Noninvasive exact procedure comfortable for the patient , 

3-D or 4-D image for volumetric display of the coronary blood vessels

Pejkovik, Danijela

UGD Academic Repository

Cardiosurgery - SkopjePitfalls in coronary CT angiography with 64 VCT Light Speed – GE- our initial experienceRad.teh. Danijela PejkovikSpecial hospital for surgery diseases  “Filip II”Skopje, MacedoniaApril, 2010Cardiosurgery - Skopje64 Cardiac MSCTNoninvasive exact procedure comfortable for the patient , 3-D or 4-D image for volumetric display of the coronary blood vessels.Cardiosurgery - Skopje64 Cardiac MSCT- Indications• Detection of CAD for a patient with atypical chest pain/ angina• Screening in asymptomatic patients with high risk for CAD• Evaluation of  suspected coronary anomalies before/after cath lab• Coronary assessment before cardiac & vascular surgery• Planning of interventions -stenting • Stent & CABG follow up• Triple rule out ( aortic dissection,PE,CAD)• Evaluation of valvular and ventricular functionCardiosurgery - Skopje64 Cardiac MSCT - our initial experience• February  to July 2008,- 254 coronary CTA • performed by two radiological technologists and independently analyzed by two radiologists• Cardiac SSegment 30 – 75 BPM ECG gated protocolCardiosurgery - Skopje64 Cardiac MSCT• High speed scanning  (rot.time 0,35)• High spatial and temporal resolution• Thin slices - 0,625 mm, • Visualization in all planes (sagital, transversal, coronal)• Acquisition in diastolic phase What more we need?• 3D postprocesing• ECG gating • An injector - Blood pressure monitor- Anti shock therapy (allergic reaction, chest pain)Cardiosurgery - Skopje64 Cardiac MSCT• patient preparation:- getting an accurate patienthistory, - ЕCG / HR / ТА/ ТТ- explain to the patient  theCT examination (Instructions for breath hold: test the breath-hold of the patient before the acquisition 8-20 sec, contrast enhancement effects)• medical premedication(if it is necessary)Cardiosurgery - Skopje64 Cardiac MSCT – Breath - hold instructions« Breath in and hold your breath »5-7s Stable window2-3sPitchAPitchBReaction timeHRtimeCardiosurgery - Skopje64 Cardiac MSCT  - PositioningPatient feet first• Reference point: SNIV in the right arm:     canila: 20G / 18G(injection rate = up to 5 ml/s)• ECG far from the injector,  screen to face the acquisition console- 3 Leads : (on bone contact) Very usefull to fix all the wires to avoid a badECG trace. (avoid artifacts)Cardiosurgery - Skopje64 Cardiac MSCT  SS Segment 45 – 70 BPM 0.625mmScan Type ScoutNum. Scout 2Start Loc. S 60.00End Loc. I 300.00kV 120mA 10Scan Type CardiacRotation Time 0.35Cardiac Mode Snap Shot Segment(Helical)Detector Coverage 40.0mmHelical Thickness 0.625Gantry Tilt S 0.0SFOV Cardiac LargekV 120mA EKG Modulated mATotal Exposure Time 12.6Prep Group Smart PrepInterval 0.625 Cardiosurgery - Skopje64 Cardiac MSCT - ScoutCardiosurgery - Skopje• R-R peakCardiosurgery - Skopje64 Cardiac MSCT - Setting the acquisition field of the patient's scoutCardiosurgery - Skopje64 Cardiac MSCT - Positioning the reference image on the Smart PrepCardiosurgery - SkopjeCardiosurgery - Skopje64 Cardiac MSCT- Ca scoring Cardiosurgery - Skopje64 Cardiac MSCT - Producing Timing GraphROI on AortaIn our hospital we use the "smart prep" option(setting the localizer 2cm above the carina - the point for extrapolating similar slices in predetermined intervals and for observing the concentration of the contrast material in the ascending aorta)Cardiosurgery - SkopjeRCA & PDA LAD LMB3Cardiosurgery - SkopjeCardiosurgery - Skopje64 Cardiac MSCT Coronary by-pass graftsCardiosurgery - Skopje64 Cardiac MSCT - Results:Out of 254 performed examinations :- 48 (18,8%) - motion artifactsand high noise,- In 10 (3,9%) - obesity of the patients,- 11 (4,3%) CTA - breathing artifacts, - 9 (3,5%) non-optimal enhancement (early or late scanning),- In 7 (2,7%) communicationwith the patients and- In 11 (4,3%) - heart rate(over 80 BPM).Breathing  artifactsCardiosurgery - SkopjeHeart rate. Obesity. Non-optimal enhancementRight chamberAo ASCAo ASCCardiosurgery - Skopje64 Cardiac MSCT • Limitations:- Heart frequency above 65-70 bpm- Uncooperative patient- Obese patients• Relative contraindications:- Oversensitivity to the contrast  material (premedication needed)- Arrhythmia• Unwanted reactions:- Extravasations of the contrast under the skin- Iodine allergyCardiosurgery - SkopjeConclusion• For a correct accomplishment of coronary CTA, the main goal is a good cooperation and communication with the patients in their preparation and during the examination.• As well as a good educated technologist for correct following of the parameters (ECG triggering, optimal enhancement, scan delay)

Pitfalls in coronary CT angiography with 64 VCT Light Speed – GE- our initial experience

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