cardiac ct how i do it september 2011
DESCRIPTION
CT cardiaccoronary how to readcoronairsclerosisatherosclerosisradiologyTRANSCRIPT
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