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Radiology
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CT Kardiak
CT Kardiak
• Screening PJK• Cepat dan non invasif
Sutton D. Textbook of Radiology and Imaging. 7th edition. London: Elsevier Science; 2003.
Jenis
• Calcium score screening heart scan• Coronary CT angiography (CT)• Total body CT scan.
Web MD. Diagnosing Heart Disease With Cardiac Computed Tomography (CT) [internet]. [cited 2014 Jul 21]. Available from: http://www.webmd.com/heart-disease/guide/ct-heart-scan.
Gambar 1 : CT scan non-kontras thoraks. Terdapat kalsifikasi pada left anterior descending artery/LAD (tanda panah). Selain itu, terdapat hiatus hernia dan kalsifikasi pleura yang mengindikasikan paparan terhadap asbes
Sutton D. Textbook of Radiology and Imaging. 7th edition. London: Elsevier Science; 2003.
Gambar 2 : Gambaran CT potongan aksial menunjukkan penyakit aterosklerosis pada left anterior descending/LAD dan arteri sirkumfleksa sinistra/LCX (tanda panah) yang merupakan bukti adanya kalsium
Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011
Indikasi
• Nuclear stress test tidak membantu• Anomali koroner atau jantung• Patensi bypass graft• Aterosklerosis, emboli paru, diseksi aorta
(three scan)
Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011.Herring W. Learning Radiology: Recognizing the Basics. 2nd edition. Philadelphia: Mosby Elsevier; 2007.
Kontras
• Patensi PD, thrombus, plak• Kelainan anatomi : diseksi, emboli• 4-5 ml/detik• IV Catheter uk. 18/20
Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011.Herring W. Learning Radiology: Recognizing the Basics. 2nd edition. Philadelphia: Mosby Elsevier; 2007.
Tipe plak
• Non-calcified
Gambar 3 : CT angiografi koroner pada plak yang tidak mengalami kalsifikasi. Plak non-kalsifikasi ditemukan pada segmen tengah dari left anterior descending artery
Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. The British Journal of Radiology 2012. 85: 495–510.
• Calcified Gambar 4 : CT angiografi koroner pada plak yang mengalami kalsifikasi. Proeksi CT menunjukkan plak kalsifikasi fokal di segmen proksimal arteri koronaria dekstra (a). Angiografi koroner menunjukkan stenosis ringan lumen koroner [tanda panah di (b)]. Plak kalsifikasi yang ekstensif dapat ditemukan pada segmen proksimal dan tengah dari left anterior descending (LAD) (c) dan (d). Stenosis di LAD pada saat dilakukan angiografi koroner [tanda panah di (e)].
Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. The British Journal of Radiology 2012. 85: 495–510.
• Mixed
Gambar 5 : CT angiografi koroner menunjukkan plak campuran. Plak campuran dapat ditemukan di segmen proksimal dari left anterior descending (LAD) dengan stenosis > 50% (tanda panah di a). Angiografi koroner mengkonfirmasi stenosis LAD (tanda panah di b).
Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. The British Journal of Radiology 2012. 85: 495–510.
Cara kerja CT• Gambar : 10-20 dt• Durasi : 15-30 menit• HR : 60-65x/menit• KI : aritmia, tachycardia• β-blocker kontras IV nitrogliserin sublingual• Interval R-R (mid to late diastole) lambat• Fokus : lumen dan dinding• Plak > 1 mm
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal 2011. 41: 5-13.
Kelebihan
• Biaya << ICA• Komplikasi << ICA (kerusakan PD, plak
terlepas)
Lazoura O, Vlychou M, Vassiou K, Rountas C, Ioannis F. 128-Detector-Row Computed Tomography Coronary Angiography Evaluating Coronary Artery Disease: Who Avoids Cardiac Catheterization?. Angiology 2010. 2(61): 174-178.Rajani R, Brum RL, Preston R, Carr-White G, Berman DS. Coronary computed tomography angiography for the evaluation of patients with acute chest pain. The Int J Clin Pract 2011. 65(12): 1267-1273.
Kekurangan• Resolusi spasial terbatas ≠ keparahan
stenosis • KI : aritmia, fibrilasi, alergi• Artefak (kalsifikasi tebal, gerak nafas dan
jantung)• Hanya kelainan anatomis• Kontras : toksisitas renal, alergi
Lazoura O, Vlychou M, Vassiou K, Rountas C, Ioannis F. 128-Detector-Row Computed Tomography Coronary Angiography Evaluating Coronary Artery Disease: Who Avoids Cardiac Catheterization?. Angiology 2010. 2(61): 174-178.Rajani R, Brum RL, Preston R, Carr-White G, Berman DS. Coronary computed tomography angiography for the evaluation of patients with acute chest pain. The Int J Clin Pract 2011. 65(12): 1267-1273.Yerramasu A, Venuraju S, Lahiri A. Evolving role of cardiac CT in the diagnosis of coronary artery disease. Postgrad Med J 2011. 87:180-188.
Sensitivitas & Spesifisitas• 18 studi 1313 sampel• CT angio 64-slice– Sensitivitas : 99%– Spesifisitas : 89%– NPV : 100%
• Sensitivitas— LCX : 85%— Ledt coroner : 95%
• Spesifisitas— LAD & LCX : 96%— Left coroner : 100%Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have
coronary heart disease?. Internal Medicine Journal 2011. 41: 5-13.
Gambar 6 : Penyempitan moderat (50-70%) pada arteri koronaria dekstra dengan plak non kalsifikasi yang ekstensif pada CT angiografi (a). Rekonstruksi CT angiogram (b). Invasive Coronary Angiogram (c).
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal 2011. 41: 5-13.
Gambar 7 : Stenosis difus pada arteri koronaria dekstra. CT angiografi menunjukkan kalsifikasi ekstensif dan plak non kalsifikasi (a). Invasive Coronary Angiogram (b).
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal 2011. 41: 5-13.
