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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
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
Figure 2 20406080 Scan time (s) 150 300 Enhancement (HU) – Artery Time Attenuation Curve (TAC) – Myocardium DynamicSnapshot or helical Dynamic Snapshot or helical
Figure 2 (QR)
Figure 4 (a)
Figure 4 (b)
Figure 4 (c)
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
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
Figure 8 (a)
Figure 8 (b)
Figure 8 (c)
Figure 9 Measurement of Relative Upslope for Myocardial Perfusion Reserve Index (MPRI)
Figure 10 (a)
Figure 10 (b)
Figure 10 (c)
Figure 10 (d) and (e)
Figure 10 (f)
Figure 11 (a)
Figure 11 (b)
Figure 11 (c)
Figure 11 (d)
Figure 11 (e)
Figure 11 (f)
Figure 11 (g)
Figure 11 (h)
Figure 11 (i)
Figure 11 (j)
Figure 11 (k)
Figure 11 (QR-h)
Figure 11 (QR-i)
Figure 11 (QR-j)
Figure 11 (QR-k)
Figure 11 (QR2-a) LADLCX
Figure 11 (QR2-b)
Figure 11 (QR2-c)
Figure 11 (QR2-d)
Figure 13 (c)
Figure 13 (d)
Figure 13 (e) RCALAD
Figure 14 (a)
Figure 14- QR-1 MR perfusion study, coronary CT angiography is inconclusive study
QR-2 for figure 14-a
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Figure 15 (a)
Figure 15 (b)
Figure 15 (c)
Figure 15 (d)
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Figure 20 (b)
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