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Harvard Medical School Coronary MDCTA Applications Thomas H. Hauser MD, MMSc, MPH, FACC Director of Nuclear Cardiology Beth Israel Deaconess Medical Center.

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Presentation on theme: "Harvard Medical School Coronary MDCTA Applications Thomas H. Hauser MD, MMSc, MPH, FACC Director of Nuclear Cardiology Beth Israel Deaconess Medical Center."— Presentation transcript:

1 Harvard Medical School Coronary MDCTA Applications Thomas H. Hauser MD, MMSc, MPH, FACC Director of Nuclear Cardiology Beth Israel Deaconess Medical Center Assistant Professor of Medicine Harvard Medical School Boston, MA

2 Harvard Medical School Outline Possible indications for coronary MDCTA How to approach a coronary MDCTA study

3 Harvard Medical School Outline Possible indications for coronary MDCTA How to approach a coronary MDCTA study

4 Harvard Medical School Possible Indications for Cardiac CT Coronary artery –CAD/Plaque –Stents –Grafts –Anomalous coronaries Ventricular size and function Valve imaging Myocardial perfusion Infarct imaging Cardiac vein imaging Congenital heart disease Cardiac masses Cardiomyopathy Pulmonary vein imaging

5 Harvard Medical School Detection of CAD Accuracy investigators, RSNA 2007

6 Harvard Medical School Clinical Evaluation of Coronary CTA

7 Harvard Medical School Multi-Center Trial: 16-Slice MDCT Garcia, M. J. et al. JAMA 2006;296:

8 Harvard Medical School Multi-Center Trials: CORE-64, Accuracy CORE-64 reported at AHA 2007 (Toshiba) –291 patients at 9 institutions –Sensitivity 85% –Specificity 90% –Excluded patients with calcium score >600 ACCURACY reported at RSNA 2007 (GE) –229 patients at 16 institutions –Sensitivity 93% –Specificity 82%

9 Harvard Medical School ACCURACY Trial J Am Coll Cardiol Budoff et al. online only

10 Harvard Medical School Limitations of Coronary CTA Coronary Motion Slab artifacts –Ventricular Ectopy –Ventilatory Motion Calcium Stents Radiation Dose

11 Harvard Medical School Coronary Motion Hoffmann et al, J Nucl Med 2006; 47:797–806

12 Harvard Medical School Higher Heart Rate = More Motion Hoffmann, M. H. K. et al. Radiology 2005;234:86-97

13 Harvard Medical School Slab Artifact Hoffmann et al, J Nucl Med 2006; 47:797–806

14 Harvard Medical School Calcium Hoffmann et al, J Nucl Med 2006; 47:797–806

15 Harvard Medical School Calcium Raff et al, J Am Coll Cardiol 2005;46:552 – 7

16 Harvard Medical School Stents Gaspar, T. et al. J Am Coll Cardiol 2005;46:

17 Harvard Medical School Stents

18 Harvard Medical School Grafts

19 Harvard Medical School Grafts

20 Harvard Medical School Grafts

21 Harvard Medical School Grafts

22 Harvard Medical School Grafts VesselsSegmentsSensSpec Grafts %96% Run-off %93% Non-BP %86% Malagutti et al. Eur Heart J 2006 epub

23 Harvard Medical School Radiation Dose: High Einstein et al, JAMA. 2007;298:

24 Harvard Medical School Radiation Dose J Am Coll Cardiol Maruyama et al. 52 (18): 1450

25 Harvard Medical School Radiation Dose J Am Coll Cardiol Maruyama et al. 52 (18): 1450

26 Harvard Medical School Problems Correlating with Angiography Angiographic stenosis is not perfectly correlated with functional significance –Potential advantages for combining with functional imaging Identification of non-obstructive plaque may identify patients at increased risk for adverse events –Ongoing prospective studies of prognosis

27 Harvard Medical School Angiographic vs. Functional Stenosis Meijboom et al, J Am Coll Cardiol, 2008; 52:

28 Harvard Medical School Outcomes after CTA Ostrom et al, J Am Coll Cardiol, 2008; 52:

29 Harvard Medical School Plaque Characterization Leber et al, J Am Coll Cardiol, 2005; 46:

30 Harvard Medical School Anomalous Coronary Arteries

31 Harvard Medical School Anomalous Coronary Arteries

32 Harvard Medical School Ventricular Function

33 Harvard Medical School Ventricular Function

34 Harvard Medical School Ventricular Function: Compared to CMR Segung et al, Circulation 2006;114: ; 31 patients

35 Harvard Medical School Ventricular Function: Compared to CMR Segung et al, Circulation 2006;114: ; 31 patients, radial method

36 Harvard Medical School Valvular Function

37 Harvard Medical School Valvular Function

38 Harvard Medical School Aortic Stenosis Pouleur et al, Radiology 2007;244:

39 Harvard Medical School Aortic Stenosis Pouleur et al, Radiology 2007;244:

40 Harvard Medical School Aortic Stenosis Pouleur et al, Radiology 2007;244: Agreement between multidetector CT and TTE in the detection of normal (AVA 2 cm 2 ), mildly stenotic (AVA 1.2 cm 2 and < 2.0 cm 2 ), moderately stenotic (AVA 0.8 cm 2 and < 1.2 cm 2 ), or severely stenotic (AVA < 0.8 cm 2 ) aortic valve opening was excellent ( = 0.88, P <.001)

41 Harvard Medical School Valvular Function

42 Harvard Medical School Valvular Dehiscence

43 Harvard Medical School Valvular Dehiscence

44 Harvard Medical School Perfusion and Late Enhancement Nieman et al. Radiology.2008; 247: 49-56

45 Harvard Medical School Perfusion and Late Enhancement Nieman et al. Radiology.2008; 247: 49-56

46 Harvard Medical School Perfusion and Late Enhancement Nieman et al. Radiology.2008; 247: 49-56

47 Harvard Medical School Cardiac CT Possible indications for coronary MDCTA How to approach a coronary MDCTA study

48 Harvard Medical School How to Review a Coronary CTA Study Review the axial images –Interrogate multiple reconstructions at different points in the cardiac cycle to determine which has the least amount of artifact If any abnormalities, further investigate them with MIPs MPRs, and curved MPRs. Volume rendered images can be helpful to communicate your findings –Generally not diagnostic –Especially helpful in graft cases The entire dataset beyond the heart needs to be reviewed to ensure that there are no other significant findings.

49 Harvard Medical School Axial Stack

50 Harvard Medical School Axial Slice

51 Harvard Medical School MIP

52 Harvard Medical School Volume Rendered Image

53 Harvard Medical School cMPR with SAX and VA

54 Harvard Medical School cMPR with SAX and VA, Orthogonal

55 Harvard Medical School Importance of Interactive Reconstructions Ferencik et al, Radiology: Volume 243: Number 3 — June 2007

56 Harvard Medical School Outline Possible indications for coronary MDCTA –Coronary artery imaging is becoming established Stenosis Plaque characterization Stents Grafts –Ventricular function –Aortic Stenosis How to approach a coronary MDCTA study –Axial images contain all of the primary data –Use interactive reconstructions to aid in assessing problem areas


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