What Are They? Computed Tomography Angiography (CTA)

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Presentation transcript:

Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA)

What Are They? Computed Tomography Angiography (CTA) Imaging of the vasculature using CT techniques Can be 3-D Requires contrast Magnetic Resonance Angiography (MRA) Imaging of the vasculature system using MRI techniques No contrast required

How Does CTA Work? Uses X-rays Tube rotates around patient at high speed Detector picks up attenuated beam Computer generates the image Collects image in axial plane but can be converted into sagittal, or coronal views Computer can generate 3-d images

How Does MRA work? Uses a large magnet align hydrogen atom in the body Pulsed radio-waves cause hydrogen atoms to flip out of alignment When the radio-waves are turned off the hydrogen atom flip back and give off their own signal Signal is detected by the computer and used to generate an image Different body tissues have different amounts of Hydrogen

What is CTA used for? Imaging of calcified atherosclerotic plaque Areas that are scan for plaque include: Carotid Bulb Iliac arteries Coronary arteries Used to detect legs clots before they break and cause pulmonary emboli

Calcified plaque seen on CTA Angiogram of the same vessel

What is MRA used for? MRA is used to image many peripheral vessels Areas that are imaged include: Circle of Willis Cerebral Arteries Renal Arteries If there is a contrast allergy then MRA is used

Benefits of CTA Detecting narrowing vessels in time for intervention Better anatomical detail than with MRA or ultrasound Can be used for screening for arterial disease Less costly and safer than conventional angiography Contrast reactions are less severe

Risks of CTA Allergic reactions to contrast media Avoided in patients with kidney disease due to contrast Ionizing radiation is used Pregnant women should not have a CT due to radiation

Benefits of MRA Detailed images without damaging the artery with a catheter Shorter procedure and recovery times than with conventional angiography Less costly than catheter angiography No exposure to ionizing radiation Use of contrast is not necessary to obtain good images

Risks of MRA Metal implants may be affected by the magnetic field Claustrophobic patients may need ot be sedated It is unknown how the magnetic field affects the fetus so first trimester patients should not have an MRI

Limitations of CTA Fuzzy images if there is patient movement Heart beat can blur images Blocked vessels are harder to interpret Not reliable for imaging small twisted vessels in rapidly moving organs Faster gantry times will solve this problem

Limitations of MRA Any metal object in the patient is contraindicative Image clarity is not as good as conventional angiography Cannot image calcified plaque Hard to image very small vessels

Accuracy of CTA 16-slice multidetector machine Sensitive and specific for 2mm diameter or greater 92-93% Ultra fast 16-slice multidetector machine Sensitive and specific for 2mm diameter or greater 95-98% 64-slice multidetector machine Sensitive and specific for 2mm diameter or greater 92-93%

Accuracy of MRA Detecting Cerebral aneurysms with an average accuracy of about 70% without contrast False positives averaged approx. 27 With contrast 100% sensitive for aneurysmal and stenotic lesions Specificity of completely occluded lesions also 100% Drops to 83.3% when only partially occluded

What’s to come? Improved spatial resolution Decreasing costs Screening Resolutions due to software advancements are improving Decreasing costs Screening CTA screening for CAD Joint Modalities Combining of the two for better images Better accuracy New contrast medias for MR and faster CT machines

Bibliography Dargan, R., Volkin, L., New Application Enhances Capabilities of Angiographic CT, retrieved February 5, from: www.asrt.org/content/News/IndustryNews Briefs/CT/NewApplica050318.aspx Sheth, T. et. al., (2005), Coronary Computed Tomography Angiography: Emerging Technique for Coronary Artery Imaging, JACR 2005:56(1):15-24 Tripathi, RP, et. al., (2002), Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography- Our Preliminary Experience, Ind. J. Raiol. Imag. 2002, 12:2:179-188 www.cir.uc.edu/ research.html www.medscape.com/viewarticle/521872?rss www.radiologyinfo.org/content/ct-angiography.htm www.radiologyinfo.org/content/mr-angiography.htm