THE STANDARD NORMAL CARDIAC CT REPORT: BACKGROUND, RATIONALE & BASICS
Modern Cardiac CT reports, especially Cardiac CT Angiography (CCTA), should follow established guidelines and criteria that ensure accurate and standardized reporting. These criteria focus on evaluating
STATE OF THE ART PHOTON COUNTING CT
Coronary stent imaging
Ex. 768x768 matrix, proximal LAD coronary stent (size 2.5mm) with 0.2mm/0.1mm . Kernel Bv84. Maximum QIR 4. Mild intimal hyperplasia and jailing of the diagonal branch.
SOA PCCT - ULTRA-HIGH RESOLUTION OF pLAD STENT
Astonishing evaluation of coronary lumen inside a stent with max spatial resolution achievable in CT with DS-PCCT Technology (high res mode: 100 micron).
Ex. from axial 1024x1024 matrix (FOV 100mm) 0.2/0.1mm;). Kernel Bv68. QIR 4.
STATE OF THE ART PHOTON COUNTING CT
Heart Valve Imaging (1)
Ex. 512x512 matrix CARDIAC CT of a Aortic Valve with 0.4mm/0.2mm, temp. res. 66ms. Kernel Bv44. QIR 4. Easy to see iodine distribution dishomogeneity between supra-aortic and infra-aortic plane.
CARDIAC PHOTON COUNTING CT
Coronary stent imaging is the most difficult task for CT stents are small, metallic and moving with the heart.
Ex.: 768x768 matrix - proximal RCA coronary stent (n. 2 stent overlapping) with 0.2mm/0.1mm. Kernel Bv72. Maximum QIR level 4.
STATE OF THE ART PHOTON COUNTING CT
Cardiac CT - Iatrogenic IAD post trans-septal Mitral ViV - 4D-dynamic assessment of shunt
Ex. 4D-cine-MPR/MIP 512x512 matrix (FOV 140mm) CCT (0.2/0.1 and 0.6/0.4mm). Kernel Bv60/36. QIR 4.
SOA PCCT - FUNCTIONAL IMAGING/IAD
Maximum level of spatial resolution achievable in CT with Dual Source Photon Counting CT Technology (Quantum HD Cardiac: 100 micron) the semeiology is completely different.
Large IAD with dynamic behavior of the issue and flow from LA to RA.
CARDIAC PHOTON COUNTING CT
Coronary stent imaging is the most difficult task for CT stents are small, metallic and moving with the heart.
Ex.: 768x768 matrix - proximal RCA coronary stent (n. 2 stent overlapping) with 0.2mm/0.1mm. Kernel Bv72. Maximum QIR level 4.
SOA PCCT - 4DVR Coronary Artery
What is the standard of care for cardiac/coronary imaging?
This time just a nice movie to look at. 4DVR of an LAD running beyond the apex of the Left Ventricle.
STATE OF THE ART PHOTON COUNTING CT
Coronary stent imaging (5)
Ex. 1024x1024 matrix (FOV 140mm) CARDIAC CT of a proximal RCA coronary stent (n. 2 stent overlapping; stent size 3.5mm) with 0.2mm/0.1mm (thickness/increment). Kernel Bv72. QIR 4.
STATE OF THE ART PHOTON COUNTING CT - What can CT do for you and your patients?
4D-VR and multi-axis MPR of severely degenerated and stenotic aortic valve (bicuspid; rare L-R).
Ex. from axial 1024x1024 matrix; source images 0.2/0.1mm; thickness/increment. Kernel Bv48-60. QIR 4.
STATE OF THE ART PHOTON COUNTING CT
Coronary artery imaging is very important in clinical practice for diagnostic and therapeutic purposes.
Ex. 768x768 matrix CCT of a LAD with 0.2mm/0.1mm. Kernel Bv72. QIR 4.
State fo the Art CCT - 4D cineMPR of Thoracic Aorta in para-sagittal view in 4 different conditions from normal to severely diseased/type B dissection.
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SOA PCCT
PCCT is the new standard of care for comprehensive cardiac assessment
Very diseased LAD with a proximal stenosis easily quantified + perfusion map.
