Cardiac ct how i do it september 2011

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Cardiac ct how i do it september 2011

  1. 1. Coronary CT How I do it
  2. 3. Patient selection <ul><li>Risk factors </li></ul><ul><li>Medium - high risk -> angio suite </li></ul><ul><li>Low - medium -> CT (exclude disease) </li></ul>
  3. 4. Patient selection <ul><li>Pre-op evaluation </li></ul><ul><li>Post CABG </li></ul>
  4. 5. Calcium score <ul><li>Risk calculation (MESA %) </li></ul><ul><li>Check RCA motion </li></ul><ul><li>1 minute </li></ul><ul><li>Stop if zero or high </li></ul>
  5. 6. Pro / retrospective <ul><li>Prospective - SAS - lower dose </li></ul><ul><ul><li>sharper image </li></ul></ul><ul><li>Retrospective - higher dose </li></ul><ul><ul><li>function / motion </li></ul></ul>
  6. 8. Checklist <ul><li>Skin / breast </li></ul><ul><li>Bone </li></ul><ul><li>Lung </li></ul><ul><li>Mediastinum </li></ul><ul><li>Abdomen </li></ul>
  7. 9. Checklist <ul><li>Skin / breast - mass </li></ul><ul><li>Bone - fracture / lesion </li></ul><ul><li>Lung - node </li></ul><ul><li>Mediastinum - hernia </li></ul><ul><li>Abdomen - organs, mesentery, fluid </li></ul><ul><li>Heart </li></ul>
  8. 10. Breast / skin - Biopsy Harish, Radiographics 2007
  9. 11. Bone - MRI radiology.casereports.net radiopaedia
  10. 12. Lung <ul><li><4mm = 0% </li></ul><ul><li>4-7mm = 1% </li></ul><ul><li>>8mm = 15% </li></ul><ul><li>>20mm = 75% </li></ul>Stacy, Radiographics 2010
  11. 13. Fleischner < 8 mm <ul><li>Solitary node </li></ul><ul><li>New </li></ul><ul><li>No history of cancer </li></ul><ul><li>Smoker? </li></ul><ul><li>CT: 6 / 12 … months </li></ul>
  12. 15. Mediastinum <ul><li>Hernia </li></ul>Pickhardt, AJR 2011
  13. 16. Mediastinum <ul><li>Lymph node </li></ul>Koyama, Radiographics 2004
  14. 17. Abdomen <ul><li>Mesentery </li></ul>Lucey, Radiographics 2005
  15. 18. Abdomen <ul><li>Fluid </li></ul>Lucey, Radiographics 2005
  16. 21. Go with the flow <ul><li>VC - RA - RV - PA </li></ul><ul><li>PV - LA - LV - Aorta </li></ul>
  17. 22. Heart 1 <ul><li>Vena cava - reflow </li></ul><ul><li>RA - abnormal pulmonary vein / ASD </li></ul><ul><li>RV - VSD </li></ul><ul><li>PA - enlarged, embolus </li></ul>
  18. 23. Vena cava <ul><li>Reflow </li></ul>Hani, AJR 2002
  19. 24. Martinez - Jimenez, Radiographics 2010
  20. 28. Martinez - Jimenez, Radiographics 2010 Left vena cava to LA
  21. 29. Right Atrium <ul><li>ASD </li></ul>emedicine
  22. 30. Right Ventricle <ul><li>VSD </li></ul>Khanna, AJR 2004
  23. 31. Pulmonary artery <ul><li>Embolism </li></ul>Wittram, Radiographics 2004
  24. 32. Pulmonary artery <ul><li>Embolism </li></ul>Wittram, Radiographics 2004
  25. 33. Pulmonary artery <ul><li>Embolism </li></ul>Wittram, Radiographics 2004
  26. 34. Heart 2 <ul><li>Pulmonary veins - stenosis / anomaly </li></ul><ul><li>LA - thrombus (auriculum) </li></ul><ul><li>LV - infarct, aneurysm </li></ul><ul><li>Aorta - diameter </li></ul><ul><li>Valves - mass, calcium </li></ul><ul><li>Pericardium - fluid, thick </li></ul>
  27. 35. Pulmonary vein <ul><li>Stenosis </li></ul>Cronin, AJR 2004
  28. 36. Pulmonary vein <ul><li>Stenosis </li></ul>Cronin, AJR 2004
  29. 37. Pulmonary vein <ul><li>PV to VC </li></ul>Cronin, AJR 2004
  30. 38. Pulmonary vein <ul><li>PV to VC </li></ul>Cronin, AJR 2004
  31. 39. Left Atrium <ul><li>Membrane </li></ul>Dillman, AJR 2009
  32. 40. Left Atrium <ul><li>Membrane </li></ul>Dillman, AJR 2009
  33. 41. Left Atrium <ul><li>Thrombus </li></ul>Dillman, AJR 2009 <ul><li>Myxoma </li></ul>
  34. 42. Left Ventricle <ul><li>Aneurysm </li></ul>Bruzzi, AJR 2006
  35. 43. Left Ventricle <ul><li>Thrombus </li></ul>Bruzzi, AJR 2006
  36. 44. Aorta <ul><li>Diameter </li></ul><ul><li>Wall </li></ul>Cronin, AJR 2004
  37. 45. Aorta <ul><li>Diameter </li></ul><ul><li>Wall </li></ul>Cronin, AJR 2004
  38. 46. Valves - normal Aortic valve Vogel, Radiographics 2006
  39. 47. Bicuspid Aortic valve Vogel, Radiographics 2006
  40. 48. Calcified Pannus Vogel, Radiographics 2006
  41. 49. Calcified Pannus Vogel, Radiographics 2006
  42. 50. Pericardium <ul><li>Thin </li></ul>Wang, Radiographics 2003
  43. 51. Pericardium <ul><li>Thin </li></ul>Wang, Radiographics 2003
  44. 52. Pericardium <ul><li>Fluid </li></ul>Wang, Radiographics 2003
  45. 53. Pericardium <ul><li>Fluid </li></ul>Wang, Radiographics 2003
  46. 54. Coronary
  47. 55. Coronary <ul><li>Anatomy </li></ul><ul><li>Dominance (inferior wall) </li></ul><ul><li>RCA </li></ul><ul><li>LM </li></ul><ul><li>LAD </li></ul><ul><li>CX </li></ul>
  48. 56. LAD RCA Cx
  49. 57. Normal Sundaram, AJR 2009
  50. 58. Malignant Sundaram, AJR 2009
  51. 59. Malignant Sundaram, AJR 2009 A P
  52. 60. Benign Sundaram, AJR 2009
  53. 61. Bridging Sundaram, AJR 2009
  54. 63. LAD - septum RCA - inferior CX - lateral Vascular territory
  55. 64. LAD RCA CX
  56. 65. LAD RCA CX
  57. 66. LAD RCA CX

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