, David Stultz, MD. Cardiac CT. David Stultz, MD Cardiology Fellow, PGY 6 March 28, 2006

Transcription

1 Cardiac CT David Stultz, MD Cardiology Fellow, PGY 6 March 28, 2006

2 Courtesy Tom Kracus Courtesy Kettering Tom Medical Kracus Cente Kettering Medical Center , David Stultz, MD

3 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD Pretty Pictures Are Nice

4 But this is where you start

5 Basic Protocol for 64 slice Coronary MDCT Heart rate <65 Administer atenolol or metoprolol po Administer metoprolol IV prn (5-10mg) Nitroglycerin just before injection Test bolus (10cc) track intensity in aorta to determine optimal time for imaging (about 20 seconds) Bolus contrast (70-120cc) with breath hold coordinated during image acquisition

6 Sequential vs Helical CT scan Braunwald 7 th ed

7 Resolution Current scanners can acquire a slice in about 0.3 seconds Spatial resolution among scanners varies 0.4mm x 0.4mm x 0.4mm for example

8 Planar vs Tomographic images Schoenhagen

9 Image Acquisition Angiography vs CTA Schoenhagen

10 EKG gating Schoenhagen

11 Data sets at different points along the R-R interval can give different results Schoenhagen

12 Vessel motion during cardiac Cycle CMRSAP

13 Arrhythmia distorts image Schoenhagen

14 Image Reconstruction Techniques MPR Multiplaner Reconstruction MIP Maximal Intensity Projection CPR Curved Planar Reformation VR Volume Rendering

15 Axial vs MPR images Schoenhagen

16 Maximal Intensity Projection Thicker slice than MPR (10mm) Takes the brightest spot (voxel) within the slice and emphasizes that point Good for general visualization and layout of vessel

17 Curved Plane Reformation

18 Axial Endovascular VR of Aorta Schoenhagen

19 Radiation dose from various sources Cardiology Clinics 2003

20 How good is 64 slice coronary MDCT? Mollet et al., 2005

21 Orientation to Anatomy Axial MPR

22 Parasternal Short Axis MPR

23 3 Chamber View MPR

24 VR graft anatomy

25 Axial images

26 Examine axial images Notice Calcium in LAD and D1

27 MIP View of Left Coronary

28 Notice misregistration of distal LAD raw Axial Slices

29 MIP View of RCA

30 CPR of LAD

31 CPR of LAD artifact mid LAD

32 CPR of OM

33 CPR of OM and RCA OM CPR RCA CPR

34 Courtesy Tom Kracus Kettering Medical Center

35 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD VR MIP of Coronary Tree

36 You can also see valves

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41 You can also look at the Left atrium

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44 Another patient There is Misregistration Artifact You will see some VR reconstruction

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48 LAD MIP 10 mm

49 RCA MIP 10mm

50 Cx MIP 10mm

51 Cx MPR 1mm

52 CPR of Cx

53 RAO slices

54 LAO slices

55 Moving on to another patient Bad Bolus timing (images too late) Misregistration artifact

56 Raw Axial Slices

57 MIP axial slices

58 Another patient LAD mid aneurysm and stenosis

59 LAD MIP 10 mm

60 LAD MPR 1mm

61 Cx MIP 10mm

62 RCA MIP 10mm

63 LAD CPR

64 MPR of Anuerysm CPR of LAD

65 Not all patients have good images Next patient is obese

66 VR heart from obese patient

67 Next patient has grafts Axial raw slices

68 LAD and Cx MIP 10mm

69 RCA MIP 10mm

70 SVG-Dx MIP 10mm

71 VR heart with grafts

72 Next patient with Calcium in RCA and LAD

73 Left Coronary MIP 10mm

74 RCA MIP 10mm

75 CPR RCA

76 VR Heart

77 VR RCA Ostium

78 Aortic Arch Calcification

79 Mitral Valve Calcification

80 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD Left Main from Right coronary cusp

81 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD RCA stenosis VR

82 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD Left Circumflex graft VR

83 Courtesy Tom Kracus Kettering Medical Center , David Stultz, MD Cardiac Mass

84 References Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, Serruys PW, Krestin GP, de Feyter PJ. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation Oct 11;112(15): Epub 2005 Oct 3. Schoenhagen P. Atlas and Manual of Cardiovascular Multidetector Computed Tomography. Taylor & Francis: 2005.