Ex. 1024 matrix (FOV 100mm) Quantum HD Cardiac (0.2/0.1mm; thickness/increment). Kernel Bv72. QIR 4.
SOA PCCT - ANATOMY
What is the standard of care for coronary imaging?
LCA (mildly diseased) with non calcified pLAD plaque determining <50% stenosis. Target of optimal OMT.
Ex. from axial 1024x1024 matrix (FOV 140mm) dataset Quantum HD Cardiac (0.2/0.1mm). Kernel Bv60. QIR 4.
SOA PCCT
What is the standard of care for coronary imaging?
PCCT changes the standard of care for coronary imaging. It elevates the accuracy, the confidence, the image quality and ultimately the precision of the evaluation.
STATE OF THE ART PHOTON COUNTING CT
Coronary stent imaging (4)
Ex. 512x512 matrix CARDIAC CT of a prox LAD coronary stent (size 3.5mm) with 0.4mm/0.2mm. Kernel Bv44. QIR 4. This is low resolution protocol for this machine 😁. Dishomogeneous stent occlusion.
STATE OF THE ART PHOTON COUNTING CT - CARDIAC
Small/thin Vieussens ring assessment with PCCT.
Ex. cine 4DVR 512x512 matrix (FOV 140mm) dataset (source images 1.0/0.7mm; thickness/increment). Kernel Bv36. QIR 4; + high resolution dataset with axial thin MIP.
SOA PCCT
What is the standard of care for coronary imaging?
PCCT changes the standard of care for coronary imaging. It elevates the accuracy, the confidence, the image quality and ultimately the precision of the evaluation.
STATE OF THE ART PHOTON COUNTING CT
Cardiac CT - Intra-Myocardial Course/Bridging
PCCT can assess bridging (also due to effective temporal resolution of 66ms.
Ex. 4D-cine-MPR 512x512 matrix (FOV 140mm) CCT (0.8/0.4mm; thickness/increment). Kernel Bv36. QIR 4.
Usefulness of delayed phase acquisition (bottom) for exclusion of left atrial appendage tip thrombus on LAA and Pulm Vein studies. Arterial phase (top) w incomplete opacification and pseudothrombus.
STATE OF THE ART PHOTON COUNTING CT
Functional assessment of LV/RV in Congenital Heart Diseases/ASD
CCT and CMR for ASD pt.
Ex. cine MPR 512x512 matrix (FOV 140mm) SAX LV/RV CTA images (1.0/0.7mm; thickness/increment). Kernel Bv36. QIR 4.
STATE OF THE ART PHOTON COUNTING CT
Carotid CT Angiography (2)
Carotid arteries are the perfect benchmark for atherosclerotic plaque analysis.
Ex. 768x768 matrix (FOV 100mm) CTA MPR images with focus on bifurcation of carotid arteries (0.2/0.1mm). Kernel Bv68. QIR 4.
SOA PCCT - ANATOMY
What is the standard of care for coronary imaging?
LCA (very diseased) from right sinus, running anterior to the RVOT/PA.
Ex. from axial 1024x1024 matrix (FOV 140mm) dataset Quantum HD Cardiac (source images 0.2/0.1mm; thickness/increment). Kernel Bv60. QIR 4.
State of the ART - Cardiovascular MR
1.5 Digital CMR of MVP (Mitral Valve Prolapse), MAD (Mitral Annulus Disjunction), MR (Mitral Regurgitation) and mild LGE (Delayed Enhancement) in the infero-lateral wall of the LV
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STATE OF THE ART - CARDIAC CT
Several findings here.
Try to check them out 😁😁😁.
Performed with Siemens SOMATOM FORCE.
Fondazione Gabriele Monasterio Regione Toscana CNR
IRCCS SDN
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SOA PCCT - STENTS
PCCT is the standard of care for coronary imaging. Including stents.
Maximum level of spatial resolution achievable in CT with DS-PCCT tech with Quantum HD Cardiac: 100 microns.
