figure 1 (a) calcium scoring adenosine infusionstress scansublingual ntg (optional) rest scan (cta)...

Figure 1 (a)

Calcium scor-ing

Adenosine infusion Stress scan Sublingual NTG(Optional)

Rest scan(CTA)

Scan range 4 to 5 minutes (until the end of stress

scan)

Retrospective ECG-gat-ing

2 minutes beforeRest scan

Retrospective ECG-gating

10 to 20 minutes interval

Option1. Static perfusion2. Dynamic perfusion

Option1. Retrospective mode2. Prospective mode3. High-pitch mode

Figure 1 (b)

Calcium scoring Rest scan(CTA)

Adenosine infusion Stress scan

Define scan range Retrospective ECG-gating 4 to 5 minutes (until the end of stress scan)

Retrospective ECG-gating

10 to 20 minutes interval

Option1. Static perfusion2. Dynamic perfusion

Option1. Retrospective mode2. Prospective mode3. High-pitch mode

Figure 2

20 40 60 80

Scan time (s)

150

300

En

han

cem

ent

(HU

)

– Artery

Time Attenuation Curve (TAC)

– Myocardium

Dynamic

Snapshotor helical

Dynamic

Snapshot or helical

Figure 2 (QR)

Figure 3(a)

Figure 3(b)

Figure 4 (a)

Figure 4 (b)

Figure 4 (c)

Figure 5

Step 1 Step 2 Step 3 Step 4 Step 5

Rest scan interpre-tation Image processing Quality assess Image interpretation Correlation with rest

scan

•Coronary artery stenosis and plaque analysis

•Best phases of motionless my-ocardium

•Epi-and endocar-dial contour (for dynamic study)

• Motion artifact• Beam hardening• Cone-beam• Stair-step• Image noise

•Transmurality (≥50% or <50%)• Reversibility• Myocardial thinning• Simultaneous vision of both stress and rest scans

Match perfusion defect and coronary artery le-

sion

Figure 6(a)

Figure 6(b)

Figure 6(c)

Figure 7

Stress Perfusion

Continuous adenosine infusion140ug/kg/min

4-5min

Start adenosine

Contrast bolus injection0.03-0.1mmol/kg

Rest Perfusion

Viability12-15 min interval

Contrast bolus injection0.03-0.1mmol/kg

5 min interval

Stop adenosine

survey Cine, etc

30min

Figure 8 (a)

Figure 8 (b)

Figure 8 (c)

Figure 9 Measurement of Relative Upslope for Myocardial Perfusion Reserve Index (MPRI)

Figure 10 (a)

Figure 10 (b)

Figure 10 (c)

Figure 10 (d) and (e)

Figure 10 (f)

Figure 11 (a)

Figure 11 (b)

Figure 11 (c)

Figure 11 (d)

Figure 11 (e)

Figure 11 (f)

Figure 11 (g)

Figure 11 (h)

Figure 11 (i)

Figure 11 (j)

Figure 11 (k)

Figure 11 (QR-h)

Figure 11 (QR-i)

Figure 11 (QR-j)

Figure 11 (QR-k)

Figure 11 (QR2-a)

LAD LCX

Figure 11 (QR2-b)

Figure 11 (QR2-c)

Figure 11 (QR2-d)

Figure 12(A)

Figure 12(B)

Figure 12(C)

Figure 13(a)

Figure 13(b)

Figure 13 (c)

Figure 13 (d)

Figure 13 (e)

RCA LAD

Figure 14 (a)

Figure 14(b)

Figure 14(c)

Figure 14(d)

Figure 14- QR-1 MR perfusion study, coronary CT angiography is

inconclusive study

QR-2 for figure 14-a

QR-2 for figure 14-b

QR-2 for figure 14-c

QR-2 for figure 14-d

Figure 15 (a)

Figure 15 (b)

Figure 15 (c)

Figure 15 (d)

Figure 16(a)

Figure 16(b)

Figure 17 (a)

Figure 17(b)

Figure 18 (a)

Figure 18 (b)

Figure 19(a)

Figure 19(b)

Figure 19(c)

Figure 19(d)

Figure 20 (a)

Figure 20 (b)