Más contenido relacionado La actualidad más candente (16) Similar a Acc v porg (20) Más de Society for Heart Attack Prevention and Eradication (20) Acc v porg1. Coronary Atherosclerosis with Multislice 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
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
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
13. Solutions
< Rot. time &
β−blocker
• Cardiac motion
artifacts
< Scan times
• Breathing artifacts
• CM utilization
< Slice thickness
• Small vessels
• Blooming artifact
14. 16 Detector Row CT
Angiography
• 200 ms
• 9 Lp/cm
• 0.8 mm
• 20 s breath hold
• 60 ml CM
18. Atheroma
• 38 YOM
• Non specific complain
• Risk Factors
– Cholesterin
– Smoker
• No calcium
50 HU
50 HU
21. Thrombus
• 42 YOM
• Epigastric chest pain
• Risk Factors
– Hypertension
– Smoker
• No calcium
20 HU
28. Plaque Distribution
Leber 2001 Circulation
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 of stenoses
– Calcium
– Small vessels
• Characterization of
plaques
• Identify atheromas
• Follow up under therapy
• Acute coronary event
• Intracoronary thrombus
• Myocardial infarction
Notas del editor Significant stenosis = stenosis for intervention
Indication for bypass surgery