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Figure 1 (a) Calcium scoring Adenosine infusionStress scanSublingual NTG (Optional) Rest scan (CTA) Scan range4 to 5 minutes (until the end of stress scan) Retrospective ECG- gating 2 minutes before Rest scan Retrospective ECG-gating 10 to 20 minutes interval Option 1.Static perfusion 2.Dynamic perfusion Option 1.Retrospective mode 2.Prospective mode 3.High-pitch mode
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Figure 1 (b) Calcium scoringRest scan (CTA) Adenosine infusionStress scan Define scan rangeRetrospective ECG-gating4 to 5 minutes (until the end of stress scan) Retrospective ECG-gating 10 to 20 minutes interval Option 1.Static perfusion 2.Dynamic perfusion Option 1.Retrospective mode 2.Prospective mode 3.High-pitch mode
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Figure 2 20406080 Scan time (s) 150 300 Enhancement (HU) – Artery Time Attenuation Curve (TAC) – Myocardium DynamicSnapshot or helical Dynamic Snapshot or helical
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Figure 2 (QR)
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Figure 3(a)
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Figure 3(b)
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Figure 4 (a)
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Figure 4 (b)
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Figure 4 (c)
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Figure 5 Step 1Step 2Step 3Step 4Step 5 Rest scan interpretation Image processingQuality assessImage interpretation Correlation with rest scan Coronary artery stenosis and plaque analysis Best phases of motionless myocardium Epi-and endocardial contour (for dynamic study) Motion artifact Beam hardening Cone-beam Stair-step Image noise Transmurality (≥50% or <50%) Reversibility Myocardial thinning Simultaneous vision of both stress and rest scans Match perfusion defect and coronary artery lesion
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Figure 6(a)
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Figure 6(b)
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Figure 6(c)
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Figure 7 Stress Perfusion Continuous adenosine infusion 140ug/kg/min 4-5min Start adenosine Contrast bolus injection 0.03-0.1mmol/kg Rest Perfusion Viability 12-15 min interval Contrast bolus injection 0.03-0.1mmol/kg 5 min interval Stop adenosine surveyCine, etc 30min
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Figure 8 (a)
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Figure 8 (b)
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Figure 8 (c)
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Figure 9 Measurement of Relative Upslope for Myocardial Perfusion Reserve Index (MPRI)
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Figure 10 (a)
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Figure 10 (b)
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Figure 10 (c)
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Figure 10 (d) and (e)
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Figure 10 (f)
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Figure 11 (a)
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Figure 11 (b)
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Figure 11 (c)
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Figure 11 (d)
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Figure 11 (e)
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Figure 11 (f)
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Figure 11 (g)
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Figure 11 (h)
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Figure 11 (i)
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Figure 11 (j)
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Figure 11 (k)
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Figure 11 (QR-h)
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Figure 11 (QR-i)
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Figure 11 (QR-j)
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Figure 11 (QR-k)
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Figure 11 (QR2-a) LADLCX
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Figure 11 (QR2-b)
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Figure 11 (QR2-c)
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Figure 11 (QR2-d)
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Figure 12(A)
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Figure 12(B)
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Figure 12(C)
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Figure 13(a)
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Figure 13(b)
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Figure 13 (c)
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Figure 13 (d)
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Figure 13 (e) RCALAD
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Figure 14 (a)
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Figure 14(b)
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Figure 14(c)
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Figure 14(d)
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Figure 14- QR-1 MR perfusion study, coronary CT angiography is inconclusive study
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QR-2 for figure 14-a
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QR-2 for figure 14-b
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QR-2 for figure 14-c
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QR-2 for figure 14-d
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Figure 15 (a)
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Figure 15 (b)
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Figure 15 (c)
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Figure 15 (d)
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Figure 16(a)
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Figure 16(b)
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Figure 17 (a)
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Figure 17(b)
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Figure 18 (a)
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Figure 18 (b)
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Figure 19(a)
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Figure 19(b)
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Figure 19(c)
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Figure 19(d)
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Figure 20 (a)
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Figure 20 (b)
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