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Multislice CT in cardiac and coronary angiography

Departments of ¹ Diagnostic Radiology and ² Internal Medicine, Division of Cardiology, Eberhard-Karls-University Tuebingen, Germany

View larger version (115K): [in a new window]   Figure 1. Multidetector-row CT angiography with 4-row technology (collimation 4 x 1 mm, pitch 1.5, 120 ml Imeron® 400). (a) Anterior view of left coronary artery with left anterior descending (LAD) artery in volume rendering technique. (b) Lateral view of left coronary artery with LAD artery and circumflex branch. (c) Maximum intensity projection of right coronary artery (RCA) with calcified plaques (arrow). (d) Diaphragmatic surface with posterolateral and interventricular branches of RCA (arrows).

View larger version (96K): [in a new window]   Figure 2. Non-calcified, soft, lipid-rich plaque in left anterior descending artery (arrow) (Somatom Sensation 4, 120 ml Imeron® 400). The plaque was confirmed at intracoronary ultrasound.

View larger version (35K): [in a new window]   Figure 3. Adaptive array detector used in the Siemens Somatom Sensation 16. Left: schematic drawing. By proper combination of the signals of the 24 detector rows, the basic collimations 16 x 0.75 mm and 16 x 1.5 mm can be realized. Right: picture of a detector module, which consists of 16 x 24 detector elements.

View larger version (61K): [in a new window]   Figure 4. 66-year-old male patient with known single vessel coronary artery disease. (a) Multidetector-row CT angiography of the right coronary artery with a 16-row CT scanner (Somatom Sensation 16, 80 ml Imeron® 400). Even subsegmental branches (arrows) can be readily delineated. (b) Multiplanar reconstruction in the long axis depicts aneurysm of left ventricle s/p myocardial infarction.

View larger version (89K): [in a new window]   Figure 5. 59-year old patient with known wall changes in proximal left anterior descending artery without significant obstruction. (a,b) The entire coronary tree is well visualized. Excellent image quality of the displayed coronary tree with only moderate calcifications present (Agatston score 257). (c) Visualization of the entire right coronary artery up to the apex. Protocol: collimation 12 x 0.75 mm, pitch 0.31.

View larger version (78K): [in a new window]   Figure 6. 58-year-old male patient with two vessel disease (16-row coronary multidetector-row CT angiography). Note the excellent image quality as well as the absence of calcifications at the site of obstruction. High grade ostial lesion (a) and a tandem lesion in the proximal circumflex artery (b) are to be seen.

View larger version (62K): [in a new window]   Figure 7. Multiplanar reconstructions along the left anterior descending artery in a patient who presented for stent patency control and refused coronary catheterization, obtained on a SOMATOM Sensation 16. Rotation time 0.42 s, basic collimation 0.75 mm, reconstructed slice width 3 mm (a), 1.5 mm (b) and 0.75 mm (c).

View larger version (16K): [in a new window]   Figure 8. Minimum width dose profiles for a 16-slice CT system and a corresponding 4-slice CT system with equal collimated width of one detector slice. The relative contribution of the penumbra region, which represents wasted dose, decreases with increasing number of simultaneously acquired slices.

View larger version (23K): [in a new window]   Figure 9. Temporal resolution (in ms) for 0.42 s and 0.5 s rotation. Temporal resolution as a function of the heart rate for the ACV approach using 0.5 s resp. 0.42 s gantry rotation time. In addition to the absolute improvement, the temporal resolution shows a different dependence on the patient's heart rate for 0.42 s rotation time, reaching its optimum (105 ms) at 81 bpm. This is clinically important, since without administration of beta blockers the majority of heart rates are in the range 75–85 bpm.