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Ct Cardiac Nvmbr2012

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Erik R. Ranschaert, MD, PhD
Erik R. Ranschaert, MD, PhD

Presentatie gehouden nav de Regioavond Zuid over beeldvorming van coronaire aandoeningen - www.nvmbr.nl

1 de 73
Cardiac CT E. R. Ranschaert radiologie JBZ NVMBR Regioavond Zuid, 30-01-12
Inleiding ,[object Object],[object Object],[object Object],[object Object]
Techniek
Multislice CT - MDCT ,[object Object],[object Object],[object Object],[object Object]
MDCT voordelen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nieuwe generatie ,[object Object],[object Object],[object Object],[object Object],Dank aan Harefield Cardiac Course
Dual source CT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Dual source CT
“ Oude” generatie ,[object Object],[object Object],Dank aan James Carr
Nieuwe generatie Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply. Gibbons, R. J. et al. J Am Coll Cardiol 2009;53:54-70 320-slice
Dual source FLASH ,[object Object],[object Object]
cCT Angiografie ,[object Object],[object Object],[object Object],[object Object],[object Object]
cCT Angiografie ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply. Gibbons, R. J. et al. J Am Coll Cardiol 2009;53:54-70
[object Object],Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply. Gibbons, R. J. et al. J Am Coll Cardiol 2009;53:54-70 Myocardial Infarction Assessment by CT
Multislice CT (MSCT, MDCT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hoe?
Hoe wordt CT hart gemaakt?
Stair step artefact
 
Voorbereiding patiënt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bètablokkers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calciumscore ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scanprocedure ,[object Object],[object Object],[object Object],[object Object],[object Object]
Straling Onderzoek effectieve dosis ( mSv ) X-thorax 0.02 CT Abdomen 5.3 CT Chest 5.8 Chest, Abdomen and Pelvis 9.9 Thallium scan 20 CTC (virtual colonoscopy) 3.6 - 8.8 (gem. 5,7) CAG 2-10 Cardiac-CT angiogram 6.7-13
Oplossingen ,[object Object],[object Object],[object Object],[object Object]
Retrospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Siemens Flash ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prospectieve scantechniek ,[object Object],[object Object],[object Object],[object Object],J.P. Earls et al, Int.J.Cardiovasc.imaging, 2008
Welke scantechniek? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT, Halliburton SS et al., J Cardiovasc Computed Tomogr (2011)5, 198-224
Indicaties cCTA
Indicaties ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calciumscore ,[object Object],[object Object],[object Object],[object Object]
Beoordeling stenosen ,[object Object],[object Object],[object Object],[object Object],matige stenose significante stenose
Beoordeling stenosen
CTA met FFR meting ,[object Object],[object Object],All images courtesy of Dr. James Min . Fractional Flow Reserve
Beperkingen cCTA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostische accuratesse ,[object Object],[object Object],[object Object],[object Object],cCTA meest zinvol bij laag tot intermediair risico-patiënten cCTA Sens 96-99% Spec 88-91% NPV >90%
Klinische toepassingen ,[object Object],[object Object],[object Object],[object Object],cCTA meest zinvol bij laag tot intermediair risico-patiënten Sens Spec Fietsproef Stress-test 54% 77%
Strategie ,[object Object],[object Object],[object Object],[object Object]
Asymptomatische pt ,[object Object],[object Object],[object Object]
Beoordeling hartfunctie
Voorbeelden 64-slice
Voorbeeld 1 ,[object Object],[object Object],[object Object]
Voorbeeld 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
Voorbeeld 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],niet-stenoserende soft-plaque in ostium van circumflex
 
Voorbeeld 4 ,[object Object],[object Object],[object Object],[object Object]
Voorbeeld 4 ,[object Object],[object Object],[object Object],[object Object]
RCA reïnjectie via links
LAD soft plaque
Voorbeeld 5 ,[object Object],[object Object],[object Object],[object Object],[object Object],Ao Tr . pulm .
inter-arterieel verloop van RCA Ao asc tr pulm RCA
 
J.P. Earls et al, Int.J.Cardiovasc.imaging, 2008 Meisje 12 j oud, borstpijn en abnormaal ECG – 0,84 mSv
Voorbeelden dual-source
Normaal onderzoek flash mode Stenose?
 
Voorbeeld 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Voorbeeld 3
Aneurysma ostium RCA
 
Post-CABG ,[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
Voorbeeld na CABG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Ct Cardiac Nvmbr2012