060 coronary atherosclerosis with multislice ct
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Transcript of 060 coronary atherosclerosis with multislice ct
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Coronary Atherosclerosis with Multislice CT:What is beyond coronary atherosclerosis
Konstantin NikolaouTobias Jakobs
Bernd Wintersperger
Radiology
Alexander Becker
Andreas Knez
Alexander Leber
Cardiology
Michael Muders
Pathology
Christoph R Becker
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Calcified & Noncalcified Plaques
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CTA Inclusion Criteria
• Asymptomatic patients• CV risk factors• Positive calcium scan
• Symptomatic patients• No CAD history• Atypical chest pain• Inconsistent stress test< 100 mg CaHA
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Patient Preparation
82 bpm
• -blocker• R/o Contra
indications• Informed consent• Metoprolol
• 50 - 100 mg orally• 30 - 90 min prior
• HR 50 - 60 bpm
65 bpm
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Coronary CTA Parameters
• Testbolus 20 ml @ 4 ml/sTestbolus 20 ml @ 4 ml/s• 120 ml (300 mg iodine) @ 3 ml/s 120 ml (300 mg iodine) @ 3 ml/s
+ NaCl 60 ml @ 3 ml/s + NaCl 60 ml @ 3 ml/s• 500 ms gantry rotation500 ms gantry rotation• 120 kV, 300 mA120 kV, 300 mA• 4 x 1 mm collimation4 x 1 mm collimation• 3 mm/s table feed3 mm/s table feed• 40 s breath hold40 s breath hold
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ECG Tube Current Modulation
Pitch<0,4
250 ms 250 ms250 ms
100%
20%
mAs
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CTA Radiation Exposure
mSv
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Left Coronary Artery (RAO)
Coronary Angiography MDCT & VRT
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LAO 60Coronary Angiography MDCT & VRT
Right Coronary Artery (LAO)
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Detection of Coronary Stenoses
MDCT Coronary Angiography
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Coronary StenosesCTA & Angiography
Author Journal PPV NPV n.a. n
Niemann Lancet2001
81% 97% 30% 35
Achenbach Circulation2001
59% 98% 32% 64
Mean/sum 70% 98% 31% 99
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CTA Limitations
• Artifacts• Cardiac motion• Breathing• Blooming
• Poor opacification• Small vessel
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Solutions
< Rot. time & blocker • Cardiac motion artifacts
< Scan times• Breathing artifacts• CM utilization
< Slice thickness• Small vessels• Blooming artifact
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16 Detector Row CT Angiography
• 200 ms• 9 Lp/cm• 0.8 mm• 20 s breath hold• 60 ml CM
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Coronary Plaque Imaging
MDCT Coronary Angiography
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Non Calcified Plaque Density
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Coronary Atherosclerosis
Calcified Nodule
Wall changes Occlusion
ThrombusFibrocalcified Plaque
Stenoses
Intimal Thickening
Atheroma
Healing Hemorrhage
Rupture/Erosion
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Atheroma
• 38 YOM• Non specific complain• Risk Factors
– Cholesterin– Smoker
• No calcium
50 HU
50 HU
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Calcified Nodule
• 62 YOM• Suspicion of CAD• 12 mg CaHA
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Fibrocalcified Plaque
100 HU
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Thrombus
• 42 YOM• Epigastric chest pain• Risk Factors
– Hypertension– Smoker
• No calcium
20 HU
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Thrombus
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Acute Posterior Wall Infarction
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Myocardial Infarction Scar
anteriorLAD
lateralLCx
posteriorRCA
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CT Plaque Density
Lipid Fibrose50 ± 12 HU 89 ± 31 HU
p = 0.018
Lipid Fibrosis
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CTA vs IVUSSchröder Heart 2001;85:576
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Carotid AtherosclerosisEstes 1998 J Cardiovasc Surg 39:527
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Plaque DistributionLeber 2001 Circulation
Non-calcified
13%
Mixed33%
Calcified54%
Myocardial Infarctionn = 12
122 Plaque
Stable Anginan = 12
135 PlaqueNon-
calcified6%
Mixed14%
Calcified80%
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Summary
• Detection of stenoses– Calcium– Small vessels
• Characterization of plaques• Identify atheromas• Follow up under therapy
• Acute coronary event• Intracoronary thrombus• Myocardial infarction
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www.CT2002.org