Ct Cardiac Nvmbr2012

Cardiac CT E. R. Ranschaert radiologie JBZ NVMBR Regioavond Zuid, 30-01-12

Inleiding ,[object Object],[object Object],[object Object],[object Object]

Multislice CT - MDCT ,[object Object],[object Object],[object Object],[object Object]

MDCT voordelen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nieuwe generatie ,[object Object],[object Object],[object Object],[object Object],Dank aan Harefield Cardiac Course

Dual source CT ,[object Object],[object Object],[object Object],[object Object],[object Object]

“ Oude” generatie ,[object Object],[object Object],Dank aan James Carr

Dual source FLASH ,[object Object],[object Object]

cCT Angiografie ,[object Object],[object Object],[object Object],[object Object],[object Object]

cCT Angiografie ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Multislice CT (MSCT, MDCT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Voorbereiding patiënt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bètablokkers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calciumscore ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Scanprocedure ,[object Object],[object Object],[object Object],[object Object],[object Object]

Straling Onderzoek effectieve dosis ( mSv ) X-thorax 0.02 CT Abdomen 5.3 CT Chest 5.8 Chest, Abdomen and Pelvis 9.9 Thallium scan 20 CTC (virtual colonoscopy) 3.6 - 8.8 (gem. 5,7) CAG 2-10 Cardiac-CT angiogram 6.7-13

Oplossingen ,[object Object],[object Object],[object Object],[object Object]

Retrospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],[object Object]

Prospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Siemens Flash ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],J.P. Earls et al, Int.J.Cardiovasc.imaging, 2008

Welke scantechniek? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT, Halliburton SS et al., J Cardiovasc Computed Tomogr (2011)5, 198-224

Indicaties ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calciumscore ,[object Object],[object Object],[object Object],[object Object]

Beoordeling stenosen ,[object Object],[object Object],[object Object],[object Object],matige stenose significante stenose

CTA met FFR meting ,[object Object],[object Object],All images courtesy of Dr. James Min . Fractional Flow Reserve

Beperkingen cCTA ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnostische accuratesse ,[object Object],[object Object],[object Object],[object Object],cCTA meest zinvol bij laag tot intermediair risico-patiënten cCTA Sens 96-99% Spec 88-91% NPV >90%

Klinische toepassingen ,[object Object],[object Object],[object Object],[object Object],cCTA meest zinvol bij laag tot intermediair risico-patiënten Sens Spec Fietsproef Stress-test 54% 77%

Strategie ,[object Object],[object Object],[object Object],[object Object]

Asymptomatische pt ,[object Object],[object Object],[object Object]

Voorbeeld 1 ,[object Object],[object Object],[object Object]

Voorbeeld 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Voorbeeld 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],niet-stenoserende soft-plaque in ostium van circumflex

Voorbeeld 4 ,[object Object],[object Object],[object Object],[object Object]

Voorbeeld 5 ,[object Object],[object Object],[object Object],[object Object],[object Object],Ao Tr . pulm .

inter-arterieel verloop van RCA Ao asc tr pulm RCA

J.P. Earls et al, Int.J.Cardiovasc.imaging, 2008 Meisje 12 j oud, borstpijn en abnormaal ECG – 0,84 mSv

Normaal onderzoek flash mode Stenose?

Post-CABG ,[object Object],[object Object],[object Object]

[object Object],[object Object]

Voorbeeld na CABG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ct Cardiac Nvmbr2012

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