Scribd Logo
Upload

Welcome to Scribd!

  • 115 views

    Coronary CT Angiography INTERN

    Uploaded by

    dr santhosh kemminje
    64-slice coronary CT angiography can accurately detect significant coronary artery stenosis greater than 50% compared to invasive coronary angiography, with negative predictive values between 97-100%. Coronary CT angiography requires patient preparation to lower the heart rate and use of contrast agent during image acquisition. Images are evaluated using multiplanar reformatted images and sliding thin-slab maximum intensity projection images to detect plaques and stenosis. While limited by heart rate, motion artifacts, and calcified plaques, coronary CT angiography shows potential for diagnosing coronary artery disease and characterizing plaque composition.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Coronary CT Angiography INTERN

    Uploaded by

    dr santhosh kemminje
    115 views23 pages
    64-slice coronary CT angiography can accurately detect significant coronary artery stenosis greater than 50% compared to invasive coronary angiography, with negative predictive values between 97-100%. Coronary CT angiography requires patient preparation to lower the heart rate and use of contrast agent during image acquisition. Images are evaluated using multiplanar reformatted images and sliding thin-slab maximum intensity projection images to detect plaques and stenosis. While limited by heart rate, motion artifacts, and calcified plaques, coronary CT angiography shows potential for diagnosing coronary artery disease and characterizing plaque composition.

    Original Description:

    coronary ct angiographic study

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    64-slice coronary CT angiography can accurately detect significant coronary artery stenosis greater than 50% compared to invasive coronary angiography, with negative predictive values between 97-100%. Coronary CT angiography requires patient preparation to lower the heart rate and use of contrast agent during image acquisition. Images are evaluated using multiplanar reformatted images and sliding thin-slab maximum intensity projection images to detect plaques and stenosis. While limited by heart rate, motion artifacts, and calcified plaques, coronary CT angiography shows potential for diagnosing coronary artery disease and characterizing plaque composition.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    115 views23 pages

    Coronary CT Angiography INTERN

    Uploaded by

    dr santhosh kemminje
    64-slice coronary CT angiography can accurately detect significant coronary artery stenosis greater than 50% compared to invasive coronary angiography, with negative predictive values between 97-100%. Coronary CT angiography requires patient preparation to lower the heart rate and use of contrast agent during image acquisition. Images are evaluated using multiplanar reformatted images and sliding thin-slab maximum intensity projection images to detect plaques and stenosis. While limited by heart rate, motion artifacts, and calcified plaques, coronary CT angiography shows potential for diagnosing coronary artery disease and characterizing plaque composition.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 23

    Coronary CT Angiography

    Intern 柳復威
    Udo Hoffmann, Maros Ferencik, Ricardo C. Cury, and Antonio J. Pena
    Coronary CT Angiography
    J Nucl Med May 1 2006 47: 797-806.
     64-slice coronary CT angiography is highly
    accurate for the exclusion of significant
    coronary artery stenosis (>50% luminal
    narrowing)
     with negative predictive values of 97%–
    100%, in comparison with invasive
    selective coronary angiography.
    INTRODUCTION
     patientpreparation
     image acquisition
     evaluation techniques
    patient preparation
    Image quality improved at low heart rates
    (<65 beats per minute)
    1. the inspirational breath hold (-6beats/min)
    2. oral ß-blocker (50—100mg oral or 5–20 mg i.v.
    metoprolol)
    3. combination (-11beats/min)
    4. short-acting nitroglycerin (selective coronary
    angiography )
    Supine position
    Sedation
    image acquisition
    A low-energy topogram
    determination of the adequate initiation of the coronary CTA image
    acquisition to ensure homogeneous contrast enhancement of the
    entire coronary artery tree
     Two techniques:
    1. the timing bolus technique
    2. the bolus tracking technique
     CT volume dataset
    The minimal equipment requirement for state-of-the-art
    coronary CTA is a 16-slice scanner. However, 40- or 64-
    slice MDCT scanners are recommended, as they
    increasethe volume coverage and permit reduction of
    the scan time and the amount of contrast agent.
    Radiation exposure
     64-sliceMDCT:11~22mSv
    (ECG-controlled dose modulation is 7–
    11mSv)
     invasive selective coronary angiography:
    2.5–5mSv,
     nuclear perfusion imaging with SPECT:
    15~20mSv
    Image evaluation
     multiplanar reformatted (MPR) images
    For the confirmation of pathologic findings in the
    long and short axes of the vessel.
     sliding thin-slab MIP (STS-MIP) images
    enhance the visualization of coronary artery
    stenosis in a long-axis view of the vessel if
    narrowing is caused by noncalcified
    atherosclerotic plaque
    Artifact
     Motion Artifacts ： occur at high rates and most
    often in the midsegment of the right coronary artery
     Misalignment and Slab Artifacts ： high
    heart rates, heart rate variability, and the presence of
    irregular or ectopic heart beats (e.g. PVC)
     Blooming Artifacts ： High-attenuation
    structures, such as calcified plaques or stents, appear
    enlarged (or bloomed) because of partial volume
    averaging effects and obscure the adjacent coronary
    lumen, the main cause of false-positive results in
    coronary CTA because of overestimation of the
    degree of stenosis
    FINDINGS AND POTENTIAL CLINICAL
    APPLICATIONS
     Detection of Significant Coronary Artery
    Stenosis
    moderate sensitivity (about 80%) and excellent specificity (about 90%)
     Detection and Characterization of Coronary
    Atherosclerotic Plaque
    1. detects calcified or mixed plaque with sensitivities and specificities
    above 90%.
    2. the detection of noncalcified plaques, with sensitivities and
    specificities ranging from 60% to 85%, but has the potential to
    further stratify noncalcified plaque into fibrous plaque and lipid-rich
    plaque
    3. smaller plaques ( ＜ 0.5 mm) are not detected
    Potential Clinical Applications
    limitation
     Data based on single-center, multicenter trials and studies with
    intermediate-risk populations are warranted
     a very specific subset of symptomatic middle-aged white men who
    had a high prevalence of CAD
    Other potential applications
     coronary CTA is to improve the triage and management of
    patients with acute chest pain.
     preoperative risk
     patency of stents placed in the left main coronary artery
     bypass patency
    CONCLUSION
     Severe coronary calcification remains the major
    limiting factor in coronary CTA.
     The high negative predictive value of 64-slice MDCT,
    relative to invasive selective coronary angiography, can
    rule out the presence of hemodynamically significant
    CAD.
     Although data on clinical utility, cost, and cost-
    effectiveness are not yet available, coronary CTA may
    improve the management of patients with an
    intermediate probability of CAD and patients with
    acute chest pain.
    Thanks for your attention!

    You might also like