TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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Coronary computed tomography
angiography – Dynamic myocardial
perfusion with GE revolution 512 slices
CT Scanner
Technician Dang Ngoc Quang
Imaging and Radiology Department
Vinmec International hospital - Nha Trang
1
C t d t h i h
I. INTRODUCTION
• Coronary computed tomography angiography
(CCTA) provides information of coronary
arterial diseases (CAD).

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F f t di d t
I. INTRODUCTION
For cases of coronary artery disease, we need to
make clear:
Is the blood flow reduce behind the narrowed
segment?
Is the myocardium behind narrowed segmentIs the myocardium behind narrowed segment
reduce vascularity or is it dying?
C i
I. INTRODUCTION
Coronary computed tomography angiography
– Dynamic myocardial perfusion with GE
revolution 512 slices CT Scanner will make
clear all those problems.
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I. INTRODUCTION
• Blood
Flow
• Blood
Volume
II. OBJECTIVES
01
02
Presenting CCTA – Dynamic
myocardial perfusion technique.
Presenting images performed in
Vinmec International hospital Nha02 Vinmec International hospital – Nha
Trang.

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ORERVIEW
• CCTA – Dynamic myocardial perfusion
technique: includes Coronary computed tomography
angiography and dynamic myocardial perfusion in
stress which is caused by injecting adenosine
• Adenosine is a vasodilator increasing blood flow to
t i d di l i it ti d icoronary arteries and cardiac muscles imitating doing
exercises.

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• Stable angina.
U bl i hi h i k f i l
Indication
• Unstable angina or high risk of coronary arterial
diseases.
• Before operation which relevant or irrelevant to heart
disease.
• After revascularization procedure or surgery.
• Majorly contraindication of Adenosine.
Contraindication
Majorly contraindication of Adenosine.
• Unstable angina or acute angina suspected of
developing acute coronary syndrome.
• Contraindication of contrast agent and Nitromint.

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• 18G IV Cannula on right upper extremity (for
contrast agent)
Patient preparation
contrast agent).
• 22G IV Cannula on left upper extremity (for
adenosine).
• Practicing inhale and exhale within scanning.
• Explaining contrast agent and adenosine effect.
Protocol
Calcium
Score
CCTA in
resting state
3 min
10‐15
min delay
CT Perfusion
Inject Inject
Adenosine
Inject
Contrast
Inject
Contrast

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OC
Technique
PROCEED
 Step 1: Scout view on AP -
lateral.
Technique

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 Step 2: Calcium score
Technique
Note:
• Has the patient had
percutaneous coronary
intervention?
• C l i > 800?• Calcium score > 800?
 Step 3: CCTA
U i S t
Technique
• Using Smart prep
• Threshold: HU 60
• ROI: descending aorta
artery (right under
carina 1cm)
• Delay: 7.9s

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 Step 3: CCTA
Technique
p
 Contrast 5ml/s,
50-60ml (11s)
 Saline 5ml/s, 30-
40ml (8s)
 Step 4: Dynamic stress CTP (Delay 10-15 minutes)
Technique

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Technique
 Dynamic stress CT Perfusion.
• Dynamic stress
- Contrast agent: Weight (kg) x 0,7ml
- Saline: Weight (kg) x 0.3ml
Velocity 5.0ml/s
Technique
Keyword: Adenosine calculator
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 Dynamic stress CT Perfusion
• Injecting Adenosine within 3 minutes, always watch
eTechnique
patients.
• After 3 minutes, injecting contrast agent and
scanning.
Adenosine
Calcium
Score
CCTA in
resting state
3 min
10‐15
min delay
CT Perfusion
Inject
Contrast
Inject
Contrast
Some cases performed in
Vinmec International Hospital
- Nha Trang

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• Male, 55 years old
CASE 1
• Weight: 43 kg
• Stable angina.
• Pulse: 55 bpm.
Protocol Contrast Case 1
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CASE 1
CASE 1

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CASE 1
CASE 1
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CASE 1
CASE 1

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CASE 1
CASE 1
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Adenosine Dose
CASE 1

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Bull eyes case 1
Bull eye map
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Dose report
Dose # 611,16 x 0,014= 8,5 Dose # 611,16 x 0,014= 8,5 mSvmSv
• Male, 60 years old
CASE 2
• Bypassed and stent CAD.
• Stable status.
• Pulse: 58 bpm.
• Technique: prospective CT.

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CASE 2
CASE 2
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CASE 2
CASE 2

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CASE 2
CASE 2

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CASE 2
CASE 2

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CASE 2
Dose Report Case 2
DOSE # 247 X 0,014 = 3,5 mSv

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CASE 3
• Male, 65 years old
• Stable angina.
• Fast fibrillation > 100 bpm
• Technique: retrospective repeat twice + stress
test
CASE 3

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CASE 3
CASE 3

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CASE 3
CASE 3

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CASE 3
CASE 3

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Bull eyes Case 3
Bull eyes Case 3

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Bull eyes Case 3
Bull eyes map
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