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Coronary CT AngiographyCurrent applications in clinical
practice and promise for the future
Samuel Wann MD, MACC
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WISCONSIN HEART HOSPITAL
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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
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Axial Images
• Thin MIP
• Adjust window and contrast levels
• Scroll thru all images
• Select phase with least motion artifact
• Multiplanar reformats as needed
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Heart window
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Lung window Bone window
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Beam hardening “streak” artifact
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10% phase
20% 30% 40%
50% 60% 70% 80%
75%
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RCA mpr
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LAD mpr
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LCX mpr
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Review of volumetric dataset
• Curved reformatted images
• 3D reconstructions
• “IVUS” view
• Functional analysis
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3D volume rendering
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LAD crf
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RCA crf
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“IVUS” view
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Anomalous Right Coronary Artery
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Right Coronary Artery Catheterization Comparison
Cardiac CatheterizationCardiac Catheterization MSCTMSCT
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Proximal LAD Coronary StentMSCT
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Occluded LAD/RCAMSCT
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3D Reconstruction Coronary bypass
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35 yo woman in ER for atypical chest pain. Normal ecg & troponin
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48 year old man in ERsudden severe chest pain/dyspnea 2 hours duration
History of hypertension
Normal troponin
ECG shows LVH with strain
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Aortic dissection
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Non-coronary CV structures
• ventricles
• pericardium
• atria, atrial appendage
• pulmonary veins and arteries
• aorta
• valves
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LV functional analysis
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32 yo woman
3 yr hx
atypical
chest
pain
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92 yo woman
Progressivedyspnea
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Non-CV Structures
• Lungs and airway
• Mediastinum
• Bones
• Lower neck and upper abdomen
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CIRCUMFLEX STENOSIS
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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