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

Coronary CT AngiographyCurrent applications in clinical

practice and promise for the future

Samuel Wann MD, MACC

WISCONSIN HEART HOSPITAL

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

Axial Images

• Thin MIP

• Adjust window and contrast levels

• Scroll thru all images

• Select phase with least motion artifact

• Multiplanar reformats as needed

Heart window

Lung window Bone window

Beam hardening “streak” artifact

10% phase

20% 30% 40%

50% 60% 70% 80%

75%

RCA mpr

LAD mpr

LCX mpr

Review of volumetric dataset

• Curved reformatted images

• 3D reconstructions

• “IVUS” view

• Functional analysis

3D volume rendering

LAD crf

RCA crf

“IVUS” view

Anomalous Right Coronary Artery

Right Coronary Artery Catheterization Comparison

Cardiac CatheterizationCardiac Catheterization MSCTMSCT

Proximal LAD Coronary StentMSCT

Occluded LAD/RCAMSCT

3D Reconstruction Coronary bypass

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

48 year old man in ERsudden severe chest pain/dyspnea 2 hours duration

History of hypertension

Normal troponin

ECG shows LVH with strain

Aortic dissection

Non-coronary CV structures

• ventricles

• pericardium

• atria, atrial appendage

• pulmonary veins and arteries

• aorta

• valves

LV functional analysis

32 yo woman

3 yr hx

atypical

chest

pain

92 yo woman

Progressivedyspnea

Non-CV Structures

• Lungs and airway

• Mediastinum

• Bones

• Lower neck and upper abdomen

CIRCUMFLEX STENOSIS

Patients

Age % with CAD by

catheterizati

on

Arteries evaluat

ed

Uneval-uable

arteries

Sens-itivity

Speci-ficity

Negative

predictive value

Heart

rate(bpm)

Dosemodula

tion

Leschka 67 60 70% >1.5 mm 0 94% 97% 99% 66 No

Ropers 82 59 31% >1.5 mm 4% 95% 93% 99% 59 Yes

Fine 66 62 >1.5 mm 6% 95% 96% 95% No

Leber 59 64 49% All 7% 73% 97% 99% 63 Yes

Raff 70 59 54% All 12% 86% 95% 98% 58 No

Mollet 52 60 75% All 2% 99% 95% 99% No

WeightedAverage for all

61 54% 3% 90% 95% 98%

64 slice Computed Tomography - Sensitivity & specificity