Coronary CT Angiography Current applications in clinical practice and promise for the future Samuel Wann MD, MACC

WISCONSIN HEART HOSPITAL

HOW TO… 16 or 64 slice scanner Cardiac gating – HR <70 bpm Regular rhythm Properly timed IV contrast bolus Breath-hold Reconstruct images at various phases of cardiac cycle

Axial Images Thin MIP Adjust window and contrast levels Scroll thru all images Select phase with least motion artifact Multiplanar reformats as needed

Heart window

Lung window Bone window

Beam hardening “streak” artifact

10% phase 20%30%40% 50%60%70%80% 75%

RCA mpr

LAD mpr

LCX mpr

Review of volumetric dataset Curved reformatted images 3D reconstructions “IVUS” view Functional analysis

3D volume rendering

LAD crf

RCA crf

“IVUS” view

Anomalous Right Coronary Artery

Right Coronary Artery Catheterization Comparison Cardiac Catheterization MSCT MSCT

Proximal LAD Coronary Stent MSCT

Occluded LAD/RCA MSCT

3D Reconstruction Coronary bypass

35 yo woman in ER for atypical chest pain. Normal ecg & troponin

48 year old man in ER  sudden severe chest pain/dyspnea 2 hours duration  History of hypertension  Normal troponin  ECG shows LVH with strain

Aortic dissection

Non-coronary CV structures ventricles pericardium atria, atrial appendage pulmonary veins and arteries aorta valves

LV functional analysis

32 yo woman 3 yr hx atypical chest pain

92 yo woman Progressive dyspnea

Non-CV Structures Lungs and airway Mediastinum Bones Lower neck and upper abdomen

CIRCUMFLEX STENOSIS

Pati ents Age% with CAD by cathet erizati on Arteries evaluat ed Uneval- uable arteries Sens- itivity Speci- ficity Nega tive predi ctive value Hea rt rate (bp m) Dose modula tion Leschka %>1.5 mm094%97%99%66No Ropers %>1.5 mm4%95%93%99%59Yes Fine 6662>1.5 mm6%95%96%95%No Leber %All7%73%97%99%63Yes Raff %All12%86%95%98%58No Mollet %All2%99%95%99%No Weighted Average for all 6154%3%90%95%98% 64 slice Computed Tomography - Sensitivity & specificity