CORONAROGRAFIA CON TC SPIRALE MULTISTRATO
L' impiego della tecnologia multistrato con la possibilità di sincronizzare l' acquisizione al tracciato elettrocardiografico del paziente, consente di ottenere immagini ad alta risoluzione delle arterie coronarie evidenziando la presenza di eventuali stenosi o la pervietà di bypass o stent metallici.
MSCT di stent posizionato a livello della MSCT di a. coronaria dx normale
a. circonflessa (ricostruzioni VR)
PURPOSE:
To optimize techical parameters, examination protocol and to evaluate the effectiveness of multidetector row coronary angiography to detect normal and patologic coronary arteries.
MATERIALS AND METHODS:
50 volunter patients (mean age 61 years, range 45 –72) with heart rates lower than 70 bmp, underwent Multidetector row ECG reconstructed
coronary CT angiography (GE Light Speed Plus, 140 kVp ,270 mA, 1.25 mm slice thickness , 0.5 second scan speed , high quality HQ pitch)
before and after cm administration (Iopamiro300 mg-dl, Bracco Italia) (volume : 140-150 ml ; flow rate 4ml/sec).
Indications for examinations in patients population were coronary artery stent placement (1 anterior descending and one leftcircunflex) , left anterior
decending artery angioplasty (1), by pass surgery (3) while in the remaining 44 patients, volunteers, non cardiac symptomswere appreciable.
All CT angiograms were reconstructed at 20-80% of the cardiac cycle to determine for every artery the fase with less motion “stair step” artifacts
RESULTS:
Examination and post processing time varied respectively from 25 to 35 minutes (mean 27) and from 30 to 60 minutes (mean 40).
The left anterior descending artery wasbest visualized in middiastole ( 70 % of the cardiac cycle) , the circunflexat 60% while the right at 40% of the cardiac cycle.
Out of 132 arteries 19 (14,4%) has been judged to be unevaluable due to motion artifacts while in 2 (1,5%) the presenceof severe wall calcifications permitted only partial artery evaluation.
In the 113 arteries evaluable we have observed:
72 normal coronary arteries (54,5%)
28 arteries with minimal wall irregularities and stenosis lower than 50% (21,2%)
7 severe stenosis > 50% (5,3%) , (2) rightcoronary artery, (4) anterior descending and (1) left circunflex
In the remaining 6 patients an optimal visulization of stent and surgical by pass has been obtained.
CONCLUSIONS:
Multislice CT coronarography with retrospectiove ECG gating permits to obtain encouraging results in detection of coronary arteries stenosis.
In selected patients (< 70 bpm) can give very interesting results in particulary to evaluate stent and surgical by pass .
More techical improvemente and further research trial are mandatory to improve the accuracy and to estabilish its application in every kind of
patients.
CASI CLINICI
Paziente con reperti di normalità
By-Pass aorto coronarico
Stent arteria discendente anteriore
