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Cardiology
Coronary Imaging Angiography, CTA, and MRA
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
11 sections · 158 slides
Overview
- Goals of contemporary coronary imaging
- Coronary imaging modalities
- Milestones in coronary intervention
- Historical development of vascular imaging
Standard coronary angiography
- Information provided by coronary angiography
- Technique of image acquisition
- Gantry rotation and angulation
- Evolution of angiographic practice
- Common imaging limitations of coronary angiography
- Sources of two-dimensional imaging error
- Two families of angiographic limitation
- Standard Coronary Angiography Imaging and Safety Limitations
- Luminology and its consequences
- Image intensifiers and flat-panel detectors
- Quantifiable three-dimensional vessel properties
- Four-dimensional coronary shape change
- Coronary contrast delivery methods
Indications, contraindications and patient risk
- Indications for coronary angiography
- Reading the appropriateness criteria table
- CTA/MRCA Appropriateness Criteria
- CTA/MRCA Appropriateness Criteria (continued)
- CTA/MRCA Appropriateness Criteria (continued)
- CTA/MRCA Appropriateness Criteria (continued)
- Contraindications to coronary angiography
- Further relative contraindications
- General risk factors for complications
- Predictors of cardiac complications
- Predictors of vascular complications
Angiographic views and optimal view mapping
- Principles of view selection
- Catheter position, spine relationship and gantry rotation
- Recognising rotation from the angiographic image
- Orthogonal views and biplane equipment
- Dual-axis rotational angiography of the left coronary artery
- Left coronary artery: standard views
- Right coronary artery views
- Common angiographic findings
- Universal optimal view map
- Optimal view map for each coronary segment
- Limitations in image acquisition
- Limitations in interpretation
- Clinical consequences of unrecognised foreshortening
- Left main and ostial imaging challenges
Complications of standard coronary angiography
- Effects of contrast during coronary injection
- Other adverse effects of contrast media
- Major complication rates in current practice
- Mortality in vulnerable subgroups
- Embolic and other procedural complications
- Prevention and treatment of contrast allergy
- Prevention of contrast-induced renal injury
Rotational coronary angiography
- Fundamentals of rotational angiography
- Standard versus rotational acquisition
- Single-axis rotational protocol
- Single-axis rotational trajectories
- Dual-axis rotational angiography
- Wide-arc rotational acquisitions
- Imaging trajectories of standard, rotational and dual-motion angiography
- Advantages of rotational angiography
- Caveats to the dose reduction data
- Limitations of rotational angiography
- Reading the technology comparison table
- Comparison of Coronary Angiographic Imaging Technologies
- Comparison of Coronary Angiographic Imaging Technologies (continued)
Three-dimensional modelling and reconstruction
- Two routes to a three-dimensional coronary representation
- Coronary Angiographic Data Processing Techniques
- Coronary three-dimensional modelling
- When modelling is the practical choice
- Coronary three-dimensional reconstruction
- Three-dimensional reconstruction of the left coronary artery
- Rendering the volumetric dataset
- Comparison Between 3D Modeling and 3D Reconstruction
- Coronary optimal view map from three-dimensional data
- Modelled coronary tree and optimal view map of the proximal LAD
- Advantages of three-dimensional imaging
Lesion assessment and coronary physiology
- Defining a significant coronary stenosis
- Why angiographic severity is hard to grade
- ACC/AHA lesion classification
- Type B1 Lesions Have One Characteristic of Type B Lesions, Whereas Type B2 Lesions Have Two or More of the Type B Lesion Characteristics
- Angiographic lesion descriptors
- Coronary Angiographic Lesions and Their Respective Description
- Coronary Angiographic Lesions and Their Respective Description (continued)
- Fractional flow reserve
- Achieving hyperaemia for fractional flow reserve
- Performing the fractional flow reserve measurement
- FAME trial
- Angiographic fractional flow reserve: principle
- Image quality requirements for angiographic FFR
- Projection and coverage requirements
- System requirements for angiographic FFR
- Accuracy of angiographic FFR
- Advantages of angiographic FFR
- Limitations of angiographic FFR
- Further limitations of angiographic FFR
Coronary computed tomography angiography
- Fundamentals of coronary CTA
- CT platforms for coronary imaging
- From axial images to renderings
- Computed tomography angiography rendering and reconstruction
- Maximum intensity projection and volume rendering of the LAD and RCA
- Current MDCT performance
- Diagnostic accuracy of 64-slice MDCT
- What routine coronary MDCT reports
- CTA of coronary stents and bypass grafts
- Plaque characterisation on CT
- Contraindications and patient factors for CTA
- Patients unsuited to coronary CTA
- What the patient must be able to do
- Advantages of CTA
- Procedural preplanning with CTA
- Volume rendering and multimodality fusion
- Fusion of computed tomography and live angiographic images
- Limitations of CTA
- Effective radiation dose by study
- Reducing radiation exposure from CTA
- Fractional flow reserve computed tomography
- FFR-CT workflow
- Indications for FFR-CT
- Evidence for FFR-CT
- Limitations and future of FFR-CT
Magnetic resonance coronary angiography
- Role of cardiac magnetic resonance
- What MRCA offers
- Physical basis of magnetic resonance
- Generating the magnetic resonance signal
- Components of the CMR scanner
- The MRCA acquisition sequence
- Coronary magnetic resonance imaging methods
- Current clinical value of coronary CMR
- Contraindications to MRCA
- Advantages of MRCA
- Technical limitations of coronary MRA
- Overcoming motion in MRCA
- Safety in the magnet environment
Summary
- Invasive and noninvasive imaging compared
- Conclusions
- Key numbers to remember
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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