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<meta name="description" content="非造影MDCTで心臓を撮るだけでも多くの重要な情報を得ることができますが，その事実は意外と知られていません．例えば，冠動脈石灰化は非造影MDCTから自動的に定量化できる指標です．動脈硬化のプロセスでしかできないものであるため，石灰化スコアを用いることにより患者のリスク層別化が可能となります．造影MDCTは冠動脈疾患の評価のみならず，心臓弁膜症や先天性心疾患における解剖の把握に必須の検査となっていま">

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		<h1 class="catchCopy">MDCTを臨床に活かす！</h1>
		

		<h1 class="title">循環器臨床を変えるMDCT（電子版のみ）<span class="version"></span></h1>
		<h2 class="subTitle">そのポテンシャルを活かす！</h2>

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					編集：小山靖史（桜橋渡辺病院心臓・血管センター）
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					<span class="transparent">編集</span>　伊藤　浩（岡山大学教授）
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				<ul class="property"><li class="disc">B5判・324頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1924-3</li><li class="disc">2015年4月4日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">非造影MDCTで心臓を撮るだけでも多くの重要な情報を得ることができますが，その事実は意外と知られていません．例えば，冠動脈石灰化は非造影MDCTから自動的に定量化できる指標です．動脈硬化のプロセスでしかできないものであるため，石灰化スコアを用いることにより患者のリスク層別化が可能となります．造影MDCTは冠動脈疾患の評価のみならず，心臓弁膜症や先天性心疾患における解剖の把握に必須の検査となっています．<br>☆図版123点，カラー写真156点，モノクロ写真291点，イラスト・線画3点</section><section class="preface">序文<br><br>　64列MDCTの出現により循環器臨床が大きく変貌しました．時間分解能と空間分解能の著しい向上により，造影剤を静注するだけで冠動脈造影に劣らない画像が得られるようになったことから，冠動脈疾患を診断するための“gate keeper”として日常臨床で広く用いられるようになりました．また，冠動脈プラーク情報が得られるのもMDCTのメリットの一つです． 個々の冠動脈プラーク性状に迫ることにより， 潜在する不安定プラークを診断することも可能となりました．さらに，死角のない広範囲の撮影は，冠動脈以外の心臓や心臓周囲の情報も提供できるようになってきました．しかし，それだけではMDCTの能力を十分に引き出しているとは言えません．<br>　実際，非造影MDCTで心臓を撮るだけでも多くの重要な情報を得ることができますが， その事実は意外と知られていません．例えば，冠動脈石灰化は非造影MDCTから自動的に定量化できる指標です．動脈硬化のプロセスでしかみられないものであるため，石灰化スコアを用いることにより患者のリスク層別化が可能となります．さらに，心膜脂肪，心筋性状にも臨床的意義があることが明らかとされつつあります．最近の被曝低減技術の進歩により，FFR-CTや心筋パーフュージョンなど狭窄の機能情報の収集や，弁膜疾患の診断や治療にも応用されつつあります．造影MDCTは冠動脈疾患の評価のみならず，心臓弁膜症や先天性心疾患における解剖の把握に必須の検査となっています．<br>　MDCTから得られる情報を最大限に活かすことにより， 個々の患者の病態を把握し，適切な治療方針を決め，そして治療効果を判定することが可能となります．そのためには，最適な画像を撮影することに加え，注意深い読影が重要であることは言うまでもないでしょう．MDCTならではの撮影法や表示法を十分理解した上で， 適切な画像情報を選択し，臨床現場に提供する必要があります．<br>　本書は，「MDCTを臨床に活かす」という観点から，最新の情報をエキスパートの先生方に執筆をお願いし，初学者の皆様もMDCTの持つポテンシャルを十分理解できるよう解説していただきました．本書が，皆様のお手元で常に活用され，明日からのMDCTの臨床診断，治療の一助になれば幸いです．<br><br>2015年4月<br>桜橋渡辺病院　小山靖史<br>岡山大学　伊藤　浩</section><section class="indexes">I 循環器臨床の常識を変えたMDCT<br>　1． 循環器臨床の常識を変えたMDCT─そのコンセプトと活用法─<br>II 造影剤を使わなくてもここまでわかる！<br>　1． 冠動脈石灰化を臨床にどう活かす？<br>　　a． 動脈の石灰化はなぜ起きる？<br>　　b． MDCTによる冠動脈石灰化の評価<br>　　　One Point Advice　冠動脈石灰化の注意点<br>　　　Controversy　腎不全の石灰化と動脈硬化の石灰化<br>　　c． 冠動脈石灰化によるリスク層別化<br>　　　One Point Advice不安定狭心症の診断に非造影MDCTを活用する<br>　　d． 冠動脈石灰化の進行とリスク層別化<br>　　e． 高リスク患者のリスク層別化をどのようにする？