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Non invasive imaging of the vulnerable plaque and the vulnerable patient ge imatron

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Non invasive imaging of the vulnerable plaque and the vulnerable patient ge imatron

  1. 1. Non-Invasive Imaging of the Vulnerable Plaque and the Vulnerable Patient Non-invasive coronary angiography by CT and EBT David G. King; Director, Clinical Sciences GE Imatron
  2. 2. Acknowledgements: John Rumberger: “The tip of the iceberg” …. 20%20%
  3. 3. 66%66% 33%33% 20%20% Lipid RichLipid Rich FibroticFibrotic Fibrotic &Fibrotic & CalcifiedCalcified The “Tip of theThe “Tip of the AtheroscleroticAtherosclerotic IcebergIceberg”” Coronary Artery Plaque:Coronary Artery Plaque: approximate amounts of lipid rich, fibrotic and calcified plaqueapproximate amounts of lipid rich, fibrotic and calcified plaque PlaquePlaque DetectableDetectable by Intravascularby Intravascular Ultrasound,Ultrasound, PathologyPathology PlaquePlaque DetectableDetectable by EBTby EBT
  4. 4. Acknowledgements: John Rumberger: “The tip of the iceberg” ….. “The Vulnerable Patient” ….. Jim Fixx, 1932-1984 Sir Winston Churchill 1874-1965
  5. 5. Non-calcified plaque components by EBT Clinical significance unclear!
  6. 6. Points for discussion Why non-invasive CTA? Who/what needs to be imaged? What needs to be measured? How can the patient outcome be changed as a result? EBT 50 ms movie
  7. 7. Points for discussion Critical scanning parameters? Scan speed Triggering Slice width Image noise Best use of dose delivered? With or w/o contrast injection? EBT 50 ms movie
  8. 8. Points for discussion Optimum display of results: Volume rendered? Multiplanar reconstructions? Maximum intensity projection? Density distribution analysis? EBT 50 ms movie
  9. 9. MSCT: LightSpeed – longer exposure, improved contrast resolution Soft Plaque with Central Ulcer Courtesy of Dr. Dowe, Atlantic Medical Imaging
  10. 10. Courtesy Dr. Sablayrolles Centre Cardiologique du Nord – Saint Denis MSCT: SnapShot LightSpeed Ultra Stenosis in LAD 2nd Segment
  11. 11. Non-contrast EBT or EBA? CAC study 50 ms EBA movie
  12. 12. Non-calcified ROI analysis NormalNormal CorAthCorAth Courtesy L.` Teichholz, MD Density distribution in CAC studies
  13. 13. Density distribution • The mean voxel intensity (HU) within the ROI in the proximal LAD is lower in patients with disease as compared to normals (p<0.005). • The standard deviation of voxel intensities (HU) within the ROI in the proximal LAD is higher in patients with disease as compared to normals (p<0.00001). • The percent of voxels with HU < 0 within the ROI in the proximal LAD is higher in patients with disease as compared to normals (p<0.00001). Courtesy L. Teichholz, MD
  14. 14. Contrast-enhanced EBA High speed & thin slices, yield improved spatial resolution Venous branches, motion – diagnostic value?
  15. 15. The need for speed 300 msec 250 msec 200 msec 150 msec 100 msec 50 msec
  16. 16. Phantom “stenoses” Requires coronary angiography? 250 msec 100 msec 50 msec ??? ???
  17. 17. Conclusions • Benefits of high resolution coronary vessel imaging: – Learn more about the atherosclerotic disease process, hard & soft plaque – Steer high risk subjects towards the appropriate intervention – Reassure those with low probability of obstruction – Keep the “normals” out of the cathlab

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