1. Coronary CT Angiography Current applications in clinical practice and promise for the future Samuel Wann MD, MACC

2. WISCONSIN HEART HOSPITAL

4. HOW TO… 16 or 64 slice scanner Cardiac gating – HR <70 bpm Regular rhythm Properly timed IV contrast bolus Breath-hold Reconstruct images at various phases of cardiac cycle

5. Axial Images Thin MIP Adjust window and contrast levels Scroll thru all images Select phase with least motion artifact Multiplanar reformats as needed

6. Heart window

7. Lung window Bone window

8. Beam hardening “streak” artifact

9. 10% phase 20%30%40% 50%60%70%80% 75%

11. RCA mpr

12. LAD mpr

13. LCX mpr

14. Review of volumetric dataset Curved reformatted images 3D reconstructions “IVUS” view Functional analysis

15. 3D volume rendering

16. LAD crf

17. RCA crf

19. “IVUS” view

21. Anomalous Right Coronary Artery

22. Right Coronary Artery Catheterization Comparison Cardiac Catheterization MSCT MSCT

24. Proximal LAD Coronary Stent MSCT

26. Occluded LAD/RCA MSCT

27. 3D Reconstruction Coronary bypass

28. 35 yo woman in ER for atypical chest pain. Normal ecg & troponin

29. 48 year old man in ER  sudden severe chest pain/dyspnea 2 hours duration  History of hypertension  Normal troponin  ECG shows LVH with strain

31. Aortic dissection

33. Non-coronary CV structures ventricles pericardium atria, atrial appendage pulmonary veins and arteries aorta valves

34. LV functional analysis

39. 32 yo woman 3 yr hx atypical chest pain

42. 92 yo woman Progressive dyspnea

44. Non-CV Structures Lungs and airway Mediastinum Bones Lower neck and upper abdomen

48. CIRCUMFLEX STENOSIS

49. Pati ents Age% with CAD by cathet erizati on Arteries evaluat ed Uneval- uable arteries Sens- itivity Speci- ficity Nega tive predi ctive value Hea rt rate (bp m) Dose modula tion Leschka 676070%>1.5 mm094%97%99%66No Ropers 825931%>1.5 mm4%95%93%99%59Yes Fine 6662>1.5 mm6%95%96%95%No Leber 596449%All7%73%97%99%63Yes Raff 705954%All12%86%95%98%58No Mollet 526075%All2%99%95%99%No Weighted Average for all 6154%3%90%95%98% 64 slice Computed Tomography - Sensitivity & specificity