Ex. 1024x1024 matrix (FOV 100mm); slice 0.2/0.1mm. Kernel Bv72. QIR iterative 4.
STATE OF THE ART PHOTON COUNTING CT
Functional assessment of LV/RV in Congenital Heart Diseases/ASD sinus venosus - Part II (RV)
Ex. cine MPR 512x512 matrix (FOV 140mm) of LA of RV CTA images (source images 1.0/0.7mm; thickness/increment). Kernel Bv36. QIR level 4.
State fo the Art CCT - axial CCT in sudden increase of heart rate (max 157bpm).
Temporal resolution is the hallmark of Cardiac CT. If u need to perform CCT in all comers (regardless of HR), u need the highest temporal resolution.
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SOA PCCT
What is the standard of care for coronary imaging?
PCCT changes the standard of care for coronary stent imaging. It elevates the accuracy, the confidence, the image quality and ultimately the precision of the evaluation.
STATE OF THE ART PHOTON COUNTING CT
Carotid CT Angiography (1)
100 microns atherosclerosis/ATH imaging - in vivo
Carotid arteries: top benchmark for atherosclerotic plaque analysis; they show many similarities with coronary arteries with a less technically challenging anatomy.
State of the Art CCT
Case of the day. Tech calls b/c contrast is hardly visible in arterial phase (request for Thoraco-Abdominal CT Angiography).
What do you see?
Fondazione Monasterio/CNR
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STATE OF THE ART PHOTON COUNTING CT - What can CT do for you and your patients?
3DVR/Cinematic Rendering and longitudinal MPR of LM postal 50% stenosis.
Ex. from axial 1024x1024 matrix (FOV 140mm); source images 0.2/0.1mm; thickness/increment. Kernel Bv60. QIR level 4.
STATE OF THE ART CARDIAC CT - Patent Ductus Arteriosus Botalli
Exemplification of a detail of anatomy and function of Patent Ductus Arteriosus Botalli.
Ex. cine4DVR 512x512 matrix (FOV 140mm) dataset (source images 0.8/0.4mm; thickness/increment). Kernel Bv36.
My father, a very experienced GP, once told me:"You know who is the most knowledgable doctor there is? The Radiologist. Radiologist tend to have a very broad knowledge and vision of medicine. If you have to ask advice on a diagnostic strategy, ask the Rads". True.
SOA PCCT - What can CT do for you and your patients?
Nice 3DVR and longitudinal MPR of severely diseased RCA.
Ex. from axial 1024x1024 matrix (FOV 140mm); source images 0.2/0.1mm; thickness/increment. Kernel Bv60. QIR level 4.
STATE OF THE ART PHOTON COUNTING CT - What can CT do for you and your patients?
3D Cinematic Rendering + curved MPR of LAD.
Ex. from axial dataset 1024x1024 matrix; source images 0.2/0.1mm; thickness/increment. Kernel Bv60. Maximum QIR iterative reconstructions level 4.
SOA PCCT - What can CT do for you and your patients?
Cardiac imaging with PCCT is the diagnostic reference standard.
3D Cinematic Rendering + curved MPR of severely calcified LAD.
Ex. 1024x1024 matrix; source images 0.2/0.1mm; thickness/increment. Kernel Bv60. QIR 4.
STATE OF THE ART PHOTON COUNTING CT
What is the standard of care for coronary imaging?
PCCT changes the standard of care for coronary imaging. It elevates the accuracy, the confidence, the image quality and ultimately the precision of the evaluation.
State fo the Art Cardiac CT
How to evaluate a Intra-Myocardial Bridge (IMB) on dynamic 4D CCT.
This took me some time to prepare 😁😁😁.
Fondazione Gabriele Monasterio Regione Toscana CNR
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STATE OF THE ART PHOTON COUNTING CT
Carotid CT Angiography (4)
100 microns atherosclerosis imaging - in vivo
Ex. 768x768 matrix (FOV 120mm) CTA MPR images of right and left carotid arteries bifrcations (0.2/0.1mm; thickness/increment). Kernel Bv68. QIR level 4.
