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This dissertation, Clinical Applications of Cardiac Multi-detector Computed Tomography by Silun, Wang, 王思倫, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: CLNICAL APPLICATIONS OF CARDIAC MDCT Wang SL Abstract of the thesis entitled Clinical applications of cardiac multi-detector computed tomography Submitted by WANG Silun For the degree of Master of Philosophy at the University of Hong Kong in August 2006 Multi-detector computed tomography (MDCT) now provides sufficient spatial and temporal resolution which has made cardiac imaging into reality. The aim of this dissertation is to explore clinical applications of cardiac MDCT including calcium score (CS) in RA patients, image quality and diagnostic accuracy of 64-MDCT coronary angiography, imaging analysis of pulmonary veins (PVs) and left atrium (LA) in patients with atrial fibrillation (AF). MDCT detected CS can be applied to evaluate risk of coronary artery disease (CAD). Rheumatoid arthritis (RA) patients and controls were studied to evaluate the prevalence and extent of atherosclerosis. We found significantly higher prevalence and extent of atherosclerosis in the coronary arteries, carotid arteries and aorta in RA II CLNICAL APPLICATIONS OF CARDIAC MDCT Wang SL patients. We found that RA patients have a 16.1 fold increased risk of atherosclerosis and that RA is an independent risk factor for CAD. MDCT is emerging as a non-invasive imaging modality to evaluate coronary artery stenosis in CAD. We evaluated the diagnostic accuracy of 64 -MDCT coronary angiography in patients with high risk of CAD by comparing with quantitative coronary angiography (QCA). We found excellent or good image quality in 79% of the coronary artery segments. Sensitivity and specificity of 64-MDCT was 94% and 98% for segment-based analysis, 93% and 94% for vessel-based analysis, 100% and 83% in patient-based analysis respectively. This study showed that 64-MDCT has a high diagnostic accuracy to evaluate coronary artery stenosis. Cardiac MDCT provides detailed anatomic characteristics of the LA and PV. We documented the anatomic characteristics of LA and PV in Southern Chinese who had AF. Our study confirmed great variation of PV pattern (36% with atypical PV anatomy) and distribution in Southern Chinese. Cardiac MDCT provides important anatomic information which will contribute to special catheter design and pre-operative analysis. III CLNICAL APPLICATIONS OF CARDIAC MDCT Wang SL Left atrium-esophageal (LA-Eso) fistula is a critical complication of radiofrequency ablation (RFA) for AF. MDCT navigator imaging provides virtual endocardial visualization of the oesophagus (Eso) and LA. By analyzing forty-five patients with AF, we found that direct LA-Eso contact was present in 96% cases. Three-dimensional navigator imaging technique enhanced the visualization of the anatomical information of the Eso, LA wall, and PV ostia that may be used to avoid thermal injury to the Eso during RFA. Cardiac MDCT also provides two-dimensional anatomic information of LA and Eso. By analyzing thirty-eight patients with AF, we found mean (S.D) wall thickness of Eso and LA to be very thin; measuring 2.680.73mm and 0.960.30mm respectively. Left superior pulmonary vein ostium was the closest PV ostium to Eso in 95% of patients. There was a great variation in fat pad thickness (range, 2.7 to 26.4mm). Therefore, potential risk of thermal injury to the Eso during RFA of the left superior PV is the highest. Pre-operative cardiac MDCT can provide critical

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