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Accv porg

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Accv porg

  1. 1. Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis Konstantin Nikolaou Tobias Jakobs Bernd Wintersperger Radiology Alexander Becker Andreas Knez Alexander Leber Cardiology Michael Muders Pathology Christoph R Becker
  2. 2. Calcified & Noncalcified Plaques
  3. 3. 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
  4. 4. Patient Preparation 82 bpm • β-blocker • R/o Contra indications • Informed consent • Metoprolol • 50 - 100 mg orally • 30 - 90 min prior • HR 50 - 60 bpm 65 bpm
  5. 5. Coronary CTA Parameters • Testbolus 20 ml @ 4 ml/sTestbolus 20 ml @ 4 ml/s • 120 ml (300 mg iodine) @ 3120 ml (300 mg iodine) @ 3 ml/sml/s + NaCl 60 ml+ NaCl 60 ml @ 3 ml/s@ 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
  6. 6. ECG Tube Current Modulation Pitch <0,4 250 ms 250 ms250 ms 100% 20% mAs
  7. 7. CTA Radiation Exposure mSv
  8. 8. Left Coronary Artery (RAO) Coronary Angiography MDCT & VRT
  9. 9. LAO 60Coronary Angiography MDCT & VRT Right Coronary Artery (LAO)
  10. 10. Detection of Coronary Stenoses MDCT Coronary Angiography
  11. 11. Coronary Stenoses CTA & Angiography Author Journal PPV NPV n.a. n Niemann Lancet 2001 81% 97% 30% 35 Achenbach Circulation 2001 59% 98% 32% 64 Mean/sum 70% 98% 31% 99
  12. 12. CTA Limitations • Artifacts • Cardiac motion • Breathing • Blooming • Poor opacification • Small vessel
  13. 13. Solutions < Rot. time & β−blocker • Cardiac motion artifacts < Scan times • Breathing artifacts • CM utilization < Slice thickness • Small vessels • Blooming artifact
  14. 14. 16 Detector Row CT Angiography • 200 ms • 9 Lp/cm • 0.8 mm • 20 s breath hold • 60 ml CM
  15. 15. Coronary Plaque Imaging MDCT Coronary Angiography
  16. 16. Non Calcified Plaque Density
  17. 17. Coronary Atherosclerosis Calcified Nodule Wall changes Occlusion ThrombusFibrocalcified Plaque Stenoses Intimal Thickening Atheroma Healing Hemorrhage Rupture/Erosion
  18. 18. Atheroma • 38 YOM • Non specific complain • Risk Factors – Cholesterin – Smoker • No calcium 50 HU 50 HU
  19. 19. Calcified Nodule • 62 YOM • Suspicion of CAD • 12 mg CaHA
  20. 20. Fibrocalcified Plaque 100 HU
  21. 21. Thrombus • 42 YOM • Epigastric chest pain • Risk Factors – Hypertension – Smoker • No calcium 20 HU
  22. 22. Thrombus
  23. 23. Acute Posterior Wall Infarction
  24. 24. Myocardial Infarction Scar anterior LAD lateral LCx posterior RCA
  25. 25. CT Plaque Density Lipid Fibrose50 ± 12 HU 89 ± 31 HU p = 0.018 Lipid Fibrosis
  26. 26. CTA vs IVUS Schröder Heart 2001;85:576
  27. 27. Carotid Atherosclerosis Estes 1998 J Cardiovasc Surg 39:527
  28. 28. Plaque Distribution Leber 2001 Circulation Non- calcified 13% Mixed 33% Calcified 54% Myocardial Infarction n = 12 122 Plaque Stable Angina n = 12 135 Plaque Non- calcified 6% Mixed 14% Calcified 80%
  29. 29. Summary • Detection of stenoses – Calcium – Small vessels • Characterization of plaques • Identify atheromas • Follow up under therapy • Acute coronary event • Intracoronary thrombus • Myocardial infarction
  30. 30. www.CT2002.org

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