1. Cardiac applications of 16 slice MDCT :Initial experience
Samsung Medical Center
Dong-Joon Ahn

2. Purpose Applications of 16 slice MDCT in cardiac disease
To evaluate the effectiveness :
CAC , CTA , Functional analysis

3. Materials & Equipments
CAC : 8 , CTA : 28
Lightspeed ultra 16 (GE)
Advantage workstation version 4.0 (GE)
Millenia 3500 CT ECG monitoring system
(Invivo rsearch Inc.)
Envision CT (Medrad)
Iomeron 300 (Braco co.)

4. Calcium scoring I. Image acquisition II. Evaluation Method
No contrast material
2.5mm x 8i scan (cine mode)
Gantry rotation time : 0.5sec
Prospective ECG gating : 75%
II. Evaluation
Agatstone score

5. Coronary arteries angiography
Method
Coronary arteries angiography
I. Image acquisition
Non-ionic CM ml, 4ml/s
0.625mm scan
Gantry rotation time : 0.5sec
Retrospective ECG gating
Image reconstruction according to cardiac
phases : % of RR interval
II. Evaluation
Compare 45%, 55% & 75% of RR interval

6. Reconstruction method & heart rate
H R
Acquisition Mode
Temporal Resolution
40~60
Snapshot Segment
250ms, 1cycle
60~75
Snapshot Burst
125ms, 2cycles
75~90
Snapshot Burst Plus
65ms, 4cycles

7. Reconstruction method
Snapshot segment mode
Snapshot burst mode
Snapshot burst plus mode

8. Post processing methods
Volume rendering
Maximum intensity projection (MIP)
Reformation in cardiac short and long axis
Vessel analysis
Endoscopic view (fly-through)
Curved reformation

9. I. Calcium scoring Agatscore 0 in 4 14 in 1 55 in 1 821 in 1 928 in 1
Results
I. Calcium scoring
Agatscore
0 in 4
14 in 1
55 in 1
821 in 1
928 in 1

10. II.Coronary arteries angiography
Results
II.Coronary arteries angiography
Best phase locations for image quality
45% : RCA in 7, distal LAD in 5
55% : RCA in 1
75% : LAD in most patients and RCA in 2
good image quality in 33/36 (91%)

11. LAD: 75% = Best
45%
55%
75%

12. Phase location and image quality
55%
45%
65%
75%

13. Short and long axis of heart

14. Coronary vessel tree view
Volume rendering
Coronary vessel tree view
LIMA - SVG
Artifact

15. Automatic MIP
MPVR
Curved reformation

16. Consideration Improved image reconstruction algorithm and software
Prospective or retrospective ECG gating
Better temporal resolution
Image acquisition of isotropic resolution

17. Limitations of coronary CTA
Extensive calcifications
Stents : spatial resolution
Variable heart rate : poor image quality
Radiation dose
Small branches / septal branches

18. Conclusion (I) Screening asymptomatic high risk population (CAC, CTA)
Exclusion of stenosis in patients with low likelihood of extensive disease
Diagnosis in pts with atypical angina
Post-procedural evaluation (CABG, stent)
Plaque characterization
Follow-up after drug treatment

19. Conclusion (II)
The fast volume coverage of ECG gated 16 slice CT enables acquisition of the entire heart volume with nearly isotropic resolution within a single breath hold.

22. Hr

30. Cardiac CT EKG 동조화 Temporal resolution 향상 Isotropic resolution영상획득
Software

31. Cardiac function

32. Short and long axis of heart

33. Phase registration
Before
After

34. Vessel analysis

35. Volume rendering

36. Isotropic resolution영상획득

37. RCA Stent HR =

38. Y- graft :RITA-LAD,
RITA-OM1-OM2-PL

39. 45% volume rendering, HR: 75-84