Ky thuat chup CT dong mach vanh - tuoi mau co tim, Dang Ngoc Quang (EN)
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TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/
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Ky thuat chup CT dong mach vanh - tuoi mau co tim, Dang Ngoc Quang (EN)
- 1. 9/6/2019 1 Coronary computed tomography angiography – Dynamic myocardial perfusion with GE revolution 512 slices CT Scanner Technician Dang Ngoc Quang Imaging and Radiology Department Vinmec International hospital - Nha Trang 1 C t d t h i h I. INTRODUCTION • Coronary computed tomography angiography (CCTA) provides information of coronary arterial diseases (CAD).
- 2. 9/6/2019 2 F f t di d t I. INTRODUCTION For cases of coronary artery disease, we need to make clear: Is the blood flow reduce behind the narrowed segment? Is the myocardium behind narrowed segmentIs the myocardium behind narrowed segment reduce vascularity or is it dying? C i I. INTRODUCTION Coronary computed tomography angiography – Dynamic myocardial perfusion with GE revolution 512 slices CT Scanner will make clear all those problems. hinhanhykhoa.com
- 3. 9/6/2019 3 I. INTRODUCTION • Blood Flow • Blood Volume II. OBJECTIVES 01 02 Presenting CCTA – Dynamic myocardial perfusion technique. Presenting images performed in Vinmec International hospital Nha02 Vinmec International hospital – Nha Trang.
- 4. 9/6/2019 4 ORERVIEW • CCTA – Dynamic myocardial perfusion technique: includes Coronary computed tomography angiography and dynamic myocardial perfusion in stress which is caused by injecting adenosine • Adenosine is a vasodilator increasing blood flow to t i d di l i it ti d icoronary arteries and cardiac muscles imitating doing exercises.
- 5. 9/6/2019 5 • Stable angina. U bl i hi h i k f i l Indication • Unstable angina or high risk of coronary arterial diseases. • Before operation which relevant or irrelevant to heart disease. • After revascularization procedure or surgery. • Majorly contraindication of Adenosine. Contraindication Majorly contraindication of Adenosine. • Unstable angina or acute angina suspected of developing acute coronary syndrome. • Contraindication of contrast agent and Nitromint.
- 6. 9/6/2019 6 • 18G IV Cannula on right upper extremity (for contrast agent) Patient preparation contrast agent). • 22G IV Cannula on left upper extremity (for adenosine). • Practicing inhale and exhale within scanning. • Explaining contrast agent and adenosine effect. Protocol Calcium Score CCTA in resting state 3 min 10‐15 min delay CT Perfusion Inject Inject Adenosine Inject Contrast Inject Contrast
- 7. 9/6/2019 7 OC Technique PROCEED Step 1: Scout view on AP - lateral. Technique
- 8. 9/6/2019 8 Step 2: Calcium score Technique Note: • Has the patient had percutaneous coronary intervention? • C l i > 800?• Calcium score > 800? Step 3: CCTA U i S t Technique • Using Smart prep • Threshold: HU 60 • ROI: descending aorta artery (right under carina 1cm) • Delay: 7.9s
- 9. 9/6/2019 9 Step 3: CCTA Technique p Contrast 5ml/s, 50-60ml (11s) Saline 5ml/s, 30- 40ml (8s) Step 4: Dynamic stress CTP (Delay 10-15 minutes) Technique
- 10. 9/6/2019 10 Technique Dynamic stress CT Perfusion. • Dynamic stress - Contrast agent: Weight (kg) x 0,7ml - Saline: Weight (kg) x 0.3ml Velocity 5.0ml/s Technique Keyword: Adenosine calculator hinhanhykhoa.com
- 11. 9/6/2019 11 Dynamic stress CT Perfusion • Injecting Adenosine within 3 minutes, always watch eTechnique patients. • After 3 minutes, injecting contrast agent and scanning. Adenosine Calcium Score CCTA in resting state 3 min 10‐15 min delay CT Perfusion Inject Contrast Inject Contrast Some cases performed in Vinmec International Hospital - Nha Trang
- 12. 9/6/2019 12 • Male, 55 years old CASE 1 • Weight: 43 kg • Stable angina. • Pulse: 55 bpm. Protocol Contrast Case 1 hinhanhykhoa.com
- 18. 9/6/2019 18 Bull eyes case 1 Bull eye map hinhanhykhoa.com
- 19. 9/6/2019 19 Dose report Dose # 611,16 x 0,014= 8,5 Dose # 611,16 x 0,014= 8,5 mSvmSv • Male, 60 years old CASE 2 • Bypassed and stent CAD. • Stable status. • Pulse: 58 bpm. • Technique: prospective CT.
- 24. 9/6/2019 24 CASE 2 Dose Report Case 2 DOSE # 247 X 0,014 = 3,5 mSv
- 25. 9/6/2019 25 CASE 3 • Male, 65 years old • Stable angina. • Fast fibrillation > 100 bpm • Technique: retrospective repeat twice + stress test CASE 3
- 29. 9/6/2019 29 Bull eyes Case 3 Bull eyes Case 3
- 30. 9/6/2019 30 Bull eyes Case 3 Bull eyes map hinhanhykhoa.com
- 31. 9/6/2019 31