CT Scan s Look Inside the Heart

Coronary artery calcification - KHK CAC-Scores - Untersuchungsmethoden Budoff Circulation 2006

Coronary artery calcification CAC-Scores 0 = none 1-400 = mild to moderate 401-1000 = severe > 1000 = very severe modifizierter Rumberger-Score Mayo Clin Proc 1999

Computertomografie - Technik

Electron Beam CT - Technik

Herz-CT: Technik

Herz-CT: Technik Alkadhi Herz CT Buch

Dual source CT

Coronary artery calcification CAC-Scores Chertow et al. Kidney Int. 2002;62:245-252 (TTG)

Comparison of Agatston and volume score Agatston score Obtained by multiplying the calcium area by a number related to density ( density factor ) Interscan variability: 8 to 10% Volume score Using additional interpolated slices providing higher resolution Interscan variability: 6 to 8% Vessel lumen Calcified plaque area=a; density=d Chertow et al. Kidney Int. 2002;62:245-252 (TTG) Budoff et a. Circulation 2006;114

Coronary Calcium Measurement: Scoring System Mean Relative Rescan Differences and Reproducibility Coefficients for Each Scanner Type according to Calcium Measure Detrano CD Radiology 2005

Coronary Calcium Measurement: CT-Scanner Type Transverse electron-beam (top) and multi detector row (Lightspeed Plus) (bottom) CT scans show typical images of heart and of calibration phantom placed appropriately below thorax. Arrows indicate four cylindrical bars containing known concentrations of hydroxyapatite (0, 50, 100 and 200 mg/ml). Image attenuation was adjusted by comparing measured attenuation in bars with predetermined attenuations corresponding to known densities of hydroxyapatite. Detrano CD Radiology 2005

Coronary Calcium Measurement: CT-Scanner Type Comparison of Mean Absolute Rescan Differences for Calcium Measures according to Scanner Type and Agatston Score Detrano CD Radiology 2005

Coronary Calcium Measurement: CT-Scanner Type - Scoring System Scatter diagrams show rescan difference plotted against (a) Agatston score, (b) calcium volume, and (c) interpolated volume score for both scans. Rescan differences increase with extent of calcium and are comparable for all three calcium measures. Lines on each diagram show limits of reproducibility and indicate boundaries within which rescan differences fall 95% of the time. Corresponding reproducibility coefficients are 0.226, 0.224, and 0.209 for Agatston score, calcium volume, and interpolated volume score, respectively. Detrano CD Radiology 2005

CT - Strahlendosis Untersuchung Strahlendosis (msv) Faktor x Rö-Thorax 0,02 natürliche Strahlung 2,1 105 CCT 1,5-1,7 85 Mammographie 3 150 CT-Abdomen 5,3-10 500 CT-Thorax 5,8-8 400 CT-Thorax - Becken 9,9 500 Transatlantikflug 0,1 5 1 Zigarette 0,07 3,5 Herz-CT 12 600

Welche Bildgebung? 3.3.1. Bei Patienten in den Stadien 3-5D einer chronischen Nierenerkrankung schlagen wir vor, dass eine konventionelle laterale Abdomen-Röntgenaufnahme zum Nachweis oder Ausschluss von Gefäßverkalkungen sowie eine Echokardiographie zum Nachweis oder Ausschluss von Herzklappenverkalkungen als sinnvolle Alternativen zur CTbasierten Bildgebung eingesetzt werden können (2C). 3.3.2. Wir schlagen vor, dass Patienten in den Stadien 3-5D einer chronischen Nierenerkrankung mit nachgewiesenen Gefäß- bzw. Herzklappenverkalkungen als kardiovaskuläre Hochrisikopatienten betrachtet werden (2A). Es erscheint sinnvoll, diese Information im Therapiemanagement von Störungen des Knochen- und Mineralstoffwechsels zu berücksichtigen (ohne Graduierung).

Konventionelles Röntgen

Echokardiographie