time)」概念,並以之診斷許多全身血管疾病,獲得良好成果,包括腎動脈與洗腎之動靜脈瘻管等。總結過去的系列研究,多切面電腦斷層的確成為心血管疾病診斷上不可或缺的新影像工具。
The rapid advancement of multi-detector row computed tomography (MDCT) has provided new clinical pathways in diagnosing cardiovascular diseases. We used the 40-, 64- and 256-MDCT in our hospital to further advance the diagnostic frontier of cardiovascular disease in four major aspects, including congenital heart disease, comprehensive whole-heart evaluation, intracardiac prosthesis and vascular CT. About congenital heart disease, we first confirmed the diagnostic accuracy of MDCT in complex congenital heart disease is 98%. Then the visibility of proximal coronary arteries is found to be 100%. The associated techniques and interpretation algorithm were summarized and published. Regarding comprehensive whole-heart evaluation, we first confirmed our scanner has a 97.9% accuracy in diagnosing coronary artery stenosis. With the evaluation of heart motion and viability, we proposed 'comprehensive whole-heart approach' in cardiac CT and diagnosed many different cardiac diseases in clinical practice. After the concept is widely accepted in academic society, we further worked with Asian experts to summarize a guideline article promoting the use of cardiac CT. Considering intracardiac prosthesis, we confirmed the accuracy of MDCT in diagnosing prosthetic valve disorder is 100%. The diagnostic skill was also applied to Amplatzer septal occluder. About vascular CT, we first developed our own novel and reproducible contrast injection skill: 'contrast-covering time' and used it to diagnose many vascular diseases. The clinical experiences in patients with suspected renal hypertension and dialysis arteriovenous fistula were also summarized and published. In conclusion, with our efforts, MDCT is confirmed to be a new diagnostic tool in cardiovascular diseases.
ENGLISH ABSTRACT ------------------------------------------------------- 1
中文摘要 ------------------------------------------------------------------------- 2
Chapter 1. INTRODUCTION ----------------------------------------------- 3
Chapter 2. MATERIALS AND METHODS ------------------------------ 13
2.1. Congenital heart disease ----------------------------------------------- 13
2.1.1. Confirming the diagnostic accuracy of MDCT in complex congenital heart disease ---------------------------- 13
2.1.2. Localizing the coronary arteries in neonates with congenital heart disease --------------------------------------- 19
2.1.3. Write the first review article of MDCT techniques for neonatal congenital heart disease ---------------------------- 27
2.2. Comprehensive whole-heart evaluation ----------------------------- 34
2.2.1. Confirming the diagnostic accuracy of MDCT in detecting coronary artery stenosis --------------------------- 34
2.2.2. The concept of comprehensive whole-heart evaluation ---- 39
2.2.3. The perception of comprehensive whole-heart evaluation among Asian doctors ------------------------------------------ 46
2.3. Intracardiac prosthesis ------------------------------------------------- 53
2.3.1. Confirming the diagnostic accuracy of MDCT in prosthetic valve disorders ------------------------------------- 53
2.3.2. The appearance and natural course of left ventricular outflow tract pseudoaneurysm after prosthetic aortic valve implantation --------------------------------------------- 62
2.3.3. MDCT techniques in prosthetic valve disorder evaluation ------------------------------------------------------- 65
2.3.4. MDCT techniques in evaluating patients post-Amplatzer septal occluder ------------------------------------------------- 66
2.4. Vascular CT ------------------------------------------------------------- 70
2.4.1. 'Contrast-covering time (CCT)' concept -------------------- 70
2.4.2. Using CCT concept to evaluate patients suspected with renal hypertension --------------------------------------------- 79
