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Summary of Cardiac CT in Ischemic Heart Disease in the Setting of Known Coronary Artery Disease

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So thank you for, uh, attending this course.

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I hope we found it useful.

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Uh, we tried to focus on the concepts we touched on in the

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introduction and, uh, hammer that home with a lot of cases.

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Just in summary, a few points that I think,

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uh, important to remember.

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Um, really recommend that you know

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and use the cadrad classifications

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to speak a common language

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and to do that across your service for all readers.

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Um, multiplanar reformatted images,

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and if you have them, curve planar reformatted

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images should be interpreted.

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So don't just use axial or Corona sal images.

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Uh, stenosis grading is inherently imprecise, so we try

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to bucket things into broad categories.

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As you've learned with Cadres 2.0, invasively, FFR

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and I-F-R-D-F-R, all those other ones are ways

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that functional significance can be assessed.

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You need to know about that

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and know what your local lab does,

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and then know how you might dovetail with that.

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Calcium scoring can be helpful.

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We talked a lot about the role of seeing calcium

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for CT for planning.

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It's never enough if you have symptoms, but it's an adjunct.

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So we do an non-con scan, but we never stop there.

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You must do the CTA myocardial

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function and profusion can help.

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Um, both looking at CT images,

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we looked at the wall thickness,

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we looked at profusion at first pass.

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We also looked, uh, at some cases

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where function was assessed.

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And that's an adjunct

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and it can be helpful if cts run into limitations

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of its spatial, uh, resolution.

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Um, so it's, it's an important adjunct when you have it

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and you always at least have some look at, uh,

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static first pass perfusion.

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'cause every CTA is also a look at the myocardium.

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And then, um, those functional images as well as the FFR,

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the IFR, the C-T-F-F-R-F-F-R ct, just another way to say it,

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um, those can help identify the vessel territory

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of interest when there is a ambiguity about what's the

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significant lesion.

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And then just to remember

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that we talked a lot about chronic total occlusion.

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Those are cases where you know, the anatomy

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before you do the ct.

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So you're just looking to work through your algorithm to add

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that additional information

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and insight for your invasive angiographers.

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So thank you for your attention

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and we hope you enjoyed the course.

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Faculty

Brian Ghoshhajra, MD, MBA, MSCCT

Academic Chief, Cardiovascular Imaging and Associate Chair, Operations Analytics

Massachusetts General Hospital / Harvard Medical School

Tags

Vascular

Coronary arteries

Cardiac

CTA

CT

Angiography