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Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

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Page 1: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Risonanza magnetica e

tomografia computerizzata

www.fisiokinesiterapia.biz

Page 2: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

scar

RM CT

Page 3: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Morphology

Function

Page 4: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

3D reconstruction (non geometric model)LVV = S1 + S2 +...

S1S2

modified Simpson’s ruleLVV=Am x L/3 x (Am+Ap)/2 x L/3+1/3 x Ap x L/3

L

AmAp

L

Am

Al

biplane ellipsoidLVV = π/6 x L x (4/π x Am/D) x (4/π x Al/L)

LAl

single plane ellipsoidLVV = 0,85 x (Al x Al)/L

D

MRI

Page 5: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Myocardial Fibers and Wall Architecture

Endocardium

Epicardiumfunction Fiber orientation

Fiber architectureMajor vector

v

Page 6: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Tissue CharacterizationTissue Characterization

time

Lateenhancement

contrastinjection

Wash-outFirst-passperfusion

~10-15 min~20-40sec

Page 7: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

WholeWhole--Heart Coronary MRAHeart Coronary MRA

RCARCA LADLAD LCXLCX

Page 8: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

FIBROMALIPOMATOSISMYXOMA ANGIOMANGIOMAA

INDICATIONS FOR MAGNETIC RESONANCE IMAGING IN PATIENTS WITH CORONARY ARTERY DISEASE Task Force of the European Society of Cardiology (1998)

Page 9: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Eur J Radiol 2001

Page 10: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Myocardial hyperenancement: ceMRIMyocardialMyocardial hyperenancementhyperenancement: : ceMRIceMRI

0

5

10

15

20

25

30

progressive disease risk factor forsudden death

yesno2 or more1 or less

The The extentextent of of hyperenancementhyperenancement isis associatedassociated withwithprogressive progressive ventricularventricular dilatationdilatation anan suddensudden deathdeath

MoonMoon JCC, JACC 2003; 41:1561JCC, JACC 2003; 41:1561--77

Patcy areas

Fine fibrosis

Page 11: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

ARVC

Page 12: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

ARVD SUSPECTARVD SUSPECTIntra-interobserver Concordance

K test 59 patients

0102030405060708090

100

fatty substitution

ventricular size

ventricular kinesis

intraobserverinterobserver

Eur Radiol June 2003

≤ 40 mm

≤ 30 mm

Page 13: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

CARDIOPATIA ISCHEMICA

Page 14: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Perfusion

Page 15: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Cine

Dept. of Cardiology, NWU, Chicago

Late Enhancement

Patient with Infarct

Page 16: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Validation

TTC (tripheniltetrazolium chloride) and Gd-enhanced MRI in infarcted myocardium

TTC MRI

courtesy of Dr. Judd, Dr. Kim, Northwestern University, Chicago

Page 17: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

MR perfusion imaging during hyperemia demonstrateshypoperfusion in the subendocardial layer

Patient with Angina and Dyspnea DuringExercise

J. Schwitter, MDUniversity Hospital Zurich

Page 18: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

WholeWhole--Heart Coronary MRAHeart Coronary MRA

Page 19: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Dirksen, Circulation 2002

ANOMALIE DELLE CORONARIE

Page 20: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

TC

Page 21: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec
Page 22: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Heavy Smoker - Asymptomatic

Page 23: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

-400 ms

0.5 mm

1 mm

~5 mSv

~20 s

750 mAs

120 kV375 ms

16x0.75 mm

16

0.7 mmIncrement

500 msRotation

-400 msGating

1.3 mmSlice

~4 mSvEff. Dose

~40 sScan

400 mAsCurrent

120 kVKilovoltage

4x1 mmCollimation

4Detector-Rows

Scan-protocols

Page 24: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Tem

pora

l-R

esol

utio

n [m

s]

50Heart Rate

60 80 90 10070

200

100

150

50

250 0.5s

Normal Heart Rate Distribution

Motion-Artifacts

0.4s1 Segment

2 Segments

Temporal Resolution of 16 DCT

Page 25: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Predictive Value 4 / 16 DCTA

97%79%2003CirculationRopers

97%72%2004JACCKuettner

97%80%2002CirculationNiemann

98%92%2002RadiologyVogl

96%85%2001AJCKnez

98%59%2001CirculationAchenbach

97%81%2001LancetNiemann

NPVPPVYearJournalAuthor

Page 26: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

CS versus CTA

Page 27: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

• 38 YOM• Non specific complain• Risk Factors

– Cholesterin– Smoker

• No calcium50 HU

50 HU

Atheroma

Page 28: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Bypasscourse – Patency Rate…

Page 29: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

Dr. Dr. FilippoFilippo CademartiriCademartiriErasmus Medical CenterErasmus Medical CenterRotterdamRotterdam

Page 30: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

1

22,5

7

3,5

0,71

1,4

4

0

1

2

3

4

5

6

7

8

MDCT 80kV /300mAs

EBCT MDCT 120kVretrospektiv male

MDCT 120kVretrospektiv

female

MD-CTA Catheter

total modulatedmSv

Exposure and Reduction

Page 31: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

R R R R

Continuous

Spiral Scan & Feed

z -P

ositi

on

Time

Tdel,Recon

ΔTN100%

mA

20%

ReconstructedImage Data

Rec

on

Rec

on Rec

on

Rec

on

Tube Current Modulation

Page 32: Risonanza magnetica e tomografia computerizzata · Tissue CharacterizationTissue Characterization time Late enhancement contrast injection Wash-out First-pass perfusion ~20-40sec

scar

RM CT