CT CARDIAC

•Dr. Loredana Popa

Anatomie
 Anatomie

CD

CX
IVP CX
RPL
CD
IVP
RPL
IVP
RPL

Dominanta dreapta- RCA Dominanta stanga -CX Codominanta- CX, RCA

 Introducere

• Coronarografia invaziva- gold standard

• CT cardiac
 metoda alternativa
 neinvaziva
 timp de achizitie scurt
 rezolutie spatiala si temporala buna
 CT cardiac - indicatii

 Boala coronariana ischemica

Criterii de includere- excludere

 simptomatici
 probabilitate pretest mica/medie pentru boala
coronariana
 factori de risc
 fara modificari EKG, teste enzimatice negative, test de
efort negativ/neconcludent
 suspiciune de anomalie coronariana
 CT cardiac - indicatii

• Excludere placi ATS – suspiciune de BCI

• Analiza paci ATS: localizare, compozitie, grad de
stenoza
• Anomalii ale arterelor coronare
• evaluarea stenturilor endovasculare la pacientii cu
suspiciune de restenozare
• Analiza by-pass
• Evaluare stenoza de valva aortica- TAVI
• Vene pulmonare
 MDCT Cardiac

Scanner Used Siemens Sensation 64

KV/ mAs 120/ 850

Detector Collimation (mm) 0.6

Slice thickness (mm) 0.75

Pitch 0.2

Reconstruction interval 0.4

Image order (acquisition) Cr-ca

Oral contrast N/A

80ml Omnipaque 350

IV contrast volume and type 40 ml ser - chaser
Injection rate 7ml/sec
bolus tracking
Scan delay (sec) 6 sec delay
3D technique used VRT/ MIP
 CT cardiac- protocol

• Pregatire pacient: B blocant!

• Sincronizare EKG
100 %

25 % 70 %

Sistola Diastola
 CT Cardiac

• Topograma (512 mm)

• FOV (180 mm)
• TAP→ diafragm
• Cranio-caudal
 CT cardiac- protocol

• Nativ- Scor de calciu- AGATSTON

 CT Cardiac

• Trigger Ao asc=100 HU
• Debit= 7 ml/s
• Cor CTA= 64x0,6 mm
• EKG gating
• Timp : 20s

achizitie
• Artefacte
vizualizare multi faza MPR
analiza functionala

coronary mapping 3D
MIP, VRT
 CT Cardiac

•ax scurt • 2 camere •4 camere

 CT Cardiac

• corect • incorect
CT cardiac -placi ATS

placa ATS complet calcificata

CT cardiac -placi ATS
 CT cardiac -placi ATS

placa ATS moale

 CT cardiac -placi ATS

placa ATS mixta

CT cardiac -placi ATS
 CT cardiac -anomalii

• Origine
 CT cardiac -anomalii

•a •b
CT cardiac -anomalii

•PLV

•PD
A

•L
A •L
M
D
•L
A
D
CT cardiac -anomalii

•TA
P •TAP

•Arterial
branch
 CT cardiac -
anomalii

• punte
miocardica

•D1
 CT cardiac -
anomalii

•Aorta

LM
CT cardiac -anomalii
CT cardiac -stent
CT cardiac : By-pass
CT cardiac –studiu functional
Caz 1
• ♂, 60 ani, rasa alba
• Scor de calciu 28.1
(5.40mg/cm3)

• percentilele 25 si 50
Caz 2
C.G. sex ♂
73 ani
Stenoze semnificative tricoronariene
Scor de calciu 2129,5 (> percentila 95
pt rasa, varsta si sex)
Fractie de ejectie 41%.
CD
Caz 3
•Controlul bypass-ului
STENOZA DE VALVA AORTICA-TAVI
TAVI
 Concluzii

CT cardiac:
 metoda neinvazica eficienta in explorarea patului
coronarian
 anatomie
 placi ATS
 stent
 by-pass
 explorari functionale( fractie de ejectie; motilitate parietala)
 TAVI
Va multumesc.