2.4.3. Using CCT concept to evaluate patients with suspected dialysis arteriovenous fistula disorder ---------------------- 87
Chapter 3. RESULTS ---------------------------------------------------------- 95
3.1. Congenital heart disease ----------------------------------------------- 95
3.1.1. Confirming the diagnostic accuracy of MDCT in complex congenital heart disease ---------------------------- 95
3.1.2. Localizing the coronary arteries in neonates with congenital heart disease --------------------------------------- 102
3.1.3. MDCT techniques for neonatal congenital heart disease 106
3.2. Comprehensive whole-heart evaluation ----------------------------- 114
3.2.1. Confirming the diagnostic accuracy of MDCT in detecting coronary artery stenosis --------------------------- 114
3.2.2. Summarizing the concept of comprehensive whole-heart evaluation ------------------------------------------------------- 119
3.2.3. The perception of comprehensive whole-heart evaluation among Asian doctors ------------------------------------------ 133
3.3. Intracardiac prosthesis ------------------------------------------------- 147
3.3.1. Confirming the diagnostic accuracy of MDCT in prosthetic valve disorders ------------------------------------- 147
3.3.2. The appearance and natural course of left ventricular outflow tract pseudoaneurysm after prosthetic aortic valve implantation --------------------------------------------- 157
3.3.3. MDCT techniques in prosthetic valve disorder evaluation ------------------------------------------------------- 163
3.3.4. MDCT techniques in evaluating patients post-Amplatzer septal occluder ------------------------------------------------- 180
3.4. Vascular CT ------------------------------------------------------------- 196
3.4.1. 'Contrast-covering time (CCT)' concept -------------------- 196
3.4.2. Using CCT concept to evaluate patients suspected with renal hypertension --------------------------------------------- 204
3.4.3. Using CCT concept to evaluate patients with suspected dialysis arteriovenous fistula disorder ---------------------- 216
Chapter 4. DISCUSSION ----------------------------------------------------- 231
Chapter 5. CONCLUSION --------------------------------------------------- 235
Chapter 6. PERSPECTIVES ------------------------------------------------- 237
Chapter 7. PUBLICATION LIST (ON SCI JOURNALS) ------------- 239
Congenital heart disease
- Lee T, Tsai IC*, Fu YC, Jan SL, Wang CC, Chang Y, Chen MC. Using multi-detector row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomic investigation - Initial experiences in technical and clinical feasibility. Pediatr Radiol. 2006; 36:1273-1282. The Walter Berdon Award for the outstanding Clinical Paper
- Tsai IC*, Lee T, Chen MC, Fu YC, Jan SL, Wang CC, Chang Y. Visualization of neonatal coronary arteries on multidetector row CT: ECG-gated versus non-ECG-gated technique. Pediatr Radiol. 2007; 37:818-825.
- Tsai IC, Fu YC*, Jan SL, Lin MC, Ho CL, Hwang B. Spontaneous regression of a large ductus arteriosus aneurysm in a neonate. J Pediatr. 2008; 153:143.
- Jan SL*, Tsai IC, Ho CL, Lin MC, Fu YC. Pseudopulmonary artery sling in a 22q11 deletion newborn with tetralogy of Fallot and isolated left subclavian artery. Echocardiography. 2008; 25:931-933.
- Tsai IC, Lee T*, Chen MC, Fu YC, Jan SL, Tsai WL, Wang CC. Gradual pulmonary artery enhancement: new sign of septal defects on CT. AJR Am J Roentgenol. 2007; 188:1660-1664.
- Tsai IC*, Chen MC, Jan SL, Wang CC, Fu YC, Lin PC, Lee T. Neonatal cardiac multidetector row CT: why and how we do it. Pediatr Radiol. 2008; 38:438-451.
- Tsai IC, Fu YC*, Lin PC, Lin MC, Jan SL. MDCT evaluation of congenital mitral-aortic intervalvular fibrosa aneurysm: implications for the aetiology and differential diagnosis. Pediatr Radiol. 2009; 39:80-83.
- Tsai WL, Wei HJ, Tsai IC*. High-take-off coronary artery: a haemodynamically minor, but surgically important coronary anomaly. Pediatr Radiol. 2010; 40:232-233.

