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