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Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis

Pathology. Michael Muders. Cardiology. Andreas Knez. Alexander Leber. Alexander Becker. Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis. Christoph R Becker. Radiology. Konstantin Nikolaou. Tobias Jakobs. Bernd Wintersperger.

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Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis

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  1. Pathology Michael Muders Cardiology Andreas Knez Alexander Leber Alexander Becker Coronary Atherosclerosis with Multislice CT:What is beyond coronary atherosclerosis Christoph R Becker Radiology Konstantin Nikolaou Tobias Jakobs Bernd Wintersperger

  2. Calcified & Noncalcified Plaques

  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. 82 bpm 65 bpm Patient Preparation • -blocker • R/o Contra indications • Informed consent • Metoprolol • 50 - 100 mg orally • 30 - 90 min prior • HR 50 - 60 bpm

  5. Coronary CTA Parameters • Testbolus 20 ml @ 4 ml/s • 120 ml (300 mg iodine) @ 3 ml/s + NaCl 60 ml @ 3 ml/s • 500 ms gantry rotation • 120 kV, 300 mA • 4 x 1 mm collimation • 3 mm/s table feed • 40 s breath hold

  6. 250 ms 250 ms 250 ms Pitch <0,4 100% 20% mAs ECG Tube Current Modulation

  7. CTA Radiation Exposure mSv

  8. Left Coronary Artery (RAO) Coronary Angiography MDCT & VRT

  9. Right Coronary Artery (LAO) LAO 60 Coronary Angiography MDCT & VRT

  10. Detection of Coronary Stenoses MDCT Coronary Angiography

  11. Coronary StenosesCTA & Angiography

  12. CTA Limitations • Artifacts • Cardiac motion • Breathing • Blooming • Poor opacification • Small vessel

  13. Solutions • Rot. time & 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

  15. Coronary Plaque Imaging MDCT Coronary Angiography

  16. Non Calcified Plaque Density

  17. Atheroma Rupture/Erosion Healing Hemorrhage Thrombus Calcified Nodule Fibrocalcified Plaque Wall changes Stenoses Occlusion Coronary Atherosclerosis Intimal Thickening

  18. 50 HU 50HU Atheroma • 38 YOM • Non specific complain • Risk Factors • Cholesterin • Smoker • No calcium

  19. 62 YOM Suspicion of CAD 12 mg CaHA Calcified Nodule

  20. Fibrocalcified Plaque 100 HU

  21. 20 HU Thrombus • 42 YOM • Epigastric chest pain • Risk Factors • Hypertension • Smoker • No calcium

  22. Thrombus

  23. Acute Posterior Wall Infarction

  24. Myocardial Infarction Scar anterior LAD posterior RCA lateral LCx

  25. CT Plaque Density p = 0.018 89 ± 31 HU 50 ± 12 HU Lipid Fibrose Lipid Fibrosis

  26. CTA vs IVUSSchröder Heart 2001;85:576

  27. Carotid AtherosclerosisEstes 1998 J Cardiovasc Surg 39:527

  28. Plaque DistributionLeber 2001 Circulation Myocardial Infarction n = 12 122 Plaque Stable Angina n = 12 135 Plaque

  29. Summary • Detection of stenoses • Calcium • Small vessels • Characterization of plaques • Identify atheromas • Follow up under therapy • Acute coronary event • Intracoronary thrombus • Myocardial infarction

  30. www.CT2002.org

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