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CT / MR: Clinical Results and Usefulness for the Interventional Cardiologist
Jeffrey C. Hellinger, MDAssociate Professor of Radiology and Pediatrics
Associate Director of Advanced Cardiovascular ImagingStony Brook University School of Medicine
Stony Brook, NY USA
MDCT & MRI: Where We AreApril 29, 2010
ANGIOPLASTY SUMMIT TCTAP2010TRANSCATHETER CARDIOVASCULAR THERAPIES ASIA PACIFICApril 28 – 30 Seoul, Korea
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CVCT / CVMR: Clinical Innovation
§ Acquisition§ Transmission§ Interpretation / Post – Processing§ Storage and Retrieval
§ Diagnosis § Treatment planning§ Intraprocedural
§ Guidance§ Monitoring
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Advanced visualization techniques
Display Principal use
Advantages Disadvantages
MIP 2D •Structural overview
•“Slice” through dataset in axial, coronal, sagittal, & oblique proj•Real-time multiplanar interrogation•Depict small caliber structures•Depict lower enhanced structures•Communicate findings
•Anatomical overlap•Visualization degraded by high density (CT)/Intensity(MRI) structures•Loss of structural detail with ↑ slab thickness
VR 3D •Structural overview
•“Slice” through dataset in axial, coronal, sagittal, & oblique proj•Real-time multiplanar interrogation•Depict structural relationships•Accurate spatial perception•Communicate findings
•Opacity-transfer function dependent•Anatomical overlap•Loss of structural detail with ↑ slab thickness
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Advanced visualization techniques
Display Principal use Advantages Disadvantages
MPR 2D • Structural details• Quantitativeanalysis
•“Slice” through dataset in coronal, sagittal, & oblique projections•Real-time multiplanar interrogation•Simplify image interpretation•Single anatomical display
Limited spatial perception
CPR 2D •Structural details•Centerline display•Simplify MPR
Single anatomical displayLongitudinal cross-sectionalanatomical display
Operator dependent
Ray sum
2D •Structural overview •“Slice” through dataset in axial, coronal, sagittal, & oblique projections•Real-time multiplanar interrogation•Radiograph like display
Loss of structural detail with ↑ slabthickness
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CCT: Early Performance
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N = 5485% sent home from ER
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N = 39Sens = 89%Spec = 95%PPV = 94%NPV = 90%
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2008 2009 2010
mSv=3.2 mSv=1.3 mSv=0.5
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mSv=0.33
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mSv=0.22
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0
5
10
15
20
25
30
0 2.5 5 7.5 10 12.5 15 17.5
Freq
uenc
y
Arterial mSv WITH Weighting Factor
Histogram
Normal Fit(Mean=4.8900, SD=3.3217)
mSv: with age weighting Factor (4.9) Pediatric CCT at 80KV
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Arterial mSv WO Weighting Factor14
12
10
8
6
4
2
0
Kvp80 100 120
60% reduction
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Standard Spiral sedated
Flash Spiral not sedated
Standard Spiral not sedated
Flash Spiral ScanningPediatric motion simulation
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§ Improving plaque characterization§ Increasing spatial resolution § Simplifying workflow: improving efficiency§ Improving patient comfort
CVMR: Current Directions
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MRA NATIVE TrueFISP
Inflowing blood
Background
Inverted blood
• TI
selective inversion
imaging
Inversion ImagingInflowTI
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NATIVE TrueFISP
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Time Resolved MR Angiography
A B A B A B A Bl l l l l l
time
TA TB TA = NA x TR
TB = s x NB x TR
A B
with 0 = s = 100[ %]< <
“temporalresolution”
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TimCT Angiography
Conventional
easier workflow
TimCT
*Results may vary. Data on file.
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Time Resolved MR Angiography
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TimCT AngiographyContinuous Table move
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TimCT Angiography
LMU, Munich, Germany
Multi-step Angiography TimCT Angiography
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§ C – Arm CT § Interventional – MRI unit
The Interventional Cardiology Suit
§ Pre-procedural imaging§ Intra-procedural guidance§ Real – time monitoring
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Workflow 3D guidance in EP
syngo DynaCT Cardiac
syngo inSpace EP
syngo iPilot
syngo iGuideToolbox
3D acquisition Segmentation
3D Overlayon live fluoro Guidance
+
+
+ +
+
+
+
+
syngo DynaCT Cardiac
syngo inSpace EP
3D acquisition Segmentation
3D Overlayon live fluoro Guidance
syngo DynaCT Cardiac
syngo inSpace EP
3D acquisition Segmentation
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§ Noninvasive CVCT and CVMR are useful adjuncts to interventional cardiology practice § CCT has rapidly revolutionized clinical algorithms§ Latest 3rd Generation MDCT scanners will further advance clinical care. Lower radiation dose with high image quality is the goal. New DATA is necessary§ New advances in MRI: plaque characterization, MRA sequences will challenge MDCT§ Interventional Cardiology suit is actively changing: CT and MR multiplanar soft tissue and angiographic visualization capabilities
Conclusions
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Thank you for your attention
MDCT & MRI: Where We AreApril 29, 2010
ANGIOPLASTY SUMMIT TCTAP2010TRANSCATHETER CARDIOVASCULAR THERAPIES ASIA PACIFICApril 28 – 30 Seoul, Korea