0:00

All right.

0:02

Let's move along to case number six.

0:05

This is a case of a cardiac CT.

0:08

So it is ECG dated.

0:13

The patient's heart rate was slowed

0:16

with beta blockers so that we could look closely at

0:20

the coronary arteries. And in this case because the

0:23

heart rate was mildly elevated.

0:26

above what we like to have at we

0:29

acquired the data using a retrospective

0:35

methodology as opposed to prospective prospective is

0:38

a lower radiation dose, but it only gives

0:41

you data in a small fraction of

0:44

the cardiac or

0:47

to our interval.

0:49

So if there is motion related artifact in the coronary arteries,

0:52

you may be unable to

0:55

clarify that artifact on other phases

0:58

determine if there is any significance

1:01

stenosis or not. So retrospective is

1:04

used in our institutions when

1:07

the heart rate is above about

1:10

65 beats per minute. So this was done in retrospective

1:13

mode.

1:15

And one of the benefits of retrospective mode is that you can actually do sin

1:18

a image just as seen on the

1:21

right hand Series. This is a cine reconstruction and

1:24

the four chamber View.

1:26

the image on the left

1:28

Is a curved multiplaner?

1:31

reconstruction

1:33

and see if you can identify the abnormalities and

1:36

how you might summarize the pathology in

1:39

this case.

1:42

Let me just give you a few minutes a few seconds.

1:50

All right, let's start with that curved multiplayer

1:53

reconstruction on the left.

1:56

This is the lad. That's the first

1:59

test. What what vessel is

2:02

it? We can see that it's coursing alongside

2:06

a very thick muscle we can

2:09

see the mitral valve or a

2:12

Val a atrial ventricular valve in

2:15

this case the mitral valve. This would

2:18

not be consistent with a circumflex despite the

2:21

circumflex. Usually of course alongside the thick LV and

2:24

it's not consistent with the RCA. So this is the LED

2:27

we identify clearly the

2:30

patient has some disease.

2:33

And there's a lot of calcification. Sometimes

2:36

the severity of calcification alone precludes aluminum

2:39

assessment. In this case. We see

2:42

a combination of both.

2:44

calcified and non-calcified plaque

2:47

I'm showing you a representative image our job as

2:50

as imagers is to make stenosities disappear using

2:53

whatever tools we have.

2:56

And in this case, we could not make this disappear and

2:59

this we interpreted as a high grade stenosis

3:02

of the proximal lad.

3:07

Now we turn our attention to the movie.

3:10

and

3:11

Appreciate the effect of that high grade

3:14

stenosis, there is thinning and hypokinesis.

3:17

In fact this kinesis.

3:20

Of the true LV Apex it's bulging out

3:23

during systole, which is disconces. There's also

3:26

this small filling defect in the

3:29

LV Apex and that is thrombus. So two

3:32

important findings are that this

3:35

patient has severe

3:38

obstructive proximal lad stenosis and

3:44

apical dyskinesis or an apical aneurysm with

3:47

a small LV thrombus