Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Coronary CTA
1. Coronary CTA.
August 23, 2014.
POOL SOCIETY WEEKEND
JAYANTH H KESHAVAMURTHY, M.D.
ASSISTANT PROFESSOR OF RADIOLOGY
GEORGIA REGENTS UNIVERSITY.
2. 1. Question
An overweight man had CAC SCORE OF 500 last
year. He has made significant life style changes
since that time. He is now requesting a
reevalauation of his cardiovascular risk. What
would you recommend?
A. Coronary CTA with CAC score.
B. Coronary CTA without CAC score.
C. CAC score only.
D. Neither Coronary CTA nor CAC score.
9. USEFULNESS
Incremental prognostic information.
Independent risk assessment over
Framingham risk evaluation alone in patients
without established CAD.
10. How is it calcium score calculated?
Agatston score is widely used.
It is area based.
Others have used volume and mass
11. Coronary calcification is pathognomonic of
atherosclerosis and represents an attempt at
healing.
12. Typically pixels with >130 HU (?90HU )are considered
to represent calcification.
Area of the lesion is multiplied by a coefficient.(1-4).
Agatston scores of all lesions are summarized to yield
the total Agatston scores per vessel and per patient.
13.
14. FALLACY
Does not detect non-calcified atherosclerotic
plaque.
Cannot accurately assess presence or absence
of CAD.
Gives a crude estimate of atherosclerotic
burden.
15. CC Scores are lower in African American men than in
Caucasian men.
Interscan reproducibilty is substantially better for high
calcium scores.
Interscan variability is rather high. So follow up testing is
not recommended.
16. Calculate calcium score from CCTA from dual energy in
future.
Using iterative reconstruction to reduce dose in future.
18. 2. Regarding contrast protocol for
performing pulmonary vein imaging
which one of the following is true.
A. Identical to coronary CTA.
B. Requires higher contrast flow rates.
C. Bolus tracker should be placed at level of left
atrium.
D. One should not consider using prospectively
ECG triggered CT.
20. TECHNIQUE
Prospective or retrospective ECG gated study .
ROI is left atrium.
No beta blocker needed as we are not
assessing coronary arteries.
Patient frequently in A.fib.
21. ASSESSMENT
LA size.
Anatomy of pulmonary veins- numbers, variations.
Ostial size is measured in Mid diastole to guide catheter
sizes for EP ablation. Measured 1 cm from ostia in
orthogonal reconstructed view.
LAA thrombus vs mixing artefact is differentiated by
repeat CT 45-60 seconds later.
Relationship to esophagus- VR image provided.
22. VARIATIONS
LA Area – 11- 33 cm2.
Normal 2 left and 2 right PV.
Variations- 1 (common) left and 2 right PV.
-2 left and 3 right PV ( separate
ostia for middle lobe.)
30. IMPORTANCE
To look for variations and assist in EP
procedures like BIVICD Placement.
Also not to falsely confuse a vein as a patent
coronary artery.
43. •Right ventricular dysfunction
• Severe dilatation and reduction of RV ejection
fraction with little or no LV impairment
• Localized RV aneurysms
• Severe segmental dilatation of the RV
•Tissue characterization
• Fibrofatty replacement of myocardium on
endomyocardial biopsy
•Conduction abnormalities
• Epsilon waves in V1 - V3.
• Localized prolongation (>110 ms) of QRS in V1 - V3
•Family history
Major Criteria
44. •Right ventricular dysfunction
• Mild global RV dilatation and/or reduced ejection
fraction with normal LV.
• Mild segmental dilatation of the RV
• Regional RV hypokinesis
•Tissue characterization
•Conduction abnormalities
• Inverted T waves in V2 and V3 in an individual over 12
years old, in the absence of a right bundle branch
block (RBBB)
• Late potentials on signal averaged EKG.
• Ventricular tachycardia with a left bundle branch
block (LBBB) morphology
• Frequent PVCs (> 1000 PVCs / 24 hours)
•Family history
• Family history of sudden cardiac death before age 35
Minor Criteria
45. ARVD diagnostic criteria
There is no pathognomonic feature of ARVD.
The diagnosis of ARVD is based on a
combination of major and minor criteria.
To make a diagnosis of ARVD requires either
2 major criteria or
1 major and 2 minor criteria or
4 minor criteria.
46. ARVD
Genetic Cardiomyopathy.
Fibro fatty replacement of RV myocardium.
LBBB
Autosomal dominant with incomplete
penetrance and autosomal recessive
inheritance.
Positive family history in 30-50%.
83. 11. Using bolus tracking which is ideal
attenuation threshold for performing
coronary CTA.
LOCATION THRESHOLD
A. Descending Aorta 400 HU
B. Ascending Aorta 300 HU
C. Descending Aorta 350 HU
D. Ascending Aorta 150 HU
87. 12. Second most common cause of
sudden death?
A. Hypertrophic cardiomyopathy.
B. Anomalous origin and course of
coronary arteries.
C. Arrhythmia.
D. Coronary dissection.
99. 14. Patient has had CABG, LIMA to LAD and SVG to OM. All the
following are true regarding coronary CTA except
A. CCTA has poor accuracy in assessing disease within
bypass grafts.
B. Radiation exposure is higher than in a CTA
evaluating native vessels.
C. His native coronaries will likely be heavily calcified
which may potentially limit diagnostic accuracy.
D. Routine surveillance of bypass graft patency in
asymptomatic is not considered appropriate.
100. A. CCTA has poor accuracy in
assessing disease within bypass
grafts.
112. 16. Name the artery arising from circumflex
coronary artery. Study performed prior to
RF ablation.
A. S shaped SA nodal artery.
B. Obtuse marginal artery.
C. AV nodal artery.
D. Acute marginal artery.
128. 20. What surgery did this patient have?
A. ASD closure device.
B. Mitral valve replacement.
C. LA appendage clip.
D. Tricuspid valve replacement.
