Coronary Artery Disease: Boxt LM

Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ, Cheng V, DeFrance T, Hellinger JC, Karlsberg RP, Anonymous00022. · Society of Cardiovascular Computed Tomography, 2400 N Street NW, Washington, DC 20037, USA. · J Cardiovasc Comput Tomogr. · Pubmed #19272853 No free full text.

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Meraj PM, Makaryus AN, Boxt LM. · Division of Cardiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA. · Int J Cardiovasc Imaging. · Pubmed #17043905 No free full text.

Abstract: Coronary artery aneurysm is an uncommon finding. It is defined as a dilated coronary artery which exceeds the diameter of the normal adjacent vessel by 1.5-2 times. Although theorized mechanisms include atherosclerotic coronary artery disease (CAD) and iatrogenic causes such as the use of percutaneous coronary interventions (PCI), the natural history and prognosis of this disease remain obscure. We describe a case of a 75 year old man who was found to have a long segmental myocardial bridge immediately followed by a 5 mm inner diameter aneurysm in the left anterior descending artery (LAD) detected on 64-detector cardiac computed tomography (64-CT). The post myocardial bridge aneurysmal dilatation in this case is unique, and has not been previously described. With the advent of 64-CT, more incidental cardiac anomalies and irregularities are likely to be found. In the end, the question as to the clinical significance of these findings and their treatment remains controversial. We report this novel case and review the literature for recommendations on treatment and management of patients with coronary aneurysms.

Boxt LM, Lipton MJ, Kwong RY, Rybicki F, Clouse ME. · Division of Cardiovascular Imaging, Beth Israel Medical Center, 1st Avenue at 16th St., New York, NY 10003, USA. · Cardiol Clin. · Pubmed #14719569 No free full text.

Abstract: The focus to date of MDCT has been primarily on CT applications for evaluating the coronary arteries, notably the measurement of coronary artery calcification, plaque characterization, and atherosclerotic lumen stenosis. This is because of the limited temporal resolution of CT, and the recent rapid improvements in MRI for cardiac applications. However, if the temporal resolution of MDCT can be improved, there will be a compelling argument for undertaking further CT validation studies. Feasibility of CT has already been established by EBT for general cardiac diagnosis. Modifications for MDCT include improved software methods for post processing ECG-gated scan data or higher speed CT hardware for faster image acquisition, both of which are being developed at this time. EBT is also evolving and continuously being refined so that the new generation of scanners have exposure times of 50 msec or less. There are many considerations in comparing the pros and cons of competing cardiac imaging modalities. Published diagnostic validations studies, convenience, procedure time, the comfort level (of patients and physicians), availability, and cost are all critical. The level of acceptance and the accuracy with which specific patient management questions can be appropriately answered are crucial issues in determining which diagnostic procedure to perform. However, the jury is still out regarding the ultimate role of CT in the diagnosis of heart disease; certainly the great potential of cardiac CT has not yet been fully realized.

Lipton MJ, Bogaert J, Boxt LM, Reba RC. · Department of Radiology, University of Chicago, 5841 South Maryland, P220, MC 2026, Chicago, IL 60637, USA. · Eur Radiol. · Pubmed #11976848 No free full text.

Abstract: Despite advances in the understanding and treatment of ischemic cardiomyopathy, characterized by extensive coronary artery disease and left ventricular (LV) dysfunction, the prognosis remains poor with only a 50-60% 5-year survival rate. The composition of atherosclerotic lesions is currently regarded as being more important than the degree of stenosis in determining acute events. If imaging techniques could distinguish vulnerable from stable plaques, then high-risk patient subgroups could be identified. Another important concept is that LV dysfunction may be the result of either scarring due to necrosis or to the presence of myocardial hibernation, in which there is sufficient blood flow to sustain viable myocytes, but insufficient to maintain systolic contraction. This concept of myocardial viability is critical for making optimal clinical management decisions. This review describes how noninvasive imaging methods can be used to distinguish regions of irreversibly injured myocardium from viable but hibernating segments. Technical advances in CT and MR have made imaging of the beating heart possible. Considerable clinical progress has already been made and further cardiac applications are expected. Radiologists therefore have new opportunities for involvement in cardiac imaging but must recognize the political implications as well as the diagnostic potential of these modalities not only for the heart, but also for the whole vascular system. This review focuses on imaging myocardial injury. It compares state-of-the-art CT and MR with more established yet contemporary echocardiography and nuclear scintigraphy.

Lipton MJ, Boxt LM, Hijazi ZM. · Department of Radiology, University of Chicago, MC 2026, Chicago, IL 60637, USA. · AJR Am J Roentgenol. · Pubmed #11090363 links to  free full text

This publication has no abstract.

Boxt LM. · Department of Radiology, Beth Israel Medical Center, New York, NY 10003, USA. · Semin Roentgenol. · Pubmed #10432550 No free full text.

This publication has no abstract.