Normal and variant coronary anatomy on CT angiography. CAD-RADS lexicon

Congress:

ECR 2018

Poster Number:

C-2139

Type:

Educational Exhibit

Keywords:

Arteriosclerosis, Normal variants, Diagnostic procedure, CT-Angiography, CT, Cardiac, Arteries / Aorta, Anatomy

Authors:

V. M. C. F. Muro Paz¹, L. Falcon¹, N. Angulo Carvallo¹, R. Hammond Castro²; ¹Lima/PE, ²Lima 31, Lima/PE

DOI:

10.1594/ecr2018/C-2139

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2139

Table 1: Indications. Appropriate use criteria of CCTA for detection and risk assessment...

Table 2: Advantages and disadvantages of ECG-gated techniques.

Fig. 1: Diagram about ECG-gated techniques with retrospective ECG-gated (continuous...

Fig. 2: Post processing imaging techniques. Evaluation of coronary arteries can be...

Learning objectives

To know protocols and techniques of coronary computed tomography angiography (CCTA) and the current indications. To describe the anatomy and common variants of normal coronary artery anatomy and to know segmental coronary arterial anatomy. To know the first version of Coronary Artery Disease - Reporting and Data System (CAD-RADS)

Background

Early recognition of coronary artery disease (CAD) is important for the prevention of its related complications and improving prognosis.1Invasive Coronary Angiography (ICA) is regarded as gold standard for the anatomical assessment of CAD: * Advantages: - High spatial and temporal resolution. - Diagnostic and treatment purposes. * Disadvantages: - No information about the vessel wall or atheroma. Bearing in mind the above considerations, coronary computed tomography angiography (CCTA) is an excellent tool in the evaluation of patients with CAD, even in the assessment of patients...

Findings and procedure details

CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY CCTA has been increasingly used in the diagnosis ofCAD due to ongoing technical development. It allow an accurate non-invasive anatomical evaluation of the coronary arteries with highly temporal and spatial resolution. Patient selection plays an important role in the performance of the exploration. Indications.6 Table 1 Patient preparation: - Hemodynamically stable - Slow heart rate (< 65 beats per min). - To minimize heart rate variability. - Slow breathing and motionless. *Pharmacologic intervention: Beta blockers, sublingual nitroglycerin. Scanning techniques: - Prospective...

Conclusion

CCTA is an essential imaging tool to assess coronary arteries. It must be performed with state-of-the-art equipment and after adequate patient preparation. Normal anatomical variants can cause confusion; its knowledge allows to avoid unnecessary intervention, appropriate planning oftherapeutic procedures and adequate communication of the findings. CAD-RADS can improve common understanding with referring physicians, allowing recommendations for further management.

Personal information

L. Falcon Centrode Excelencia de diagnóstico por Imágenes, Clínica Internacional Lima -Perú [email protected] V.M.C.F. Muro Paz Centrode Excelencia de diagnóstico por Imágenes, Clínica Internacional Lima -Perú [email protected]

References

1. Kantarci M, Ceviz N, Sevimli S, et al. Diagnostic performance of multidetector computed tomography for detecting aorto-ostial lesions compared with catheter coronary angiography: multidetector computed tomography coronary angiography is superior to catheter angiography in detecting of aorto-ostial lesions. J Comput Assist Tomogr. 2007; 31:595–599. 2. Mhairi D, Newby D. Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspectives from the SCOT-HEART Trial. Curr Cardiol Rep. 2016; 18: 18. 3. Sun Z, Choo G, Ng k.Coronary CT angiography: current status and continuing challenges. Br...