Cardiac CT Coronaro CT - Az Damiaan · 2018-10-04 · American College Cardiology Foundation 2010...
Transcript of Cardiac CT Coronaro CT - Az Damiaan · 2018-10-04 · American College Cardiology Foundation 2010...
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Cardiac CT – Coronaro CT
Dr. Geert Heirwegh
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Cardiac CT
• Richtlijnen
• Technische vereisten
• Patiënt voorbereiding
• Scan protocol
• Voorbeelden
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I. Richtlijnen
• Niet invasief onderzoek
• coronaire ziekte
• evaluatie bypass grafts
• hoge “negatief predictieve waarde”
• met lage stralingsdosis
Diagnostische performantie is afhankelijk van een goede patiënt selectie
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Meijboom et.al , Journal American College Cardiology ( 2007) 64-Slice Computed Tomography Coronary Angiography
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Meijboom et.al , Journal American College Cardiology ( 2007) 64-Slice Computed Tomography Coronary Angiography
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American College Cardiology Foundation 2010
Appropriate Use Criteria
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American College Cardiology Foundation 2010
Appropriate Use Criteria
Vooral voor patiënten met lage en matige kans op coronair lijden
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Updated NICE guideline 2017
NICE recommend cardiac CT as the first-line test for the evaluation of
stable coronary artery disease in chest pain pathways.
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2. Technische vereisten
Goede beeldkwaliteit =
- goede spatiale resolutie
- goede temporele resolutie : 75ms
- aan de laagst mogelijke stralingsdosis • Ca score: 0,5mSV
• Flash : 1 mSV
• Step & Shoot: 1-3mSV
• Spiraal : 11 mSV
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Ideaal - FLASH • ECG Gated Prospectieve scan
• laag hartritme ( < 60 bpm)
• Volledige scan in 1 hartslag
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Moeilijke scenario’s
• sneller hartritme
• onregelmatig hartritme / extrasystole
• scan in meerdere fasen - step & shoot
• eind systolisch
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Aangepaste Contrastinjectie
• 70 ml jodium houdend contrast - 5 ml/s
• 40 ml Fysiologisch - 5 ml/s
Voordeel
- lagere contrastload - goede arteriele fase
- verminderde streak artefacts veneus
- lage densiteit rechter hart en minder artefact
- (septum defect )
- direct opnieuw scannen mogelijk
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3. Patient voorbereiding
• Hartslag en BD meting
• goede IV access
• medicatie voorgeschiedenis - contraindicaties voor β-blokkers en cedocard
• toediening sublinguaal cedocard
• uitleg over verloop onderzoek
• ademhalingstechniek
• 1 amp 5mg/5ml seloken
• aansluiten ECG op tafel met ademstoptest
• evtl nog seloken ( tot max 20 mg)
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4. Scan Protocol
1. topogram
2. Calcium score
3. Bolus trigger
4. CT angio coronairen
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Voorbeelden - Calcium score
• Quantificatie coronaire calcificatie
• Agatston score
- geen : O
- minimaal :1-10
- mild: 11-100
- matig: 101-400
- ernstig: > 400
• Percentiel coronaire leeftijd
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Coronairen
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Take Home
• Niet invasief
• Lage stralingsdosis
• normaal en afwijkend hartritme
• indien juiste patientselectie
Terugbetaling enkel voorzien via aanvraag door cardioloog