538 Special Features [ 147 # 2 CHEST FEBRUARY 2015 ] he imaging of intrathoracic structures has always been susceptible to movement arti- facts, mainly due to physiologic movements caused by heart beats or, depending on the patient’s clinical conditions and compli- ance, by uncontrolled coughing, inability to perform and keep adequate breath-hold, esophageal peristalsis, or involuntary Valsalva maneuver. The continuous, impressive technical evolution in the ield of CT imaging in the last decade has made it possible to achieve adequate CT image quality in patients with poor respiratory compliance, mainly through the reduction of scan time and higher temporal resolution of the scanner. Similarly, the development of ECG-gated CT imaging and its introduc- tion in the clinical routine, with ever-less radiation exposure, has made it possible to scan the thorax, heart, and great intratho- racic vessels, avoiding the classic step arti- facts due to the heart beats, with improved Comprehensive CT Cardiothoracic Imaging A New Challenge for Chest Imaging Riccardo Marano, MD; Federica Pirro, MD; Valentina Silvestri, MD; Biagio Merlino, MD; Giancarlo Savino, MD; Claudia Rutigliano, MD; Agostino Meduri, MD; Luigi Natale, MD; and Lorenzo Bonomo, MD In the past, thoracic and cardiac imaging were two distinct specialties of radiology. The tech- nical evolution, however, has changed their boundaries with an important impact on CT imaging practices and has opened the new era of “cardiothoracic” imaging, due to the strong ana- tomic, mechanical, physiologic, physiopathologic, and therapeutic cardiopulmonary correla- tions. Modern thoracic radiologists can no longer avoid the assessment of heart and coronary arteries, as they used to do with earlier generations of CT scanner. The advent of ECG gating and state-of-art CT scanner faster rotation speed, high spatial and temporal resolution, high- pitch mode, shorter acquisition time, and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, integrating cardiac morphologic and even func- tional information within a diagnostic chest CT scan. The aim of this review is to briefly show and summarize the concept of integrated cardiothoracic imaging, which redefines the bound- aries of chest CT imaging, opening the door to a new radiologic specialty. CHEST 2015; 147(2):538-551 ABBREVIATIONS: AHT 5 arterial hypertension; ASD 5 atrial septal defect; ATS 5 atherosclerosis; CAD 5 coronary artery disease; CMP 5 cardiomyopathy; CTA 5 CT angiography; CV 5 cardiovascu- lar; CXR 5 chest radiograph; DSCT 5 dual-source CT; HR 5 heart rate; IHD 5 ischemic heart disease; IVC 5 inferior vena cava; LV 5 let ventricle; MDCT 5 multidetector CT; PAPVR 5 partial anomalous pulmonary venous return; PFO 5 patent foramen ovale; PHT 5 pulmonary hypertension; RA 5 right atrium; RV 5 right ventricle [ Special Features ] Manuscript received June 10, 2014; revision accepted August 7, 2014. AFFILIATIONS: From the Department of Radiological Sciences, Insti- tute of Radiology, Catholic University, Rome, Italy. CORRESPONDENCE TO: Riccardo Marano, MD, Department of Radiological Sciences, Institute of Radiology, Catholic University, “ A. Gemelli” Hospital, L.go Agostino Gemelli, 8, 00168, Rome, Italy; e-mail: riccardo.marano@rm.unicatt.it © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. DOI: 10.1378/chest.14-1403 Downloaded From: http://journal.publications.chestnet.org/ on 05/30/2016