New trends in Cardiovascular Imaging

Hatem Alkadhi, MD, MPH, EBCR

Institute of Diagnostic and Interventional Radiology

New trends in Cardiovascular Imaging

synopsis

Automated tube voltage selection

- CT Angiography

Cardiac CT

- Turbo flash mode

CT Angiography

- low contrast media volume examinations

Cardiovascular CT: tomorrow ?

Automated tube voltage selection

Winklehner et al. Invest Radiol 2011;46:767-73

How does it work?

earlier study – CTA of the aorta

fix 120 kVp vs automated tube voltage selection

• SOMATOM Flash (80/100/120/140 kVp)

-18%

Götti et al., AJR 2012; 199:W380-5

Automated tube voltage selection

Study with SOMATOM Force on 40 patients

follow-up CTA of the aorta

Previous CT in the same patients with SOMATOM Flash

identical CTA-protocol

• CAREkV, 100 ref kVp, 90 ref mAs

identical contrast media protocol

• 80ml Ultravist® 300: 25 ml @ 5 ml/s and 45 ml @ 2.5 ml/s

Automated tube voltage selection

FLASH FORCE

FLASH FORCE

-19%

Winklehner et al. Eur Radiol 2015;25:2346-53

Automated tube voltage selection

FLASH FORCE FLASH FORCE

CNR: +20%

FLASH FORCE

Winklehner et al. Eur Radiol 2015;25:2346-53

Automated tube voltage selection

100 kVp 90 kVp

dose: -22%

Winklehner et al. Eur Radiol 2015;25:2346-53

Automated tube voltage selection

synopsis

Automated tube voltage selection

- CT Angiography

Cardiac CT

- Turbo flash mode

CT Angiography

- low contrast media volume examinations

Cardiovascular CT: tomorrow ?

ex-vivo experiment: moving phantom with coronaries

Morsbach et al. Eur Radiol 2014;24:1889-95

Cardiac CT

bpm

in-vivo study

Morsbach et al. Eur Radiol 2014;24:1889-95

Cardiac CT

40 ml Ultravist® 370 @ 5 ml/sec

Cardiac CT - example

37-year-old man w atypical chest pain

Cardiac CT – higher heart rates - example

Klingenberg et al., Eur Heart J 2015;36:1001

op

tica

l co

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rence to

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, 83bpm, spiral mode, 4.1mSv

synopsis

Automated tube voltage selection

- CT Angiography

Cardiac CT

- Turbo flash mode

CT Angiography

- low contrast media volume examinations

Cardiovascular CT: tomorrow ?

Single-energy CTA – kVp dependent CM protocol

Higashigaito K, et al. Invest Radiol 2015 Dec 5. [Epub ahead of print]

Single-energy CTA – kVp dependent CM protocol

Higashigaito K, et al. Invest Radiol 2015 Dec 5. [Epub ahead of print]

coronary artery bypass grafts

Single-energy CTA – kVp dependent CM protocol

Higashigaito K, et al. Invest Radiol 2015 Dec 5. [Epub ahead of print]

coronary artery bypass grafts

Single-energy CTA – kVp dependent CM protocol

Higashigaito K, et al. Radiology 2016, in press

CTA of the aorta with high-pitch

Dual-energy approach – mono +

Meier A, et al. Clin Radiol. 2015 Jul 28 [Epub ahead of print]

conventional monoenergetic reconstruction

mono +

Dual-energy approach – mono +

• CT pulmonary angiography with15 ml CM (400 mg/ml)

Dual-energy approach – mono +

• CT pulmonary angiography with15 ml CM (400 mg/ml)

synopsis

Automated tube voltage selection

- CT Angiography

Cardiac CT

- Turbo flash mode

CT Angiography

- low contrast media volume examinations

Cardiovascular CT: tomorrow ?

Adenosin MRI

Adenosin CT (40 ml contrast media, 70 kVp, 2.5 mSv)

Functional imaging: myocardial perfusion with CT

Courtesy of T. Henzler, Unversitätsmedizin Mannheim, Germany

Functional imaging: dynamic CT angiography

summary

Automated tube voltage selection

- optimization of CTA, lowering of radiation dose

Cardiac imaging

Ultra high-pitch up to 75 bpm @ 0.2-0.3 mSv

Low CM protocols

dual-energy or single-energy approaches