多排CT：冠心病的诊断与危险分层.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Assessment of Stent Patency by MSCT (Abnormal Case) 64-MSCT in Coronary Artery Disease Symptomatic chronic CAD Acute chest pain with low risk Pre-operative evaluation for AS Status post stent implantation Status post CABG Assessment of Graft by MSCT (Normal Case) Assessment of Graft by MSCT (Normal Case) Assessment of Graft by MSCT (Normal Case) Assessment of Graft by MSCT (Normal Case) Assessment of Graft by MSCT (Normal Case) SVG Anast Advances of MSCT Regional myocardial perfusion (Adenosine) 256-MSCT: * Low dose of radiation * 4D quantitative perfusion Calcium subtraction (low/high energy X-rays) Global score of non-calcified plaque for clinical outcome trial Cost-effective and downstream testing analysis Berman D et al, JACC 2007;50:2329-35 Indication for Cardiac CTs Chest pain, uninterpretable or equivocal stress test Appropriateness (8) Chest pain with intermediate pretest probability of CAD, ECG uninterpretable or unable exercise Appropriateness (7) Acute chest pain with normal ECG and negative Tn, intermediate pretest probability of CAD Appropriateness (7) Evaluation of coronary arteries in patient with new onset of heart failure Appropriateness (7) Symptomatic, suspected coronary anormalies Appropriateness (9) Patient Preparation Renal function: GFR 60 ml/min Hydrate Allergy to contrast Beta-blocker: Lopressor 50 mg p.o. 1hr before exam Nitrates: Nitroglycerine 0.4mg S.L. immediately before CT angiography * * * * * * * * * * * * * * * * * * * * 64-MSCT in Coronary Artery Disease Symptomatic chronic CAD Acute chest pain with low risk Pre-operative evaluation for AS Status post stent implantation Status post CABG 64-MSCT in Coronary Artery Disease Symptomatic chronic CAD Acut