cord comp 2015.ppt

7/21/2019 cord comp 2015.ppt

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EXAMINAREA CT A

CORDULUI

Dr. SIMONA MANOLE

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Explorarea CT cardiaca -TEHNICA

Revolutionarea explorarii cardiace

prin aparitia scanner ulti-slices!cupe achizitie simultana a mai multorsectiuni acoperirea unui volum mare intr-un

timp dat, mai scurtAl"orit de reconstructie aia"inilor sincroni#ate la E$%

sincroni#are la inceput prospectiva,iar mai nou, retrospectiva ++

Re#olutie teporalade ordinul a &'()* + ,)* s

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Al"oritul de reconstructie

Sincronizare prospectiva

Declansarea achizitiei la unmoment de timp de!nit, dupa!ecare unda " # ima$ini adiacente in timpul!ecarui ciclu

Doza % pacient, numar desectiuni si timp de reconstructiereduse

Sincronizare retrospectiva

"econstructie helicoidalacardiaca multi slicesReconstructie la diferite pozitiisi in orice faza a cicluluicardiac , a imaginilor ,obtinute printr-o achizitie

helicoidala

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- 5 -

P

Q

R

S

T

R Peak 70% default

Phase Location is defined

with respect to the Center

of recon window as a

percentage distance

between adjacent Rpeaks.

Reconstruction !indow"

& a#a . tipul raportat la unda R /0 - ,001 2

'aza se e#prima in procente (ata de intervalul de timp dintre )

unde "

'aza in (unctie de (ereastra de reconstructie

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scanner MD*

Evolutie te3nolo"ica

RE4OLUTIE spatiala teporalas

MD* /-/,)0mm )01

MD* / 1,20 mm /0-/33

MD* 1, mm 20-/0 MD* )0%4)1 1,0- 1, mm /40-/20

*O"ONA"O5"A'IE 1,)mm )1

Aportul 5CT 6& cupe

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D S

FOV

NB

RV

A 6eun 7(ara ca(eina8 Evitarea oricarui efort cardiovascular

Abord venos Plasare electrozi de EKG

Oxigen !"#in

+%- nitro$licerina ) doze su9lin$ual inainte de *oro-* + *

+%: 9eta-9locant

7re"atirea pacientului Li$htspeed 5E

DII , V4 et V5

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serie de repera8Ac3i#itie nativa

;olum cord 'O; adaptat )0 cm imp de rotatie a tu9ului minimum % 5atin$prospectiv

colimare de ),0 mm pana la 4mm intercalare 01< 5atin$ prospectiv parametri = Lo? dose @ /)1 ;B /11mAs

reperajul morfologic al cordului, pregurarea volumului

7rotocol 9 Li$htspeed 5E DM

toracic

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# 1, mm 'O; adaptata )0 cm imp de rotatie a tu9ului min. ;olum in 6ur de /0 - )1 cm

imp de apnee 0 - /1 sec

Sincroni#are $& ' gating retrospectiv

reconstructie fina(intercalare 0 - 50%

7rotocol9 Li$htspeed 5E

*O"O-*

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7rotocol de in8ectare9

In6ectare in 9olus :i;a#icCd* iodat /1ml % 1 mlSer !ziolo$ic 1 ml % 1 ml

<cop9 evitarea arte(actelor din ;*I ;*S, opaci!ere

selectiva a ;S

olus tri;a#ic Cd* iodat /11 ml cu -0 ml%sCdc iodat diluat 1ml diluat

Ser !z. 1 mlOpaci!care ma#imala a cavitatilor stan$i

moderata a cavitatilor drepte

De9it -0 ml%s

De9it -0 ml%s

*oncentratie in iod 401 mmol iod%ml minim11 mmol iod%ml +++

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<erie tardiva70 - /1 min dupa Ii;8de tip = lo? dose @

/,)0 mm alaturate , camp mic de )0 cm imp de rotatie tu9 minim ;olum cord Carametri = Lo? dose @

priza de contrast tardiva a miocardului in(arctizat B=in mozaic@ in miocardita, = in 9andaF in IM etcG.

7rotocol DM toracic

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examen diagnostic al tuturor structurilor toracice :

- Pleura- Plaman

- Artere pulmonaire- Aorta- Artere coronare- iocard

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ECG Trace

-/ 0 1 1 1

-/ 1 1 1 1

-0 1 1 1

1

0 1 1 1

/ 1 1 1 1

/ 0 1 1 1

) 1 1 1 1

) 0 1 1 1

4 1 1 1 1

4 0 1 1 1

Time (ms)

A

m

p l i t

E * 5

C e a A

"itm cardiac 20-31 9pm

Mod de reconstructie

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'azele de retro-reconstructie

$%% &R R

' Posibilitate de retro reconstructie a i#aginilor in orice #o#ent al

ciclului cardiac (faza) o data ce a fost realizata ac*izitia

' Per#ite ca+tura #o#entelor sau fazei, de i#obilitate a cordului

in intregi#e sau in +arte

' fazele in diastola --- ( ./ ' 0/& din / in /& sau $%"$%)

