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Risonanza magnetica e
tomografia computerizzata
www.fisiokinesiterapia.biz
scar
RM CT
Morphology
Function
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
Myocardial Fibers and Wall Architecture
Endocardium
Epicardiumfunction Fiber orientation
Fiber architectureMajor vector
v
Tissue CharacterizationTissue Characterization
time
Lateenhancement
contrastinjection
Wash-outFirst-passperfusion
~10-15 min~20-40sec
WholeWhole--Heart Coronary MRAHeart Coronary MRA
RCARCA LADLAD LCXLCX
FIBROMALIPOMATOSISMYXOMA ANGIOMANGIOMAA
INDICATIONS FOR MAGNETIC RESONANCE IMAGING IN PATIENTS WITH CORONARY ARTERY DISEASE Task Force of the European Society of Cardiology (1998)
Eur J Radiol 2001
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
ARVC
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
CARDIOPATIA ISCHEMICA
Perfusion
Cine
Dept. of Cardiology, NWU, Chicago
Late Enhancement
Patient with Infarct
Validation
TTC (tripheniltetrazolium chloride) and Gd-enhanced MRI in infarcted myocardium
TTC MRI
courtesy of Dr. Judd, Dr. Kim, Northwestern University, Chicago
MR perfusion imaging during hyperemia demonstrateshypoperfusion in the subendocardial layer
Patient with Angina and Dyspnea DuringExercise
J. Schwitter, MDUniversity Hospital Zurich
WholeWhole--Heart Coronary MRAHeart Coronary MRA
Dirksen, Circulation 2002
ANOMALIE DELLE CORONARIE
TC
Heavy Smoker - Asymptomatic
-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
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
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
CS versus CTA
• 38 YOM• Non specific complain• Risk Factors
– Cholesterin– Smoker
• No calcium50 HU
50 HU
Atheroma
Bypasscourse – Patency Rate…
Dr. Dr. FilippoFilippo CademartiriCademartiriErasmus Medical CenterErasmus Medical CenterRotterdamRotterdam
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
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
scar
RM CT