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Stephanes talk aeha

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Stephanes talk aeha

  1. 1. Emerging CT technologies are racing to meet the future of noninvasive cardiology S. Achenbach Disclosure: Research Support, Siemens Medical Solutions
  2. 2. CARDIAC IMAGING: - Complex Anatomy - Small Dimensions - Rapid Movement
  3. 3. Z Continuous x-ray data acquisition and table feed Simultaneous recording of ECG signal Multi-Detector Spiral/Helical CT
  4. 4. Z Continuous x-ray data acquisition and table feed Simultaneous recording of ECG signal ECG-gated image reonstruction Multi-Detector Spiral/Helical CT
  5. 5. Z Continuous x-ray data acquisition and table feed Simultaneous recording of ECG signal ECG-gated image reonstruction Partial scan reconstruction Multi-Detector Spiral/Helical CT
  6. 6. 16-slice MSCT: 370-500 ms rotation 16 x 0.5-0.75 mm collimation ~ 18 s breathhold, 80 - 100 ml of contrast 64-slice MSCT: 330-420 ms rotation 64 x 0.5-0.6 mm collimation ~ 6-12 s breathhold, 50-70 ml of contrast
  7. 7. 16-slice MSCT: 370-500 ms rotation 16 x 0.5-0.75 mm collimation ~ 18 s breathhold, 80 - 100 ml of contrast 64-slice MSCT: 330-420 ms rotation 64 x 0.5-0.6 mm collimation ~ 6-12 s breathhold, 50-70 ml of contrast Spatial resolution: 0.4 mm x 0.4 mm x 0.4 mm Temporal resolution: ~165 ms
  8. 8. EBT (3mm) 4 slice (1.25mm) 16 slice (0.75mm) 64 slice (0.6mm) 1994 2000 2002 2004
  9. 9. EBT (3mm) 4 slice (1.25mm) 16 slice (0.75mm) 64 slice (0.6mm) 1994 2000 2002 2004
  10. 10. 96-99% negative predictive value for detection of coronary stenoses Mollet et al, JACC 2005 Morgan-Hughes et al, Heart 2005 Kuettner et al, JACC 2005 Achenbach et al, Eur Heart J 2005 Hoffmann et al, JAMA 2005 Raff et al, JACC 2005 Leschke et al, Eur Heart J 2005 Leber et al, JACC 2005 Mollet et al, Circulation 2005
  11. 11. 96-100% sensitivity for bypass graft occlusion Nieman et al, Radiology 2003 Schlosser et al, JACC 2004, Martuscelli et al, Circulation 2004 Chiurlia et al, AJC 2005
  12. 12. Limited spatial and temporal resolution as compared to - cardiac cath - size and speed of coronary arteries -
  13. 13. LIMITATIONS: Motion artifacts -- heart rate -- temporal res. Spatial resolution -- radiation Several heart beats -- arrhythmias
  14. 14. FUTURE PATHS: > 64 slices: shorter breathhold / less contrast >> 64 slices: one heart beat (120 mm)? < 0.5 mm slices: spatial resolution – radiation! Faster rotation: better temporal resolution
  15. 15. FUTURE PATHS: Better temporal resolution => Prospective triggering => Less radiation => Thinner slices?
  16. 16. We will see: Up to 256-slice scanners Faster temporal resolution Better software Heart 2005
  17. 17. We will see: Up to 256-slice scanners Faster temporal resolution Better software
  18. 18. We will see: Up to 256-slice scanners Faster temporal resolution Better software Heart Phantom with Stent at 95bpm Sensation 64, 165ms 83ms
  19. 19. SUMMARY Temporal resolution and spatial resolution as well as radiation/noise are issues in cardiac CT Simply adding more slices will not solve the major problems => One heart beat (256 sl.) => Temporal resolution => COST?
  20. 20. 2005 10 years 1995
  21. 21. 2005 10 years 10 years 2015 ? 1995
  22. 22. Education, carefully performed studies, and good guidelines will be at least as important as new technology..
  23. 23. www.SCCT.org Society of Cardiovascular CT

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