Multislice Computed Tomography (MSCT): Diagnosis and Stratification of CAD
Gong-Yuan Xie, MD, FACC Professor of Clinical Medicine Director, Echocardiography Laboratory Co-Director, Cardiac Imaging Center Division of Cardiovascular Medicine University of Missouri
Extensive plaque
Significant lesion in > 1 vessel
Mayo Clinical Proceedings 1999;74:March; Carr JJ et al, AJR 2000;174:915-21
Incremental Value of Calcium Score
Coronary visualization Ventricular function


Assessment of Calcium Score (Agatston)
Results LM: 4 RCA: 21 LAD: 61 Cx: 0 PDA: 0 Total: 86
Translation of Calcium Score

Coronary Visualization by MSCT
3D volume-rendered image Brief survey of 2D axial images Visualizing major coronary arteries and secondary branches: 1. “Probe”: curved multiplanar reformation 2. “Walk-down”: along long axes using oblique planes (MPR), manipulating by maximum intensity projection (MIP) 3. Combination
Calcium Score
0 1 - 10 11 - 100 101 - 400
Implication
No plaque Minimal plaque Mild plaque Moderate plaque
Risk for CAD
< 5% < 10% Minimal CAD Mild CAD
> 400

Coronary Visualization by MSCT
3D volume-rendered image Brief survey of 2D axial images Visualizing major coronary arteries and secondary branches: 1. “Probe”: curved multiplanar reformation 2. “Walk-down”: along long axes using oblique planes (MPR), manipulating by maximum intensity projection (MIP) 3.onary Visualization by MSCT
3D volume-rendered image Brief survey of 2D axial images Visualizing major coronary arteries and secondary branches: 1. “Probe”: curved multiplanar reformation 2. “Walk-down”: along long axes using oblique planes (MPR), manipulating by maximum intensity projection (MIP) 3. Combination
Technical Advances of CT

Increase in speed of gantry rotation
Multiple detectors Dual radiation sources


64-MSCT vs. Coronary Angiography
64-MSCT Temporal resolution Spatial resolution 83-165 msec

Coronary Visualization by MSCT
3D volume-rendered image Brief survey of 2D axial images Visualizing major coronary arteries and secondary branches: 1. “Probe”: curved multiplanar reformation 2. “Walk-down”: along long axes using oblique planes (MPR), manipulating by maximum intensity projection (MIP) 3. Combination
Coronary Angiography
6 msec
0.4 mm
0.25 mm
Analysis of MSCT Images

Calcium score
Coronary visualization Ventricular function


Analysis of MSCT Images

Calcium score
Analysis of MSCT Images

Calcium score
Coronary visualization Ventricular function


Coronary Visualization by MSCT
3D volume-rendered image Brief survey of 2D axial images Visualizing major coronary arteries and secondary branches: 1. “Probe”: curved multi-planar reformation 2. “Walk-down”: along long axes using oblique planes (MPR) , manipulating by maximum intensity projection (MIP) 3. Combination