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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

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

cta inclusion criteria
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
patient preparation

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
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
ecg tube current modulation

250 ms

250 ms

250 ms

Pitch

<0,4

100%

20%

mAs

ECG Tube Current Modulation
left coronary artery rao
Left Coronary Artery (RAO)

Coronary Angiography

MDCT & VRT

right coronary artery lao
Right Coronary Artery (LAO)

LAO 60

Coronary Angiography

MDCT & VRT

detection of coronary stenoses
Detection of Coronary Stenoses

MDCT

Coronary Angiography

cta limitations
CTA Limitations
  • Artifacts
    • Cardiac motion
    • Breathing
    • Blooming
  • Poor opacification
  • Small vessel
solutions
Solutions
  • Rot. time & blocker
    • Cardiac motion artifacts
  • Scan times
    • Breathing artifacts
    • CM utilization
  • Slice thickness
    • Small vessels
    • Blooming artifact
16 detector row ct angiography
16 Detector Row CT Angiography
  • 200 ms
  • 9 Lp/cm
  • 0.8 mm
  • 20 s breath hold
  • 60 ml CM
coronary plaque imaging
Coronary Plaque Imaging

MDCT

Coronary Angiography

coronary atherosclerosis

Atheroma

Rupture/Erosion

Healing

Hemorrhage

Thrombus

Calcified Nodule

Fibrocalcified Plaque

Wall changes

Stenoses

Occlusion

Coronary Atherosclerosis

Intimal Thickening

atheroma

50 HU

50HU

Atheroma
  • 38 YOM
  • Non specific complain
  • Risk Factors
    • Cholesterin
    • Smoker
  • No calcium
calcified nodule
62 YOM

Suspicion of CAD

12 mg CaHA

Calcified Nodule
thrombus

20 HU

Thrombus
  • 42 YOM
  • Epigastric chest pain
  • Risk Factors
    • Hypertension
    • Smoker
  • No calcium
myocardial infarction scar
Myocardial Infarction Scar

anterior

LAD

posterior

RCA

lateral

LCx

ct plaque density
CT Plaque Density

p = 0.018

89 ± 31 HU

50 ± 12 HU

Lipid

Fibrose

Lipid

Fibrosis

plaque distribution leber 2001 circulation
Plaque DistributionLeber 2001 Circulation

Myocardial Infarction

n = 12

122 Plaque

Stable Angina

n = 12

135 Plaque

summary
Summary
  • Detection of stenoses
    • Calcium
    • Small vessels
  • Characterization of plaques
    • Identify atheromas
    • Follow up under therapy
  • Acute coronary event
    • Intracoronary thrombus
    • Myocardial infarction