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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.

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Coronary ct angiography

Coronary CT Angiography

Intern 柳復威


Udo Hoffmann, Maros Ferencik, Ricardo C. Cury, and Antonio J. Pena Coronary CT AngiographyJ Nucl Med May 1 2006 47: 797-806.



Introduction
INTRODUCTION exclusion of significant coronary artery stenosis (>50% luminal narrowing)

  • patient preparation

  • image acquisition

  • evaluation techniques


Patient preparation
patient preparation exclusion of significant coronary artery stenosis (>50% luminal narrowing)

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
image acquisition exclusion of significant coronary artery stenosis (>50% luminal narrowing)

  • 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
Radiation exposure coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

  • 64-slice MDCT: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
Image evaluation coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

  • 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
Artifact coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

  • 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
FINDINGS AND POTENTIAL CLINICAL APPLICATIONS coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

  • 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
Potential Clinical Applications coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

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
CONCLUSION coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit

  • 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

Thanks for your attention! coronary CTA is a 16-slice scanner. However, 40- or 64-slice MDCT scanners are recommended, as they increasethe volume coverage and permit


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