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

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Presentation on theme: "Cardiac applications of 16 slice MDCT :Initial experience Samsung Medical Center Dong-Joon Ahn."— Presentation transcript:

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 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.) CAC : 8, CTA : 28

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

5 Coronary arteries angiography –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 Method I. Image acquisition II. Evaluation – Compare 45%, 55% & 75% of RR interval

6 Reconstruction method & heart rate H RAcquisition Mode Temporal Resolution 40~60Snapshot Segment250ms, 1cycle 60~75Snapshot Burst125ms, 2cycles 75~90Snapshot 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 Method

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

10 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%) II. Coronary arteries angiography Results

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

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

13 Short and long axis of heart

14 Volume rendering Coronary vessel tree view LIMA - SVGArtifact

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 –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 Conclusion (I)

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.

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22 Hr

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30 Cardiac CT EKG 동조화 EKG 동조화 Temporal resolution 향상 Temporal resolution 향상 Isotropic resolution 영상획득 Isotropic resolution 영상획득 Software Software

31 Cardiac function

32 Short and long axis of heart

33 BeforeAfter Phase registration

34 Vessel analysis

35 Volume rendering

36 Isotropic resolution 영상획 득 Isotropic resolution 영상획 득

37 RCA Stent HR =

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

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

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