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1 Wilhelm Conrad Röntgen Mr. and Mrs. Röntgen s hands (1895) X
2 CT CT
3 NPO
4 0.8 /1 CT MDCT /
5 Takayasu CAD+PAD CT CT Angiography CTA SG Adamkiewicz PCI CABG CTA plaque CTA+CT perfusion CTA+virtual bronchoscopy CTA AAD (stent) AKA
6 <4 54 / PCI CABG 17 7 CAG Circ J 68: ,
7 CT CAG (FPD) 2D: 0.15x0.15~0.2x0.2 8 ms 3D: 0.194~ ms MDCT 0.4x0.4x0.6 (64ch) (0.1 3 ) X ~60msec
8 -blocker 60~90 CT Angiography ECG CT bolus-triggering software ROI, Coronary CTA CT NTG 1puff 15 BW 0.8ml BW 0.08ml/s 20~30
9 Cardiac CT: clinical applications : Plaque PCI CABG : 16ch : 0.625mm 20sec 1.25mm 40sec 8ch : 1.25mm 20sec : 4ch 64ch Ablation 0.625mm 10sec
10 Unstable angina ( B-2 #6 99% #6 soft plaque ( HU; fibrous plaque) calcified plaque ( HU)
11 Unstable angina ( B-2 Pre PCI Post PCI (DCA+stent)
12 Diagnostic performance of 16- vs 64-section spiral CT: Meta-analysis Per-segment analysis p<0.001 p<0.001 p<0.001 p<0.001 sensitivity specificity PPV NPV 16-section 64-section Hamon M. Radiology 07; 245:
13 Plaque Attenuation Score Lipid-rich plaques HU Intermediate plaques HU Calcified plaques HU Schreoder S. JCAT 28: 449, 2004 Predominantly lipid-rich plaques 60HU Intermediate plaques HU Predominantly calcified plaques 120 HU Calcified HU HU HU HU Estes JM. JCVS 39: 527, 1998 Becker CR. Eur Radiol 13: 2094, HU Lipid-rich Fibrous HU 20 5 HU ACS
14 #6 chronic total occlusion HU fibrous plaque
15 16-detector Assessable stents: 42/61 (68.9%) >/=3.5, stainless steel or cobalt: : 31/35 (88.6%) 3.0 : 11/19 (57.9%) all 2.5 non-assessable tantalum stents: : totally obscured 5 in-stent restenoses correctly detected Kitagawa T, et al. Int J Cardiol 2006;109:188 soft plaque Diagnostic accuracy for detection of significant in-stent or peristent restenosis 64-detector 50% in-stent restenosis peristent restenosis Assessable stents 65/76 (86%) 128/129 (99%) Sensitivity 6/6 (100) 5/5 (100) Specificity 52/52 (100) 121/123 (98) PPV 6/6 (100) 5/7 (71) NPV 52/52 (100) 121/121 (100) Schuijf JD. Radiology 2007;245:416
16 MDCT CABG LITA RITA RITA LMT Graft assessability: 92.4% (16ch;90%, 64ch;96%, p<0.001) Assessment of graft obstruction (occlusion and >50% stenosis) Sensitivity: 97.6% (CI: 96, 98.6%) Specificity: 96.7% (CI: 95.6, 97.5%) PPV: 92.7% (CI: 90.5, 94.6%) NPV: 98.9% (CI: 98.2, 99.4%) LAD D1 IM LAD Hamon M. Radiology. 2008; 247:
17 CT X CAG Cardiac Helical CT 5 10mSv 7 21mSv Cardiac Helical CT scan X-ray overlap scan ( 80 ) X X Retrospective gating R R R R R R
18 Prospective ECG-gating Conventional Scanning BMI # Pts Dose-Average Dose-Range < > (msv) (msv) CAG: 5 10mSv Cardiac Helical: 7 21mSv Courtesy of Dr. Sablayrolles, CCN, France
19 Prospective ECG-gating Retrospective ECG-gating
20 Prospective ECG-gating Retrospective ECG-gating Clinical Advantages CAG X ( 90% ) Cardiac helical scan
21 P/O Aortic dissection SG planning ECG-gated C CT CT non-gated ECG-gated scanning: Disadvantages increased irradiation dose longer scanning time Hybrid Cardiovascular CT Examination ECG-gated + non-gated scanning
22 Non-gated scan
23 20 CT
24 20 CT 600 CT CT 850 CT ,
25 64ch MDCT 64ch MDCT CAG ( ) hrs X (msv) Retrospective: 7~21 Prospective: 2.8~6.5 5~10 (3 ) 12,000 30,000 SE: 88%, SP: 96% PPV: 79% NPV: 98% plaque,,,, 100%
26 CT CT paradigm shift CT (Fast, Most, Best)
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CCT Website C ONTENTS 1 s 1 2 2 3 s 3 4 s 4 s 5 s 6 6 s LMT 7 s Bifurcation 7 s Calcified Lesion 8 CTO 8 9 s s s s Peripheral s Imaging 11 11 12 12 Renal Failure 13 13 9/21 Dr. Suzuki's Comment Complications
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