Multislice CT. - fast scanning - submilimeter slices
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1 CT angiography
2 Multislice CT - fast scanning - submilimeter slices
3 CT angiography - Minimal invasivity - High resolution (similar to DSA, higher than MRI) - Cannot assess hemodynamics (contrary to DSA) - Radiation - Iodinated CM In most of diagnostic indications CT replaced DSA
4 CM application Power injector - CM volume - injection rate - acquisition timing CM volume ml rate ml/s
5 Pharmacokinetics of CM 1 Peripheral vein 1 2 Right heart parts 3 Pulmonary arteries and veins Left heart parts Systemic arteries 6 Systemic veins 7 B 7 Portal system
6 Circulation phases and circulation time 1 Venous prephase (immediately after CM application) 2 pulmonary arterial phase (10-15 s) 3 systemic arterial phase (15-30 s)
7 Cirkulační fáze a cirkulační čas II. 4 venous phase (variable: 40 s - 2 min) 5 portal phase (40-60 s)
8 Density of vessels after CM bolus 1 Ao 2 VP 3 VCI First pass (higher concentration of CM) - arteries - perfusion examination Recirculation (lower concentration of CM) - veins
9 Conditions of CT angiography 1) exact timing of data acquisition determination of circulation time 2) sufficient density during whole acquisition correct injection parameters (volume, rate, scanning delay)
10 The dynamics of CM is determined by: 1) cardiac output 2) injection rate 3) volume of CM 4) concentration of CM 5) patient pathology
11 Acquisition timing Circulation time interval between start of contrast bolus and opacification of evaluated vessel 1) empirical assessment recirculation - veins 2) automatic monitoring dynamic serial scanning after CM administration automatic start after increase of density above threshold value the most accurate method
12 Evaluation Thin slices (0,6-3 mm) Multiplanar reconstructions 3D reconstructions Automatic analysis
13 Basic findings 1. Abnormal course 2. Dilatation 3. Stenosis 4. Occlusion 5. Dissection 6. Extravasation 7. Arteriovenous malformation 8. Pathological vascularization
14 Cerebral vessels Acute stroke with short anamnesis - possibility of thrombolysis (precontrast examination + perfusion exanimation + CT AG) Intracranial bleeding - detection of the source (aneurysm, AVM) Sinus thrombosis Chronical Atherosclerotic involvemnet (symptomatic, asymptomatic) Asymptomatic vascular malformations and aneurysms Tumors Follow-up examinations after vascular interventional procedures or surgery
15 Perfusion examination Functional method for quantification of perfusion. directly proportional relationship between amount of iodine and density in CT - small amount of CM (30-50 ml) - high injection rate (5-9 ml/s) - repeated scanning during the first pass of CM - calculation of perfusion parameters Basic parameters - cerebral blood volume (CBV) - cerebral blood flow (CBF) - time to peak (TTP)
16 Ischemia in the left cerebral haemisphere CBF CBV TTP Necrosis <12 ml/100mg/min, Penumbra ml/100mg/min
17 Volume perfusion CT of the brain before thrombolysis (aphasia, right hemiplegia) after thrombolysis(aphasia remaind, right hemiplegia recovered)
18 Embolisation to the basilar artery, ischemia of the right cereballar haemisphere
19 CBV CBF TTP cclusion of the right middle cerabral artery before and after a thrombolysis CBV CBF TTP
20 Atherosclerotic plaque Stable fibrous plaque calcified plaque unstable lipoid plaque ulcerated plaque
21 Tortuosity - coiling Tortuosity - kinking CBV CBF TTP CBV CBF TTP
22
23 Multiple stenoses carotic bifuracation and carotic chanell
24
25 Aneurysm of anterior communicant artery + inctacerebral hematoma
26 Arteriovenous malformation