Whole heart evaluation
- Tsai IC, Lee T*, Lee WL, Tsao CR, Tsai WL, Chen MC, Ting CT. Use of 40-Detector Row Computed Tomography before Catheter Coronary Angiography to Select Early Conservative versus Early Invasive Treatment for Patients with Low-Risk Acute Coronary Syndrome. J Comput Assist Tomo 2007; 31:258-264.
- Tsai IC*, Lee WL, Tsao CR, Chang Y, Chen MC, Lee T, Liao WC. Comprehensive evaluation of ischemic heart disease using MDCT. AJR Am J Roentgenol. 2008; 191:64-72.
- Su CS, Tsai IC, Lin WW, Lee T, Ting CT, Liang KW*. Usefulness of Multidetector-Row Computed Tomography in Evaluating Adult Cor Triatriatum. Tex Heart Inst J. 2008; 35:349-351.
- Tsai IC*, Lee T, Tsai WL, Chen MC, Wu MJ, Lee WL, Ting HJ. Contrast enhancement in cardiac MDCT: comparison of iodixanol 320 versus iohexol 350. AJR Am J Roentgenol. 2008; 190:W47-53.
- Tsai IC*, Liang KW, Lee WL. Penumbra imaging as a prognostic indicator for acute myocardial infarction using MDCT. AJR Am J Roentgenol. 2009; 192:W75-76.
- Tsai IC, Huang YL*, Liao WC, Kao KH, Chen MC. Left ventricular myocardial volumes measured during arterial and delayed phases of multidetector row computed tomography: a study on intra- and interobserver variability. Int J Cardiovasc Imaging. 2009; 25 Suppl 1:55-63.
- ASCI CCT & CMR Guideline Working Group, Tsai IC*, Choi BW, Chan C, Jinzaki M, Kitagawa K, Yong HS, Yu W. ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline Working Group. Int J Cardiovasc Imaging. 2010; 26 Suppl 1:1-15.
- Huang JL*, Tsai IC, Su CS, Hsieh YC, Ueng KC, Wu TJ, Ting CT, Tsao HM, Chen SA. Mimetic total coronary sinus occlusion due to superselection with the balloon catheter. Europace. 2010; 12:449-450.
- Hsieh YC, Tsai IC, Tsao CR, Lin TC, Ting CT, Wu TJ*. Spontaneous remission of ruptured intramyocardial hematoma detected upon serial multidetector computed tomography. Tex Heart Inst J. 2010; 37:350-353.
- Tsai IC, Huang JL*, Ueng KC, Hung YW, Hung CF, Liao WC, Lei HY, Chen MC, Tsai WL, Chen SA, Chen CC, Fu YC, Ting CT. Global and regional wall motion abnormalities of pacing-induced heart failure assessed by multi-detector row CT: a patient and canine model study. Int J Cardiovasc Imaging. 2010; 26(Suppl 2):223-235.

Intracardiac prosthesis
- Tsai IC*, Lin YK, Chang Y, Fu YC, Wang CC, Hsieh SR, Wei HJ, Tsai HW, Jan SL, Wang KY, Chen MC, Chen CC. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol. 2009; 19:857-867.
- Tsai IC*, Tsai WL, Lin YK, Chang Y, Fu YC. Pannus formation on MDCT: A case of black and white? Eur Radiol. 2009; 19:2953-2954.
- Tsai IC, Hsieh SR, Chern MS, Huang HT*, Chen MC, Tsai WL, Chen CC. Pseudoaneurysm in the left ventricular outflow tract after prosthetic aortic valve implantation: evaluation upon multidetector-row computed tomography. Tex Heart Inst J. 2009; 36:428-432.
