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The
Department of Imaging Intervention and Radiology at Jaslok
Hospital and Research Centre, Mumbai, India, has state-of-the-art
facilities and highly qualifies faculty. |
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Coronary artery disease is the single largest cause of
mortality & morbidity amongst all diseases. It thereby
places a very high burden on the health infrastructure
of our country. An analysis of the prevalence of coronary
artery disease from the 1960’s to 1990’s revealed
an approximate 9-fold increase in the prevalence of coronary
heart disease in the urban population & a 2-fold increase
in coronary heart disease in the rural population. |
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 An
increasingly sedentary lifestyle, changing food habits
& an ever increasing stressful & competitive work
culture have just multiplied the risk factors for coronary
artery disease.
The need of the hour is a non-invasive, out patient investigation
that accurately diagnoses coronary artery disease early.
CT Coronary angiography plays this role to perfection.
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A
simple, noninvasive method to evaluate the status of the
coronary vessels that supply the heart using an ultrafast
16 slice per rotation Mutislice CT scanner.
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 The
patient is placed on a comfortable CT scanner table.- A baseline Coronary Calcium Score is calculated
within 30seconds.
- A CT angiogram is obtained following contrast injection
in one of the peripheral veins of the hand with online
ECG monitoring.
- All the images are obtained in one single breathhold
of 12-15 secs.
- The entire procedure hardly takes 10 to 15 minutes
after which the patient is ready to continue his/her
routine.
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 Firstly
detection & quantification of calcium within the coronary
vessels. Calcification in the vessel wall is an indicator
of degree of damage that has occurred to the vessels.
A high calcium score is consistent with a moderate to
high risk of coronary artery disease. A negative calcium
score is predictive of a comparatively very low incidence
of coronary artery disease. The coronary arteries are
seen similar to as seen on a regular catheter angiogram. |
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We
can evaluate narrowing of the arteries, blockage of the
arteries, presence or absence of collateral vessels &
presence of different varieties of plaques(wall thickening)
along the arteries causing arterial narrowing.Plaques
can be soft plaques(fatty/fibrous) or calcified plaques.Plaques
can be stable or unstable, rupture of which is a common
cause of sudden death. CT scan can evaluate the types
of plaques & decide the various modes of therapy.The
status of the heart chambers, heart muscles, valves, aorta
& pulmonary vessels can be easily evaluated.
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CT Coronary angiography is an excellent investigation
to assess the patency of stented vessels, postoperative
grafts & to exclude noncardiac causes of chest pain.
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All
the patients with high risk factors are potential candidates. |
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Patients
with strong family history, heavy smokers,diabetics,patients
with high blood pressure, obese patients,patients with
high cholesterol & triglycerides,people with high
stress & high tension jobs, alcoholics, etc. |
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 Changing
lifestyle, dietary habits, less physical activity &
irregular exercise has certainly created a large section
of our society who can be potential heart patients.
Hence, such people usually above the age of 40 should
worry. CT Coronary angiography is capable of showing
& evaluating coronary arteries as good as catheter
coronary angiography.
It may be said that CT Coronary angiography is one step
ahead, enabling radiologists to detect blocks at the
origin of the coronary arteries as well as being able
to comment on the type of plaques visualised in the
arteries(which cannot be done on regular catheter angiography)
& hence comment on the course of treatment.
Thus, CT Coronary angio, is capable of seeing inside
the arteries, seeing the walls of the arteries &
evaluating structures outside the coronary arteries.
CT Coronary angiogram today is an extremely accurate,
reliable, ultrafast, noninvasive, outpatient procedure
which is capable of providing detailed information of
the heart & coronary vessels, thereby giving the
most needed breakthrough in primary evaluation of coronary
artery disease.
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- To measure the amount
of blood passing through a particular part of the
body.
- This is useful in
cases of cerebrovascular insults, brain tumours &
tumours in other parts of the body.
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 To
study the tracheobronchial tree from within &
without using a bronchoscope.- It is useful in children with foreign body aspiration
& in patients in whom bronchoscopy is contraindicated.
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 For
noninvasive evaluation of colonic lesions by just distending
the colon with air & acquiring axial images. Useful
in diagnosing polyps, neoplasms & ulcerative colitis. |
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With
good multiplanar reformatted images, it is useful in suspected
cases of pulmonary thromboembolism. |
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Abdominal
& renal angiography is useful to study tumor vascularity.
Upper & lower limb angiography is useful in cases
of polytrauma where early diagnosis is the need of the
hour. |
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Used
for pre operative planning & post operative evaluation
of brain tumours, aneurysms & A-V malformations.
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To
study inner ear structures with volume rendered images.
Of course, regular studies like those to study the brain,
neck, chest, abdomen & pelvis can be done with unmatched
resolution, at much higher speed & much less radiation
dosage to the patient. In fact, the entire body can
be scanned in 10 seconds.
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- This decreases scan time, increases clarity &
contrast.
- Entire brain can be studied in thirty seconds.
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Excellent for abdominal & cardiac studies.- Entire liver can be studied in one single breath
hold.
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 This
is a revolutionary application of MRI to study the
functional aspects of different body organs.- Diffusion MRI : this shows tissue water mobility.
Excellent for detecting very early infarcts, ischemia,
not seen on routine MRI.
- BOLD : excellent for mapping different centres
like motor cortex, visual cortex, speech area, etc.
highly useful in presurgical localisation of brain
centres.
- Perfusion MRI : can measure cerebral blood volume
(CBV) & cerebral blood flow (CBF). Useful in grading
of tumours, distinguishing viable tumour from necrosis
& edema .
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- Noninvasive method to measure body metabolites &
monitor the biochemistry of acute & chronic stages
of disease.
- Useful for diagnosis of tumor, differentiation
of neoplasm from infarct & infection, to diagnose
type & cause of dementia, localization of epileptic
centre.
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Excellent
noninvasive cerebral, neck, renal, thoracic, abdominal
& peripheral angiogram.
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- Revolutionary near real time MR imaging.
- Can obtain thirty slices (entire brain) in 4 ms.
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Noninvasive myelography in 7 seconds. |
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- Non invasive display of gall bladder, biliary tree
& pancreatic duct in 7 to 20 seconds.
- Sensitivity & specificity equals ERCP.
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Useful for early detection of prostatic malignancy
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- Real time noninvasive cine MR & cardiac studies,
to assess structural & functional cardiac status.
- Perfusion cardiac studies toassess heart function.
Soon, the latest Siemens 32 – channel Avanto MRI
followed by 3 T MRI will be installed in the hospital.
This will open up the entire gamut of high end applications
like Cardiac MRI, Diffusion Tensor Imaging (DTI) &
Total Body Imaging.
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