Exe#+lu/ &

~ Sistla

1% &

~ Diastla

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2alitatea i#aginii 3 valva cardiaca (burst -)

)0%7*% )*%

0% &1% &

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"ezolutie temporalainadecvata Miscari non cardiace7respiratie8

'luu cinetic al

arterelorcoronare

Arte(acte (recvente

"ezolutie temporalainadecvata 7structuri inmiscare

= 9lac circulararti(act @

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decala6 de (aza in MC"

si 4D prin de(ect alal$oritmului dereconstructie 7aritmie, ES;etcG8

= phasemisre$istration @

A*'A

A*'A

ahicardie la !nalul achizitiei

al$oritm inadaptat

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Cd* neuni(orma arte(acte in 9anda

datorate opaci!erii ;*S saua unei structuri metalice7Cace Maer8 z$omote de (ond

Hetero$enitate =in9anda @

Streain$

Diluarea pro$resiva a prod. decontrast in cavitatile drepte

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'actori limitatori

arte(acte de miscare cardiaca sau nu 7respiratie8 ciclu cardiac nere$ulat, tul9urare de ritm

rezolutie in contrast 7mor(otipul pacientului, iradiere..8 arte(act de duritate a (asciculului metal 7CM, clipuri8, calci!cari

rezolutie spatiala e#celenta 7G.. dar coronarele distale milimetric

Re#olutie teporala

Re#olutie spatiala

Re#olutie in contrast

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Achizitiesincroni#are E$%

Recon

trans;er autoatic

Post procesare

Re;orat ulti ;a#e

Anali#avase

Ar:orescenta 'D 5R 'D

Re;orat

Re#ultat pacient

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!st !rcessi"#

$ati%e a&ial ima#es "eed t

'e prcessed t #et (ull

ad%a"ta#e ( ac)uired data

4ransfer data to

4*e 5or6 Station

GE Advantage 5indo7s

4D MIC

"e(ormat

"e(ormata# lun$ si scurt

Analiza (unctionala

Analiza vase ;olume "enderin$

7O<T7ROCE<ARE IMA%INI

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- Ster$erea automata a structurilorcardiace si a miocardului- *oronare in MIC 4D

- reconstruirea structurilor deintensitate ma#imala- aspect pseudo an$io$ra!c

- limite structuri de inaltadensitate 7calci!cari8

'D MI7

+/-

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"econstructie 4D astructurilor cardiace, sau deinteres si a coronarelor

- Atri9uirea culorii in (unctiede densitatea tesuturilor- Atri9uirea unei

transparente !ecarei(erestre de densitate- Ale$erea pra$ului 7aparitia% disparitia de vo#el8

5olu Renderin"

++

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- "e(ormat multiplanarMC" % MC;"*ur9iliniuO9lic % Sa$ital % *oronal

- )D sectiuni +%- $roase- MIC % minIp % ;"- 9aza analizei pt dia$nostic

- mod multi(azic ++++

Re;orat M7R

++++

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Coronary Vessel Analysis

- protocoale dedicate - "3ida8

anatoic- reconstructie cur:ilinieautoata- cuanti=carea luenuluivaselor /steno#e( anevris2- anali#a placilor ateroatoase

Anali#a vasculara

+++

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Reconstructia M7R dupaaxele de re;einta

- reconstructie automataAM%AM;%AMO

7a# mic%a# mare vertical% a# mareorizontal%*8 - necesara pt. analiza(unctionala

- standardizare

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Anali#a unctiei Cardiace /Optional2

& Anal>se des ventricules "auc3e et droit /5% et 5D2

5olue =n de s>stole 5% ? 5D( volue en s>stole

tardive raction d@8ection du 5% avec taux d@8ection( taux de

replissa"e

Mo:ilit de la paroi du >ocarde( paisseur et asse>ocardiBue

& Dtection autoatiBue des contours

& ore Intuitive 'D des ventricules

& D>naiBue cin du petit axe

& Rapport cliniBue

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7atolo"ie

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Anoalii anatoice

con"enitale a arterelorcoronare

CT coronarian

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Reteaua coronariana 9

Coroana anterioara 9

in santul inter-ventricularconstituita din ramuri ale *S si *D

- C< trunchi comun %inter-ventricularaanterioara, terminindu-se in recurentaape#ului, intalneste pe (ata dia(ra$maticaa inimii inter-ventriculara posterioararamura a 9i(urcatiei terminale a CD

Coroana posterioara 9

in santul A-; - CD si ramura sa terminala retro-ventriculara

- C< trunchi comun % circume#apropriu zisa % circume#a terminala

!" # din cazuri : %& dominanta

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Anoalii de eer"enta din aorta9 emer$enta separata a I;A si circume#ei

variatiuni multiple

caracter pato"en depinde de traiect 9- posterior de aorta sau anterior de AC (ara consecinta clinica

ma6ora- raiect intre radacina Ao si AC complicatii de tip ischemiemiocardica prin compresiune a arterei intre M; 7fenomene de

forfecare' compresiune la efort prin (uxului sanguin ) sau tul9uraride ritm chiar letale 7moarte su9ita8

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*S din sinus anterior dr cu traiect interarterial

