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