cardiac ct how i do it september 2011

Coronary CTHow I do it

Patient selection

• Risk factors• Medium - high risk -> angio suite• Low - medium -> CT (exclude

disease)

Patient selection

• Pre-op evaluation• Post CABG

Calcium score

• Risk calculation (MESA %)• Check RCA motion• 1 minute• Stop if zero or high

Pro / retrospective

• Prospective - SAS - lower dose– sharper image

• Retrospective - higher dose– function / motion

Checklist

• Skin / breast• Bone• Lung• Mediastinum• Abdomen

Checklist

• Skin / breast - mass• Bone - fracture / lesion• Lung - node• Mediastinum - hernia• Abdomen - organs, mesentery, fluid

• Heart

Breast / skin - Biopsy

Harish, Radiographics 2007

Bone - MRI

radiology.casereports.net

radiopaedia

Lung

• <4mm = 0%• 4-7mm = 1%• >8mm =

15%• >20mm =

75%

Stacy, Radiographics 2010

Fleischner < 8 mm

• Solitary node• New• No history of cancer• Smoker?• CT: 6 / 12 … months

Mediastinum

• Hernia

Pickhardt, AJR 2011

Mediastinum

• Lymph node

Koyama, Radiographics 2004

Abdomen

• Mesentery

Lucey, Radiographics 2005

Abdomen

• Fluid

Lucey, Radiographics 2005

Go with the flow

• VC - RA - RV - PA• PV - LA - LV - Aorta

Heart 1

• Vena cava - reflow• RA - abnormal pulmonary vein /

ASD• RV - VSD• PA - enlarged, embolus

Vena cava

• Reflow

Hani, AJR 2002

Martinez - Jimenez, Radiographics 2010

Martinez - Jimenez, Radiographics 2010

Left vena cava to LA

Right Atrium

• ASD

emedicine

Right Ventricle

• VSD

Khanna, AJR 2004

Pulmonary artery

• Embolism

Wittram, Radiographics 2004

Pulmonary artery

• Embolism

Wittram, Radiographics 2004

Pulmonary artery

• Embolism

Wittram, Radiographics 2004

Heart 2

• Pulmonary veins - stenosis / anomaly

• LA - thrombus (auriculum)• LV - infarct, aneurysm• Aorta - diameter• Valves - mass, calcium• Pericardium - fluid, thick

Pulmonary vein

• Stenosis

Cronin, AJR 2004

Pulmonary vein

• Stenosis

Cronin, AJR 2004

Pulmonary vein

• PV to VC

Cronin, AJR 2004

Pulmonary vein

• PV to VC

Cronin, AJR 2004

Left Atrium

• Membrane

Dillman, AJR 2009

Left Atrium

• Membrane

Dillman, AJR 2009

Left Atrium

• Thrombus

Dillman, AJR 2009

• Myxoma

Left Ventricle

• Aneurysm

Bruzzi, AJR 2006

Left Ventricle

• Thrombus

Bruzzi, AJR 2006

Aorta

• Diameter• Wall

Cronin, AJR 2004

Aorta

• Diameter• Wall

Cronin, AJR 2004

Valves - normal Aortic valve

Vogel, Radiographics 2006

Bicuspid Aortic valve

Vogel, Radiographics 2006

Calcified Pannus

Vogel, Radiographics 2006

Calcified Pannus

Vogel, Radiographics 2006

Pericardium

• Thin

Wang, Radiographics 2003

Pericardium

• Thin

Wang, Radiographics 2003

Pericardium

• Fluid

Wang, Radiographics 2003

Pericardium

• Fluid

Wang, Radiographics 2003

Coronary

Coronary

• Anatomy• Dominance (inferior wall)• RCA• LM• LAD• CX

LAD

RCA Cx

Normal

Sundaram, AJR 2009

Malignant

Sundaram, AJR 2009

Malignant

Sundaram, AJR 2009

A P

Benign

Sundaram, AJR 2009

Bridging

Sundaram, AJR 2009

LAD - septum

RCA - inferior

CX - lateral

Vascular territory

LAD

RCA

CX

LAD

RCA

CX

LAD

RCA

CX