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CD

CD

C<

C<

A7Ao

CD

A7A7

AoAo

CD

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- sdr land-Jhite-5arland8, rar *D sau I;A.

viata (etala oK

la nastere IM 7 dim pres AC8

C/<2 din A7

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7unte iocardica - m*ocardiobridge

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cmu"icare a"rmala i"tre arterele cr"are si ca%itatile

cardiace8 (VD 9 AD 9 S2 9 AP)

Dilatatie coronariana traiect sinuos, -"' furt coronarian si isc*e#ie

istule coronariene

+%- shunt S-D si drena6 in cavitatile drepte

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Ateroato#a

CORONARO CT

D ! i= l i= il i

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Detectarea ! cuanti=carea calci=carilor coronariene

Calciu score 7*S8E* score A$atston

mi6loc de predictie a riscului cardiovascular

detectarea pacientilor asimptomatici dar cu incarcareateromatoasa crescuta

'actori de risc conventionali 7'ramin$ham8 - istoric (amilial- dia9et

- LDL colesterol crescut- HDL colesterol scazut- ta9a$ism- HA- o9ezitate % inactivitate !zica

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incarcare calcica +++I;A

calciu coron 1*alci!cari I;A si *#

Spot calcic *D

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C<

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C<

C< si steno#a coronariana Corelatie edie intre C< crescut si steno#a an"io"ra=ca

C< si dia"nostic di; de durere toracica :a#at pe o inalta 57N a C< eliina o :oala ateroatoasa

coronariana in a:senta calci=carilordar un C< 0 nu este sinoni cu a:senta steno#ei

C< si depista8ul :olii ateroatoase

rata evenientelor anuale/Decesul si IM2

0,1 pt un C< de 0F,1 pt C< de ,-GG

&,1 pt un C< de ,00-&00&1 pt un C< de &00

1< din evenimente se produc la pacienti cu scor inalt 7)0< din popula

CORO <CANNER

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CORO-<CANNERsensi9ilitate 22 - 0< si speci!citate 2 - 3<

;CN crescuta;CC - se$mente nonanaliza9ile 7= 9loomin$ @ in

caz de calci!cari, decala6 de (aza8

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Inalta ;CN scannercardiac

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<tudiul le#iunilor ateroatoase coronariene

- nr. arterelor atinse 7uni, 9i, - tri tronculare8- severitatea leziunilor 7stenoza, ocluzie +++8

- tipul si lun$imea leziunilor, diametrul de artereilezate

- colaterale- pat vascular in aval

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Jlooin" KKK

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rom9oza a se$mII coronara

dreapta

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rom9oza *#pro#

7laca de atero

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7laca de atero

Copo#itie 9- lipidica + .'- /0 12)

- trom9%moale 9 *0-60 UH- intermediara sau !9roasa *0 -,F0 UH- calci!cata ,F0 UH

*az clinic

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03 ani

- *AD % 9. coronariana AS

- An$ioplastie 9i tronculara

*az clinic

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St semni!cativa aI;A pro#

Claca mi#ta

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* li tii IM

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- "uptura septala 7*I;8 septo-apical

- "uptura ;S 7perete li9er8 hemopericard, (alsanevrism

- Anevrism ventricular S

- rom9 intra-ventricular S

- Insu( Mi acuta prin ruptura de pilier

*omplicatii IM

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- AS

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Anevrisme *D si *# (araateromatoza

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Mar(an. A*D chir entall cu

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reimplantare de coronare siinlocuire valvulara aortica

CT di

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ponta8e ! stenturi

CT cardiac

C3irur"ie de revasculari#are coronara

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7er;orante scanner cardiac

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stent coronare

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Stent

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trom9oza "e-stenoza

Normal = loomin$

@

CT cardiac

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cavitati cardiace( pericard

valve

CT cardiac

DA5D

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DA5D

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CT CARDIAC - 7roceduri

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CT CARDIAC 7rocedurielectro=#iolo"ice

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D

S

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Cericarditaconstrictiva post

*alci( pericardice post-

K

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C *

ilant pre ponta6 coronarian

u cardiace

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T&:T&:

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7*H*8

valve cardiace

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".A.*.d 4

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$rad 4

Aorta ascendenta

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Aorta

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Conclu#ie

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tehnica promitatoare in curs de dezvoltare

inovatii ++ optimizare ++

indicatii tot mai lar$i+++

Avanta6e ;olume 4D Ima$istica intra et e#tra-lumenala non invaziva "eprsentations multiples

TDM coronarian

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Indicatii scanner cardiac

In completarea unei coronaro$ra!i di!cile +3% ' segment

proximal 45A ' %& ' %x, disectie post-coro, anomalii de implantare,stenoze, caracterizare a placii, 4 coronare sanatoase ;ariante anatomice %mal(ormatii cardiace

Cericardita *ontrol postop Detectarea stenoze, placi AS 7*A%*S8 sau e#cluderea 9oliicoronariene ilant inainte de tt. electro!ziolo$ic

ilant anatomic inainte de pacemaer 4c ilant e#tensie loco-re$ionala si $enerala a unei tu cardiace

cord comp 2015.ppt

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