Coronary atherosclerosis with multislice ct what is beyond coronary atherosclerosis
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Pathology. Michael Muders. Cardiology. Andreas Knez. Alexander Leber. Alexander Becker. Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis. Christoph R Becker. Radiology. Konstantin Nikolaou. Tobias Jakobs. Bernd Wintersperger.

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Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis

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Pathology

Michael Muders

Cardiology

Andreas Knez

Alexander Leber

Alexander Becker

Coronary Atherosclerosis with Multislice CT:What is beyond coronary atherosclerosis

Christoph R Becker

Radiology

Konstantin Nikolaou

Tobias Jakobs

Bernd Wintersperger


Calcified & Noncalcified Plaques


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


82 bpm

65 bpm

Patient Preparation

  • -blocker

    • R/o Contra indications

    • Informed consent

    • Metoprolol

      • 50 - 100 mg orally

      • 30 - 90 min prior

    • HR 50 - 60 bpm


Coronary CTA Parameters

  • Testbolus 20 ml @ 4 ml/s

  • 120 ml (300 mg iodine) @ 3 ml/s + NaCl 60 ml @ 3 ml/s

  • 500 ms gantry rotation

  • 120 kV, 300 mA

  • 4 x 1 mm collimation

  • 3 mm/s table feed

  • 40 s breath hold


250 ms

250 ms

250 ms

Pitch

<0,4

100%

20%

mAs

ECG Tube Current Modulation


CTA Radiation Exposure

mSv


Left Coronary Artery (RAO)

Coronary Angiography

MDCT & VRT


Right Coronary Artery (LAO)

LAO 60

Coronary Angiography

MDCT & VRT


Detection of Coronary Stenoses

MDCT

Coronary Angiography


Coronary StenosesCTA & Angiography


CTA Limitations

  • Artifacts

    • Cardiac motion

    • Breathing

    • Blooming

  • Poor opacification

  • Small vessel


Solutions

  • Rot. time & blocker

    • Cardiac motion artifacts

  • Scan times

    • Breathing artifacts

    • CM utilization

  • Slice thickness

    • Small vessels

    • Blooming artifact


16 Detector Row CT Angiography

  • 200 ms

  • 9 Lp/cm

  • 0.8 mm

  • 20 s breath hold

  • 60 ml CM


Coronary Plaque Imaging

MDCT

Coronary Angiography


Non Calcified Plaque Density


Atheroma

Rupture/Erosion

Healing

Hemorrhage

Thrombus

Calcified Nodule

Fibrocalcified Plaque

Wall changes

Stenoses

Occlusion

Coronary Atherosclerosis

Intimal Thickening


50 HU

50HU

Atheroma

  • 38 YOM

  • Non specific complain

  • Risk Factors

    • Cholesterin

    • Smoker

  • No calcium


62 YOM

Suspicion of CAD

12 mg CaHA

Calcified Nodule


Fibrocalcified Plaque

100 HU


20 HU

Thrombus

  • 42 YOM

  • Epigastric chest pain

  • Risk Factors

    • Hypertension

    • Smoker

  • No calcium


Thrombus


Acute Posterior Wall Infarction


Myocardial Infarction Scar

anterior

LAD

posterior

RCA

lateral

LCx


CT Plaque Density

p = 0.018

89 ± 31 HU

50 ± 12 HU

Lipid

Fibrose

Lipid

Fibrosis


CTA vs IVUSSchröder Heart 2001;85:576


Carotid AtherosclerosisEstes 1998 J Cardiovasc Surg 39:527


Plaque DistributionLeber 2001 Circulation

Myocardial Infarction

n = 12

122 Plaque

Stable Angina

n = 12

135 Plaque


Summary

  • Detection of stenoses

    • Calcium

    • Small vessels

  • Characterization of plaques

    • Identify atheromas

    • Follow up under therapy

  • Acute coronary event

    • Intracoronary thrombus

    • Myocardial infarction


www.CT2002.org


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