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dc.contributor.advisorNewby, David
dc.contributor.advisorUren, Neal
dc.contributor.advisorMcKillop, G.
dc.contributor.authorWilliams, Michelle Claire
dc.date.accessioned2018-01-08T16:05:38Z
dc.date.available2018-01-08T16:05:38Z
dc.date.issued2016-07-02
dc.identifier.urihttp://hdl.handle.net/1842/25852
dc.description.abstractComputed tomography imaging has revolutionised modern medicine and we can now study the body in greater detail than ever before. Cardiac computed tomography has the potential to provide information not just on coronary anatomy, but also on myocardial function, perfusion and viability. This thesis addresses the optimisation and validation of computed tomography imaging of the heart using a wide volume 320-multidetector scanner. Computed tomography coronary angiography now has diagnostic accuracy comparable to invasive coronary angiography. However, radiation dose remains an important concern. It is therefore important to minimise computed tomography radiation dose while maintaining image quality. I was able to demonstrate that iterative reconstruction and patient tailored imaging techniques led to a 39% reduction in radiation dose in computed tomography coronary angiography, while maintaining subjective and objective assessments of image quality. In addition, I demonstrated that diagnostic images can be obtained in 99% of unselected patients presenting with suspected coronary artery disease when using single heart-beat 320- multidetector computed tomography coronary angiography. Computed tomography myocardial perfusion imaging can provide additional and complementary information as compared to computed tomography coronary angiography that can aid diagnosis and management. I established both quantitative and qualitative assessment of computed tomography myocardial perfusion imaging and validated it against both a clinical “gold-standard”, fractional flow reserve during invasive coronary angiography, and a physiological “gold-standard”, positron emission tomography with oxygen-15 labelled water. Finally, I was able to show that techniques to reduce radiation dose can also be applied to computed tomography myocardial perfusion imaging, leading to a 60% reduction in radiation dose, while maintaining image quality. In my thesis, I have established that comprehensive cardiac angiographic and perfusion imaging can be performed with wide volume computed tomography in a broad generalizable population of patients with relatively low radiation exposure. These techniques provide both structural and functional assessments from a single imaging modality that are valid and readily applicable to the clinic in the assessment and management of patients with suspected coronary artery disease.en
dc.contributor.sponsorotheren
dc.language.isoenen
dc.publisherThe University of Edinburghen
dc.relation.hasversionWilliams MC, Reid J, McKillop G, Weir N, van Beek EJR, Uren, NG, Newby DE. Cardiac and coronary CT comprehensive imaging approach in the assessment of coronary heart disease. Heart. 2012: 98(7); 512-2.en
dc.relation.hasversionWilliams MC, Weir NW, Mirsadraee S, et al. Image quality with single heart beat 320 multidetector computed tomography coronary angiography. Journal of Computer Assisted Tomography 2014: 38 (3); 444-450.en
dc.relation.hasversionWilliams MC, Weir NW, Mirsadraee S, et al. Iterative reconstruction and individualized automatic tube current selection reduce radiation dose while maintaining image quality in 320-multidetector computed tomography coronary angiography. Clinical Radiology 2013: 2013: 68(11); e570-7.en
dc.relation.hasversionWilliams MC, Golay SK, Hunter A, et al. Observer variability in the assessment of computed tomography coronary angiography and coronary artery calcium score: Sub-study of the Scottish Computed Tomography of the HEART (SCOT-HEART) trial. Open Heart 2015: 2(1): e000234.en
dc.relation.hasversionWilliams MC, Cruden NL, Uren NG, Newby DE. A low-dose comprehensive cardiac CT protocol assessing anatomy, function, perfusion, and viability. Journal of Cardiovascular Computed Tomography 2013: 7(1); 69-72.en