<br>　　　Controversy　治療による冠動脈石灰化の退縮は可能か<br>　　　Controversy　カルシウムスコア“0”は冠動脈病変を否定できるのか<br>　2． 最近注目されている心膜脂肪<br>　　a． 心膜脂肪は内臓脂肪である─その病的意義は？─<br>　　　Topics皮下脂肪と内臓脂肪の違いとは？<br>　　b． MDCTによる心膜脂肪の定量的評価<br>　　　One Point Advice　心エコーでもできる心臓周囲脂肪の評価<br>　　c． MDCTによる心膜脂肪の病的意義<br>　3． 心筋の脂肪変性を評価する<br>　　a． 心筋の脂肪変性はどのような時に出現するのか<br>　　b． 心筋梗塞と心筋脂肪変性<br>　　　One Point Advice ARVCの脂肪変性を評価する<br>　4． 非造影MDCTで見逃してはならない他臓器の病変<br>　　a． 脂肪肝の診断のコツとその意義<br>　　b． 大動脈弁石灰化と大動脈病変<br>　　c． 慢性閉塞性肺疾患の重症度を評価する<br>　　d． 腹部脂肪量を評価する<br>III 造影心臓CTで冠動脈を評価する<br>　1． 正常冠動脈はCTでどうみえる？<br>　2． 見逃してはならない冠動脈走行異常<br>　　　One Point Advice 腎機能障害患者に造影CTを行う際の注意点─造影剤腎症に対するリスク・患者評価とその予防─<br>　3． 冠動脈狭窄を評価する<br>　　a． MDCTによる冠動脈狭窄評価の実際─CAGとの相違─<br>　　b． 冠動脈石灰化病変がある時の対応<br>　　c． 中等度冠動脈狭窄をどう評価する？<br>　　d． Fractional-flow reserveをMDCTから求める<br>　　　One Point Advice Fusion imageを活用する<br>　　　One Point Advice 薬剤負荷perfusion MDCTを効率よく行うために<br>　　e． 心筋血流から冠動脈病変の重症度を評価する<br>　　f． ステント病変を評価する<br>　　g． CABGにおけるMDCTの有用性<br>　4． 冠動脈閉塞を評価する<br>　　a． 冠動脈閉塞では何をみたらよいのか─PCIに役立つ情報を得るために─<br>　　b． 側副血行路を評価する<br>　　c． CABGプランニングをどうする？<br>　5． 冠動脈プラークを評価する<br>　　a． 安定プラークと不安定プラーク<br>　　b． 急性冠症候群では何をみる？<br>　　c． プラークの石灰化とその意義<br>　　d． プラークの定量評価をどうする？<br>　　　Topics プラーク性状は薬剤治療により変わるのか<br>　　　Controversy low density plaqueは不安定プラークなのか<br>　　e． 他のモダリティ（IVUS，OCT）との対比<br>IV 心臓を評価する<br>　1． 心筋を観察する<br>　　a． 正常心筋はCTでどのようにみえるか<br>　　b． 心筋梗塞（急性・陳旧性）<br>　　　Topics CTによるdelayed enhancementと心筋viabilityの撮影・解析のポイント<br>　　　One Point Advice 壊死心筋はどのようにみえるのか─移植後，補助循環装置後，どのように評価するか─<br>　　c． 肥大型心筋症<br>　　d． 特発性拡張型心筋症，心筋緻密化障害<br>　2． 心機能を評価する<br>　　a． 心腔容量を評価する<br>　　b． 左室収縮能，局所壁運動を評価する<br>　3． 心臓弁膜を評価する<br>　　a． 大動脈弁の評価とTAVIのプランニング<br>　　b． 僧帽弁の評価─心臓手術に欲しい情報は？─<br>　　c． 人工弁の機能評価<br>　4． 異常構造物を評価する<br>　　a． 心腔内血栓<br>　　　One Point Advice 左心耳血栓の評価は経食道エコーでなくても十分？<br>　　b． 心臓腫瘍を診断する<br>　5． カテーテルアブレーションに活かす<br>　　a． 心房細動のカテーテルアブレーション─術前に必要な情報とは─<br>　　b． 心房細動のカテーテルアブレーション─術後評価とは─<br>　　c． その他の不整脈のカテーテルアブレーション<br>　6． 成人先天性心疾患で活かす<br>　　a． 心房中隔欠損症の治療方針に活かす<br>　　b． その他の成人先天性心疾患の診断における有用性<br>　7． 心膜，心囊液を診断し治療に活かす<br>V 肺動脈血栓塞栓症を評価する<br>　1． 肺動脈血栓塞栓症を診断する<br>　　　One Point Advice 肺動脈性肺高血圧症との鑑別<br>　　　Controversy 肺静脈閉塞症および肺毛細血管腫症のCT所見<br>　2． バルーン肺動脈形成術に活かす肺動脈CT<br>VI 救急外来で行う心臓CT<br>　1． triple-rule-out─どうする？ どう解釈する？─<br>　2． 急性冠症候群はCTで診断できるか<br>VII 心臓CTを理解するために<br>　1． MDCTの基本原理を知っておこう！<br>　　a． 放射線被曝量とその低減化の試み<br>　　b． 知っておいて欲しい画像再構成のプロセス─基本的な時間分解能，空間分解能，CT値の意味─<br>　　c． 表示法とその特徴<br>　2． 心臓CTを成功させるために必要なこと<br>　　a． 造影検査前にチェックするポイント<br>　　　One Point Advice 腎不全患者に造影剤を使用する際の注意点<br>　　b． なぜ心拍数のコントロールが必要なのか<br>　　　One Point Advice β遮断薬の選択─経口 vs. 静注─<br>　　c． 撮影対象別，造影剤の注入タイミングと注入量<br>　　d． レポーティングの活用─大量のデータを活かす！─<br>索引</section></article>
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