- Huang HT, Hsieh SR, Chern MS, Tsai IC*. Spontaneous thrombosis of left ventricular outflow tract pseudoaneurysm after prosthetic aortic valve implantation. Tex Heart Inst J. 2010 (accepted)
- Tsai WL, Tsai IC, Chen MC, Liao WC, Chang Y. Comprehensive evaluation of patients with suspected prosthetic heart valve disorder using MDCT. AJR Am J Roentgenol. 2011; 196:353-360.
- Lee T, Tsai IC*, Fu YC, Jan SL, Wang CC, Chang Y, Chen MC. MDCT evaluation after closure of atrial septal defect with an Amplatzer septal occluder. AJR Am J Roentgenol. 2007; 188:W431-439.

Vascular CT
- Tsai IC, Lee T*, Chen MC, Tsai WL, Lin PC, Liao WC. Homogeneous Enhancement in Pediatric Thoracic CT Aortography Using a Novel and Reproducible Method: Contrast-Covering Time. AJR Am J Roentgenol. 2007; 188:1131-1137.
- Tsai IC, Tzeng WS, Lee T, Jan SL, Fu YC, Chen MC, Lin PC, Liao WC, Chen CC*. Vertebral and carotid artery anomalies in patients with aberrant right subclavian arteries. Pediatr Radiol. 2007; 37:1007-1012.
- Tsai IC*, Chen MC, Lee WL, Lin PC, Tsai IT, Liao WC, Chen CC. Comprehensive evaluation of patients with suspected renal hypertension using MDCT: from protocol to interpretation. AJR Am J Roentgenol. 2009; 192:W245-254.
- Shih SY, Tsai IC, Chang YT, Tsan YT, Hu SY*. Fatal haemoptysis caused by a ruptured Rasmussen's aneurysm. Thorax. 2010 Aug 30. [Epub ahead of print]
- Chen MC, Tsai WL, Tsai IC*, Chan SW, Liao WC, Lin PC, Yang SJ. Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer. AJR Am J Roentgenol. 2010; 194:838-847.
- Jan SL*, Lin SJ, Fu YC, Tsai IC, Chan SC, Lin MC. Effect of exercise on asymptomatic children with an isolated aberrant subclavian artery. Acta Cardiol. 2010; 65:231-237.
- Tsai WL, Tsai IC, Lee T, Hsieh CW. Polyarteritis nodosa: MDCT as a "one-stop shop" modality for whole-body arterial evaluation. Cardiovasc Intervent Radiol. 2008; 31 Suppl 2:S26-29.
- Lin YT#, Tsai IC#, Tsai WL*, Lee T, Chen MC, Lin PC, Chan SW. Comprehensive evaluation of CT pulmonary angiography for patients suspected of having pulmonary embolism. Int J Cardiovasc Imaging. 2010; 26 Suppl 1:111-120. (# co-first author)
- Lin YT*#, Tsai IC#, Tsai WL, Chen MC, Lin PC, Chan SW, Chen CC. Comprehensive evaluation of patients suspected with deep vein thrombosis using indirect CT venography with multi-detector row technology: from protocol to interpretation. Int J Cardiovasc Imaging. 2010; 26(Suppl 2):311-322. (# co-first author)
- Chen WH, Tsai IC, Huang HC, Lin CH, Hung HC, Wu CH, Chen CC*. Transcutaneous puncture of the superior ophthalmic vein for embolization of dural carotid-ophthalmic fistula. Interv Neuroradiol. 2008; 14 Suppl 2:9-11.
- Tsai IC, Tsai WL, Chen MC, Chang GC, Tzeng WS*, Chan SW, Chen CCC. CT-guided core biopsy of lung lesions: a primer. AJR Am J Roentgenol. 2009; 193:1228–1235.

Others
- Tsai IC, Chou YH*. Radiology in Taiwan. AJR Am J Roentgenol. 2008; 191:11-13.
- Kitagawa K*, Choi BW, Chan C, Jinzaki M, Tsai IC, Yong HS, Yu W. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group. Int J Cardiovasc Imaging. 2010; 26(Suppl 2):173-86.
 
 
 
 
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