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This document discusses the use of coronary CT angiography (CTA) to detect and characterize coronary atherosclerosis beyond just detecting coronary stenoses. CTA can identify calcified plaques, non-calcified plaques, and mixed plaques. It can detect atheromas and characterize plaque density. CTA can also identify intracoronary thrombi and myocardial infarction scars. The document outlines the CTA scanning parameters and techniques used to minimize motion artifacts and optimize image quality for plaque detection and characterization.
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- 1. Coronary Atherosclerosis withMultislice 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
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- 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. 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. 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. ECG Tube CurrentModulation Pitch <0,4 250 ms 250 ms250 ms 100% 20% mAs
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- 8. Left Coronary Artery(RAO) Coronary Angiography MDCT & VRT
- 9. LAO 60Coronary AngiographyMDCT & VRT Right Coronary Artery (LAO)
- 10. Detection of CoronaryStenoses MDCT Coronary Angiography
- 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. CTA Limitations • Artifacts •Cardiac motion • Breathing • Blooming • Poor opacification • Small vessel
- 13. Solutions < Rot. time& β−blocker • Cardiac motion artifacts < Scan times • Breathing artifacts • CM utilization < Slice thickness • Small vessels • Blooming artifact
- 14. 16 Detector RowCT Angiography • 200 ms • 9 Lp/cm • 0.8 mm • 20 s breath hold • 60 ml CM
- 15. Coronary Plaque Imaging MDCTCoronary Angiography
- 16. Non Calcified PlaqueDensity
- 17. Coronary Atherosclerosis Calcified Nodule Wallchanges Occlusion ThrombusFibrocalcified Plaque Stenoses Intimal Thickening Atheroma Healing Hemorrhage Rupture/Erosion
- 18. Atheroma • 38 YOM •Non specific complain • Risk Factors – Cholesterin – Smoker • No calcium 50 HU 50 HU
- 19. Calcified Nodule • 62YOM • Suspicion of CAD • 12 mg CaHA
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- 21. Thrombus • 42 YOM •Epigastric chest pain • Risk Factors – Hypertension – Smoker • No calcium 20 HU
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- 23. Acute Posterior WallInfarction
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- 25. CT Plaque Density LipidFibrose50 ± 12 HU 89 ± 31 HU p = 0.018 Lipid Fibrosis
- 26. CTA vs IVUS SchröderHeart 2001;85:576
- 27. Carotid Atherosclerosis Estes 1998J Cardiovasc Surg 39:527
- 28. Plaque Distribution Leber 2001Circulation 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. Summary • Detection ofstenoses – Calcium – Small vessels • Characterization of plaques • Identify atheromas • Follow up under therapy • Acute coronary event • Intracoronary thrombus • Myocardial infarction
- 30.
Editor's Notes
- #12 Significant stenosis = stenosis for intervention Indication for bypass surgery