27 Thorax Aorta Anatomic anomalies Aneurysm Pseudoaneurysm (trauma) Dissection (Marfanův sy.) Coronary arteries Atherosclerosis Bypasses Pulmonary artery Tromboembolic disease Anomalies Pulmonary hpertension Superior vena cava Anatomické anomalies Compression Thrombosis
28 Aortic diverticle
29 A. Lusoria
30 Right aortic arch
31 Coarctation
32 Aortic dissection A B tear in the intima bleeding between the layers of the wall Stanford classification Type A - involvement of ascending aorta Type B - involvement of descending aorta Complications Rupture Hemoperikardium - cardiac tamponade Cerebral ischemia Myocardial ischemia Aortic valve insuficiency Ischemia of abdominal organs
33
34
35 Aortic bleeding Dissection Perforation of atherosclerotic ulcer Rupture of aneurysm Trauma
36 Injury Deceleration trauma - fall from height -traffic injuries Isthmus - end of aortic arch (insertion of arterial ligament)
37 Pulmonary embolism - Filling defect in the pulmonary artery - Right heart failure (dilatation of right heart parts, deviation of intraventricular septum to the left side)
38 Chronic pulmonary hypertension
39 lymphoma - stenosis of SVC
40 Duplication of VCS
41 Heart tumors
42 Partial anomalous venous return
43 Abdominal vessels Abdominal aortic aneurysm Atherosclerosis Vasculitis Pathologic ascularization or encasement of vessels Anomalies of IVC IVC thrombosis Trauma Follow-up after vascular procedures
44 Aneurysm of abdominal aorta Suprarenal beginning above the level of renal arteries Juxtarenal - beginning less than 1 cm below the level of renal arteries Subrenální beginning more then 1 cm below the level of renal arteries
45 Stentgraft
46 Crescent sign Rupture of aneurysm
47 Leriches syndrome - aortoiliac occlusion Acute embolisation acute ischemia of lower extremities and sometimes of kindneys and bowel Chronic atherosclerotic occlusion - colaterals
48 Aortitis Rare condition - bacterial, aseptic - Takayasu arteriits, Lupus erytematodes Thickening of aortic wall with contrast enhancement
49 Vascular reconstructions
50 Anomalies of renal vessels Laparoscopic nefrectomy planning
51 Acute occlusion of mesenteric artery High mortality and morbidity - intestinal ischemia - gangrena - peritonitis
52 Abdominal angina Postprandial abdominal pain severe stenosis of two (from three) arteries supplying GIT
53 Renal arteries stenoses květen 1995
54 Thrombosis of IVC
55 Pathological vascularization Hepatocellular carcinoma, conventional renal carcinoma tortuous vessels, lacunae, A-V shunts
56 Tumorous invasion into the IVC Tumorous thrombus has pathological vascularization - contrast enhancement, vessels
57 Pancreatic carcinoma Vascular encasement
58 CT angiography of peripheral vessels Stenosis Embolisation Aneurysm Trauma Venous thrombosis Dialysis fistula
59 Chronic atherosclerotic obliteration ofsuperficial femoral artery CTA and DSA
60 Atrial fibrilation peripheral embolisation CTA and DSA
61 Femoropopliteal bypass pseudoaneurysm + embolisation to the popliteal artery
62 Acute thrombosis CTA and DSA
63 Acute ischemia, traffic accident (motorcycle)
64 Dialysis fistula
65 MR angiogrpahy - Without contrast (TOF) - flow-void phenomenon - Contrast - same principle as CT angiography TOF - WE cemra
66 MR angiography advantages - no radiotion - may be performed without CM Disadvantages - long acquisition - lower resolution - more artifacts Indicated as a method of the second choice when it is no possible or suitable to perform CT AG. iodine allergy, renal failure, children
67 Superficial femoral artery occlusion
68
69 Dialysis fistula
70 ECG synchronisation Heart imaging
71 Indications Multidetector CT coronary arteries bypasses valves - morphology MRI kinetics - dobutamin stress test kardiomyopathy ischemia valves - morphology and function intracardial masses
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