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64-Slice Coronary Computed Tomography Angiography |
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Radiology Regional Center is proud to introduce the new Seimens Sensation 64 multislice CT. This machine has the fastest rotation time available (.33sec) and can acquire 192 slices per second. The entire coronary arterial tree can be imaged in 10 seconds with exquisite detail.
CT Coronary Angiography Procedure
Patient Preparation
In order to optimize the most diagnostic images of the coronary arteries, it is essential that the heart rate be controlled. Each patient will need his/her heart rate to be < 60bpm. If your patient's resting heart rate is > 60bpm, oral and/or intravenous |
beta blockers will be administered before the examination, barring any contraindications (Steroid dependent Asthma, 1st degree heart block or systolic BP<90mmHg). Patients are also asked to eliminate caffeine 24hrs. prior to the examination.
Sublingual nitroglycerin is also administered prior to the exam to optimize visualization of small coronary vessels. Recent Sildenafil use is a contraindication to SL nitroglycerin.
Scan Protocol and Contrast Material
After achieving an optimal heart rate, your patient will be placed on the CT table and ECG leads will be applied. Your patient will receive an injection of nonionic iodinated contrast and saline during their CT coronary angiogram.
During the injection, your patient will be required to hold their breath for approximately 10 seconds. After this, the exam will be completed and a board-certified radiologist who supervises the study will review the images and provide a complete report to the physician's office.
Multislice CT Coronary Angiography compared to Conventional Coronary Angiography
Historically, conventional coronary angiography has been the gold standard to quantify coronary artery stenosis. Recent studies have shown that 64 Slice CT Coronary angiography compares quite favorably with conventional angiography for the detection of luminal stenosis: > 50% with a sensitivity of 86%, specificity of 95% and negative predictive value of 98%. In addition to quantifying luminal stenosis, coronary CTA can evaluate the degree of overall plaque burden by visualizing both calcified and noncalcified (lipid or fibrotic) plaque. Recent data also shows that coronary CTA adds prognostic data concerning cardiac events above and beyond conventional risk factors.
Top Indications for Coronary CTA
Rule Out Coronary Stenosis
1. Evaluation of chest pain in patients with low to intermediate probability of CAD
2. Preoperative evaluation for non-coronary surgery
3. Evaluation of intermittent arrhythmias
4. Alternative to invasive angiography in patients who are at high risk for conventional coronary angiography
5. Workup of equivocal nuclear stress test/stress echo
Coronary Bypass Graft Evaluation
1. Alternative to invasive angiography
2. Bypass graft not visualized on invasive angiography
Coronary Stents
1. Evaluate stent patency
Unresolved questions after cardiac cath
1. Coronary anomalies
Contraindications to CT Coronary Angiography
There are a few contraindications for CT coronary angiography: 1) allergy to iodinated contrast; 2) patients not in a sinus rhythm(atrial fibrillation or significant ventricular ectopy); 3) rapid heart beat and contraindication to beta blockers; 4) Renal insufficiency;5) Recent use of Sildenafil is a contraindication for Nitroglycerin.
Insurance Coverage
Coronary CTA is now reimbursed by Medicare and Cigna. The remaining insurers are expected cover the exam shortly.
Indicates that MSCT angiography may help in the detection of vulnerable plaque.
Raffe et al, " Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography", JACC, 2005:46;552-7.
2Pundziute et al,"Prognostic Value of MDCT Coronary Angiography in Patients With Known or Suspected CAD", JACC, 2006:49;62-70
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