Coronary CT Angio – PDF

Coronary Main purpose for CT coronary angiography Answer 1/ morphology Detection and analysis of coronary artery disease and depict anatomy of coronary artery. 2/ possible to obtain function information in the same scan. Contractility of myocardium Valve morphology and function Viability of myocardi...

Coronary Main purpose for CT coronary angiography Answer 1/ morphology Detection and analysis of coronary artery disease and depict anatomy of coronary artery. 2/ possible to obtain function information in the same scan. Contractility of myocardium Valve morphology and function Viability of myocardium Indication for CT coronary angio Answer 1/evaluation of suspected pulmonary embolism 2/evaluation of aortic disease 3/evaluation of pericardial disease 4/evaluation of cardiac mass 5/pre surgical evaluation especially before redo open heart surgery 6/evaluation of pulmonary veins 7/evaluation of chest pain in patients at low to intermediate pretest probability of disease 8/suspicion of coronary artery anomalies 9/assessment of anatomy in complex congenital heart disease 10/assessing graft patency after prior bypass surgery Contraindication Anserw 1. Pregnancy 2. Clinical instability 3. Renal in sufficiently 4. Known history of anaphylactic contrast reaction Patient preparation Checking indication and contraindication for scan 1/checking contraindication for nitrate and beta blockers 2/patient should take their cardiac medication as usual 3/no food 3/4 h before scan 4/no caffeine for 12h 5/instruction on how to breath 6/ECG signal need to be acquired 7/heart rate control heart rate and blood pressure of patient ‫الزم قبل اي ادويه تتاكد من‬ beta blocker or ‫ انه ياخد‬contraindication ‫ونتاكد ان مفيش اي‬ nitroglycerin ‫ وبعدين نشتغل الفحص‬calcium score ‫هنتاكد قبل الفحص من‬ Patient position supine with arm above ‫هنشتغل الفحص بطريقتين ممكن دي او دي‬ Prospective ECG MOST COMMON Method step and shoot method ‫اسمها التاني‬ Purpose to capture high quality image of heart with minimum motion artifact by synchronized scan with ECG Procedures images are taken at specific point in cardiac cycle usually during mid to end of diastole Advantages this method result in lower radiation exposure and providing diagnostic quality image as scan required in short period and not thought the entire cardiac cycle Limitation it require regular sinus rhythms and its less effective for patients with high heart rate or arrhythmias ‫تتطلب بيشت متعاون ونبضاته اقل من المعدل الطبيعي وجهاز يلحق ياخد‬ 100 kg ‫ ووزن البيشنت ميعديش‬diastole ‫الصور ف فتره‬ cardiac cycle of ‫ بيها اتعرفنا ع ال‬ECG ‫فكرتها اننا وصلنا‬ diastole ‫ وشوفنا امتي‬systole ‫ وشوفنا امتي ال‬patient  ‫‪ ,,‬وصورنا خالل الفتره دي الن بالنسبالننا دي فتره مفيهاش حركه‬ ‫ونقدر نخد صور كويسه ‪diastole‬‬ ‫بتمثل ‪ 700‬ثانيه من ال ‪ cardiac cycle‬ف االساس ال ‪cardiac‬‬ ‫‪ cycle‬كلها ‪ 1000‬ثانيه منهم ‪ 300‬ثانيه انقباض و ‪ 700‬ثانيه‬ ‫انبساط وبندي اشعه ف ال ‪ phase‬الل بصور فيها بس مش ف لب‬ ‫‪ cardiac cycle‬كلها‬ ‫‪Retrospective ECG GATE‬‬ ‫‪method‬‬ ‫دي الطريقه التانيه‬ ‫‪Using to capture images during entire cardiac cycle‬‬ ‫بستخدمها لو منفعش معايا الطريقه االولي الطريقه االولي بتعتمد ع بيشنت‬ ‫ضربات قلبه قليله وانا اقدر اتحكم فيها طيب لو مش قليله ومش عارف اتحكم‬ ‫فيها بنستخدم الطريقه دي فبناخد صور خالل ال ‪ cardiac cycle‬كلها من اولها‬ ‫الخرها عيبها اني عرضت لبيشنت الشعه كتير بس حلو اني شفت القلب ف حاله‬ ‫االنقباض واالنبساط فاقدر اقيم ال ‪ function‬بتاعته‬ ‫‪Purpose used when it's difficult to control heart‬‬ ‫‪rate or when additional information about ventricular‬‬ ‫‪or valvular function is needed‬‬ ‫‪Procedure images are acquired continuously‬‬ ‫‪during entire cardiac cycle and best image are‬‬ ‫‪selected from different phases‬‬ Advantages provide information about heart function and it's useful for patient with irregular heart rate or high heart rate Disadvantages higher radiation exposure Contrast indication ‫فيها‬biphasic injection ‫عندنا طريقتين اول وحده اسمها‬ ‫بنحقن كل كميه الصبغه ثم كل كميه‬ saline‫ال‬ ‫ ف‬70 ‫ ف الميه من الصبغه وبعدين‬70 ‫الطريقه التانيه بنحقن‬ ‫ ف الميه ثم باقي‬30 ‫ مع باقي الصبغه الل هما‬saline ‫الميه من‬ triphasic ‫ كدا حقنا تالت حقنات ورا بعض فاسمها‬saline ‫كميه ال‬ injection ‫مللي صبغه‬400 ‫الي‬275 ‫بنحقن سواء ف دي او دي من‬ biphasic injection important for good evaluating of RCA And poor opacification of RT ventricle for functional analysis Triphasic injection important for maintain dense opacification for coronaries and left ventricle Second phase improve right ventricle opacification for segmentation Post processing technique 1/multiplanar reformat MPR 2/maximum intensity projection MIP 3/volume rendering VR 4/curved reformation 5/cine imaging Calcium score It's useful as a risk stratification tool in coronary artery disease and it outperforms other risk assessment method Predicating risk for future cardiovascular events and death ‫معروف طبعا ان الكالسيوم ليه هايبر دينستي‬ ‫ وطالع‬130 ‫احنا بنشوف كثافه الكالسيوم ف الوعاء لدموي من‬ 1.130/199 its score 1 2.200/299 score 2 3.300/399 its score 3 4.400 its score 4 Limitation for CTC ‫امتي معملش الفحص‬ Irregular heart rate Obesity Stents more than 3mm Calcium and stents blooming artifact lower specialty of CCTA CT anatomical planes of heart 1. vertical long axis 2, short axis view 3, three chamber view 4.four chamber or horizontal long axis Prepared by DR.Farha Ahmed ‫سبحانك اللهم وبحمدك‬ ‫اشهد ان ال اله اال انت‬ ‫استغفرك واتوب اليك‬