SOA PCCT - What can CT do for you and your patients?
3D-Cinematic Volume Rendering and axial+curved MPR of LAD-D1 stent.
Ex. from axial 1024x1024 matrix; source images 0.2/0.1mm; thickness/increment. Kernel Bv60. Maximum QIR iterative reconstructions level 4.
STATE OF THE ART PHOTON COUNTING CT
RV wall tissue imaging (1)
RV wall is a headache (thin, irregular, shapeless).
Ex. 512x512 and 768x768 matrix (FOV 140mm) axial images with focus on the free wall of the RV (0.8/0.4 and 0.2mm/0.1mm). Kernel Bv48 and Bv60. QIR 4.
State fo the Art Cardiac CT - First access in patient with dyspnea and dilated LV.
Many reasons why a Radiologist should look at this images (post-AMI dilated CMP with layered thrombus in LV and nodular thrombus in RV. But also... ? Check it out.
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State of the Art CCT (single source CT)
Multiple coronary stents on the RCA (middle segment and crux).
Fondazione Gabriele Monasterio Regione Toscana CNR
IRCCS SDN, Istituto di Ricerca
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State of the ART - Cardiovascular CT
Incidental finding on Cardiac CT; patient comes for suspected obstructive Coronary Artery Disease (not present) and the exam reveals an Hypertrophic Cardiomyopathy (apical)
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State of the ART - Cardiovascular MR
CMR 4D Flow on 3T Equipment with analysis by Arterys software platform - Aortic Insufficiency
Fondazione Gabriele Monasterio Regione Toscana/CNR
HEART CENTER
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#yesCCT
@ArterysInc
State of the Art CCT
Cinematic/functional Cardiac CT: 2 examples of hyper mobile inter-atrial septum without significant shunt/PFO.
Fondazione Monasterio - Heart Center
IRCCS SDN, Istituto di Ricerca
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SOA PCCT
What is the standard of care for coronary imaging?
PCCT changes the standard of care for coronary imaging. It elevates the accuracy, the confidence, the image quality and ultimately the precision of the evaluation.
SOA PCCT
See the confidence rising .
Cardiac PCCT vs. 320-slice EiD CT.
Ex (PCCT parameters): axial dataset of about 1000 slices, 1024x1024 matrix; source images 0.2/0.1mm; thickness/increment. Kernel Bv60. Maximum QIR 4. SR 100 microns; TR hardware 66 ms.
State fo the Art CCT - cMPR and cine MPR in SAX/RAO/4CH of newly diagnosed CTO of RCA; LV moderately dilated with evidence of previous subendocardial myocardial infarction/chronic ischemia.
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Medicine is a constant battle between the 2 armies of: standardized vs. personalized… to make science work you have to standardize and focus, to make medicine work you often have to improvise. A bit like being psycho with 2 personalities: JS Bach vs. Miles Davis.
❤️GIORNATA MONDIALE DEL CUORE ❤️
Oggi nella giornata del cuore ricordiamoci che oltre che la sede dell'anima è anche l'organo che causa la maggior parte dei problemi di salute nella nostra società.
FFR-ct - Is it something we can actually rely on?
In the study "Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort" from Sebastian Gassenmaier et al. the Authors conclude:
Tips and Tricks about Calcium and Coronary CT.
First of all: do not be scared about calcium.
- Calcium is par of the disease you are studying
- Calcium is significant information
- Calcium is not just a number (is a pattern, a phenotype, a study of the patient).
1
State fo the Art CCT
Agatston Calcium Score 7000
Can you still assess coronary arteries on CCT?
Yes you can. Follow me to see how.
Know your technique.
Know your technology.
Make a beta diagnosis.
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Cardiac Imaging is not just another thing you can do. It’s a highly complex job which your undivided attention for several decades. Only then you become an imager.
State fo the Art CCT
Agatston Calcium Score 7000
Can you still assess coronary arteries on CCT?
Yes you can. Follow me to see how.
Know your technique.
Know your technology.
Make a beta diagnosis.
#WhyCMR
#yesCCT
#CardioTwitter
#MedTwitter