Coronary Atherosclerosis with Multislice CT: What is beyond coronary atherosclerosis

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Coronary Atherosclerosis with Multislice CTWhat
is beyond coronary atherosclerosis
Christoph R Becker
Radiology
Konstantin Nikolaou
Tobias Jakobs
Bernd Wintersperger
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Calcified Noncalcified Plaques
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CTA Inclusion Criteria

• Asymptomatic patients
• CV risk factors
• Positive calcium scan
• Symptomatic patients
• No CAD history
• Atypical chest pain
• Inconsistent stress test
• 100 mg CaHA

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Patient Preparation

• ??-blocker
• R/o Contra indications
• Informed consent
• Metoprolol
• 50 - 100 mg orally
• 30 - 90 min prior
• HR 50 - 60 bpm

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Coronary CTA Parameters

• Testbolus 20 ml _at_ 4 ml/s
• 120 ml (300 mg iodine) _at_ 3 ml/s NaCl 60 ml
  _at_ 3 ml/s
• 500 ms gantry rotation
• 120 kV, 300 mA
• 4 x 1 mm collimation
• 3 mm/s table feed
• 40 s breath hold

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ECG Tube Current Modulation
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CTA Radiation Exposure
mSv
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Left Coronary Artery (RAO)
Coronary Angiography
MDCT VRT
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Right Coronary Artery (LAO)
LAO 60
Coronary Angiography
MDCT VRT
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Detection of Coronary Stenoses
MDCT
Coronary Angiography
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Coronary StenosesCTA Angiography
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CTA Limitations

• Artifacts
• Cardiac motion
• Breathing
• Blooming
• Poor opacification
• Small vessel

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Solutions

• Rot. time ??blocker
• Cardiac motion artifacts
• Scan times
• Breathing artifacts
• CM utilization
• Slice thickness
• Small vessels
• Blooming artifact

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16 Detector Row CT Angiography

• 200 ms
• 9 Lp/cm
• 0.8 mm
• 20 s breath hold
• 60 ml CM

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Coronary Plaque Imaging
MDCT
Coronary Angiography
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Non Calcified Plaque Density
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Coronary Atherosclerosis
Intimal Thickening
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Atheroma

• 38 YOM
• Non specific complain
• Risk Factors
• Cholesterin
• Smoker
• No calcium

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Calcified Nodule

• 62 YOM
• Suspicion of CAD
• 12 mg CaHA

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Fibrocalcified Plaque
100 HU
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Thrombus

• 42 YOM
• Epigastric chest pain
• Risk Factors
• Hypertension
• Smoker
• No calcium

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Thrombus
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Acute Posterior Wall Infarction
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Myocardial Infarction Scar
anterior LAD
posterior RCA
lateral LCx
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CT Plaque Density
p 0.018
50 12 HU
89 31 HU
Lipid
Fibrose
Lipid
Fibrosis
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CTA vs IVUSSchröder Heart 200185576
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Carotid AtherosclerosisEstes 1998 J Cardiovasc
Surg 39527
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Plaque DistributionLeber 2001 Circulation
Myocardial Infarction n 12 122 Plaque
Stable Angina n 12 135 Plaque
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Summary

• Detection of stenoses
• Calcium
• Small vessels
• Characterization of plaques
• Identify atheromas
• Follow up under therapy
• Acute coronary event
• Intracoronary thrombus
• Myocardial infarction

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