dc.relation.hasversionWilliams MC, Newby DE. Computed tomography myocardial perfusion, a step towards quantification. Heart, 2012; 98:521-2.en
dc.relation.hasversionJoshi NV, Vesey AT, Williams MC, et al. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet 2014;383:705–13. doi:10.1016/S0140-6736(13)61754-7en
dc.relation.hasversionWilliams MC. How can adherence with multi-drug therapy in leprosy be improved? Lepr Rev 2005;76:160–1.en
dc.relation.hasversionThe SCOT-HEART Investigators. Newby DE, Williams MC, et al. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOTHEART): an open label parallel group multicentre trial. Lancet 2015: 385 (9985); 2383-2391.en
dc.relation.hasversionPapanastasiou G, Williams MC, et al. Measurement of myocardial blood flow by magnetic resonance perfusion imaging. Comparison of distributed parameter and Fermi models with single and dual bolus. Journal of Cardiovascular Magnetic Resonance. 2015: 17 (17).en
dc.relation.hasversionPellegrini E, Robertson G, Trucco E, MacGillivray TJ, Lupascu C, van Hemert K, Williams MC et al. Blood vessel segmentation and width estimation in ultra-wide field scanning laser ophthalmoscopy. Biomedical Optics Express. 2014: 5 (12); 4329-4337.en
dc.relation.hasversionWilliams MC, Murchison JT, Edwards LD, et al. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. Thorax 2014: 69(8); 718-23.en
dc.relation.hasversionPapanastasiou G, Williams MC, et al. Assessing the reliability of DP and Fermi estimates in single and dual bolus cardiac MR perfusion imaging. Journal of Cardiovascular Magnetic Resonance 2014: 16 (Suppl 1); P347.en
dc.relation.hasversionDweck MR, Khaw HJ, Sng GKZ, Luo ELC, Baird A, Williams MC, et al. Aortic stenosis, atherosclerosis, and skeletal bone: is there a common link with calcification and inflammation. European Heart Journal 2013: 34 (21); 1532-3.en
dc.relation.hasversionRomme EAPM, Murchiston TJ, Edwards LD, van Beek EJR, Murchison DM, Rutten EPA, Smeenk FWJM, Williams MC, Wouters EFM, MacNee W. CT measured bone attenuation in patients with chronic obstructive pulmonary disease: relation to clinical features and outcomes. Journal of Bone and Mineral Research. 2013: 28 (6); 1369-77.en
dc.relation.hasversionNewby DE, Williams MC, Flapan AD, et al. Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic: the Scottish COmputed Tomography of the HEART randomised controlled trial. Trials 2012; 13: 184.en
dc.relation.hasversionRichards JMJ, Shaw CA, Lang NN, Williams MC, et al. In vivo mononuclear cell tracking using superparamagneic particles of iron oxide: feasibility and safety in humans. Circulation cardiovascular imaging. 2012: 5(4); 504-17.en
dc.relation.hasversionDweck MR, Chow MWL, Joshi NV, Williams MC, et al. Coronary Arterial 18FNaF Uptake: a novel potential marker of plaque biology. JACC Cardiovascular Imaging 2012: 59 (17); 1593-48.en
dc.relation.hasversionRichards JMJ, Semple SI, MacGillivray TJ, Gray C, Langrish JP, Williams MC, et al. Abdominal aortic aneurysm growth predicted by uptake of ultrasmall superparamagnetic particles of iron oxide: A pilot study. Circulation: Cardiovascular Imaging. 2011: 4; 273-81.en
dc.relation.hasversionMaroules CD, Cheezum MK, Joshi PH, Williams MC, et al. SCCT curriculum guidelines for general (level 1) cardiovascular CT training. JCCT 2015: 9 (2); 81-88.en
dc.relation.hasversionWilliams MC. Conversion factors specific to CCTA. In Radiation Dose in Adult and Paediatric Multidetector CT, Second Edition. Editors Tack D, Kalra M. Springer, 2012.en
dc.subjectcomputed tomographyen
dc.subjectpositron emission tomographyen
dc.subjectcoronary artery diseaseen
dc.subjectmyocardial perfusionen
dc.subjectradiation doseen
dc.titleComputed tomography imaging of the hearten
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD Doctor of Philosophyen
dc.rights.embargodate2100-12-31en
dcterms.accessRightsRestricted Accessen


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