Multispiral computed tomography is a large-scale study of the heart arteries using a special multispiral sixty-four-slice computed tomograph with intravenous bolus injection of a radiopaque agent in large volumes (one hundred milliliters) and synchronization with the work of the heart. This analysis is virtually non-invasive, unlike standard x-ray selective angiography, except for the use of an intravenous catheter to inject a contrast solution, and does not require any more manipulations. The analysis is carried out as soon as possible, absolutely all stages of the procedure take no more than ten minutes. But the information obtained allows us to assess the general condition of the vascular bed and walls, to determine the features or defects in the formation of blood vessels.
MSCT of the coronary arteries begins with an assessment of the level of atherosclerotic lesions of the coronary arteries themselves. If a high calcium index is found, in other words, the volumetric value of the number of calcium in the walls of blood vessels is more than four hundred units, then it is not worth conducting research, because it is obviousthe presence of palpable stenoses that require selective coronary angiography.
What does the procedure allow you to see?
MSCT of the coronary arteries makes it possible to obtain information not only about the general condition of the arteries, but also to evaluate the aorta of the chest, as well as the pulmonary artery, and at the same time quickly, without problems, exclude or, on the contrary, confirm some conditions: aortic dissection, acute coronary syndrome and other ailments. If you quickly identify these ailments, then it is possible to start treating a person in a timely and correct manner, otherwise ailments can lead to quick death.
MSCT of the coronary arteries of the heart makes it possible to examine valvular structures, determine whether there are myocardial lesions, determine the general condition of the heart cavities and pericardium. Another procedure provides information on determining the systolic function of the myocardium with the establishment of zones of impaired contractility. The procedure is also valuable in that it makes it possible to conduct a morphological assessment of the plaque, without the use of invasive intravascular ultrasound.
Why is the procedure the best of its kind?
A large number of studies were conducted, where independent experts took part. They took for comparison the results of multislice computed tomography of the coronary arteries and coronary angiography. Analysis of the data obtained showed that MSCT has a high sensitivity and specificity, and the result is close to almost 100%. The resulting 3D model during image reconstruction is indispensable in establishing anomaliesdevelopment of coronary arteries and other vessels, arteriovenous fistulas.
What is this examination - MSCT? The procedure allows assessing the state of shunts after coronary artery bypass surgery, as well as under certain conditions, after stent implantation. It turns out that the procedure combines the capabilities of a pair of diagnostic methodologies at the same time: coronary angiography, echocardiography, cardiac MRI and intravascular ultrasound.
What are the indications for the procedure?
For MSCT of the coronary arteries, the indications will be as follows:
- there is a suspicion of atherosclerotic lesions of the coronary arteries;
- there is a suspicion of an anomaly in the formation of the coronary arteries;
- establishment of significant stenosis of the coronary arteries in ischemic heart disease;
- control of patency of coronary stents, coronary bypass grafts.
In what areas does this procedure apply?
You understand what kind of examination - MSCT, but do not know in what areas it is used. This is:
- define coronary atherosclerosis to quantify calcification;
- non-invasive coronary angiography;
- assessment of the anatomy and performance of the heart muscle in congenital malformations;
- non-invasive shuntography;
- angiography of the aorta, peripheral veins and so on.
What are the restrictions and contraindications?
MSCTcoronary arteries are difficult to assess for arteries that have pronounced calcification, small caliber (less than a couple of millimeters). Difficulties will arise if previously there was a study of installed stents, the diameter of which is less than two and a half millimeters, as well as in overweight patients. The study of coronary arteries on tomographs in people with an abnormal heart rhythm will not bring the desired results. It may be atrial fibrillation, frequent extrasystoles.
Yes, state-of-the-art 265-slice tomographs have been created that reduce the radiation dose to patients due to improved scan times, but this did not change the diagnostic capabilities in the least with pronounced calcium in the arteries, because the very principle of detecting an ailment by detectors remained the same.
The presence of calcium in the wall of the artery, where progressive atherosclerosis is observed, as well as a number of calcium metabolism disorders, cause "illumination" of the arterial lumen during the procedure, and this just makes it difficult to assess the level of damage to the presented area. Therefore, MSCT of the coronary arteries is performed with the introduction of intravenously specialized iodine-containing contrast, which means that preliminary monitoring of renal function is required, and sometimes even special initial preparation. If impaired renal function is pronounced, then it is best to choose an alternative study, because manifestations of allergic reactions to contrast are frequent. You should also not forget that iodine-containing contrast interacts adversely with metformin. That's whyyou will need to cancel metformin two days before and after the procedure.
It is forbidden to perform the procedure during pregnancy, as the study is directly related to X-ray exposure.
Some nuances
If you properly prepare the patient for the procedure and give the necessary recommendations for the study, then the analysis is safe for the patient, and the doctor himself will receive highly informative results that are no different in productivity from invasive studies.
Such modern diagnostics is an excellent alternative to invasive coronary angiography in the field of studying diseases of the coronary and other arteries. The procedure also has a number of advantages: non-invasiveness, no need for hospitalization and the possibility of obtaining information about other cardiovascular structures. To establish indications for the procedure, a preliminary consultation with a cardiologist will be required.
When is the procedure justified?
MSCT of the coronary arteries with contrast is performed to determine calcification and is justified in such situations:
- A study is underway on men who are now between forty-five and sixty-five and women between fifty-five and seventy-five. Also, they should not have established cardiovascular ailments. The procedure is used for the purpose of early detection of the initial features of coronary atherosclerosis.
- Screening for coronary calcification can be used as a routine diagnostic test inoutpatient clinics in patients who are under sixty-five years of age and have non-characteristic chest pain in the absence of a diagnosis of coronary artery disease.
- Screening for coronary calcification can be used as an adjunct in patients under 65 with inconsistent exercise test results and no diagnosis of CAD.
- The presented technique can be used to make a differential diagnosis.
Current issue
The procedure makes it possible not only to examine the scheme of the coronary arteries of the heart, but also to assess the patency of coronary stents. Stents are quite visible during the procedure, but they have metal parts that complicate the internal lumen during examination. Now new models of devices use the thinnest sections and improved imaging algorithms in practice, and this significantly improves the visualization of all lumen of the stents, and at the same time you can see a complete detailed diagram of the coronary arteries of the heart.
MSCT or CT?
Based on the principle of the procedure of going to a conventional computed tomography. The technique is based on X-ray scanning through tissues and the establishment of a reflected signal thanks to special detectors. MSCT is now more accurate and safer than helical CT, because MSCT scans organs very quickly, and the radiation dose is reduced by 30%. To date, the Scandinavian He alth Center usesthe unique AquillionPrime tomograph, which gives you the opportunity to get good images with minimal workload.
High sensitivity and excellent accuracy of readings are achieved through the use of a device that makes layer-by-layer scanning of the heart and blood vessels. The emitter moves in a circle, along and thus describes a spiral. Such shooting from all angles allows the doctor to receive 3D images of the arteries, where the slightest deviations are visible in detail. A clear visualization is provided by the use of contrast, which contains iodine. The contrast is injected into the patient, and the drug itself increases the reflectivity of the rays, which improves the information content of the study.
How is the procedure done?
Are you wondering how MSCT of the coronary arteries is performed? The first thing you need is a referral from your doctor or cardiologist. Special preparation is not required, however, six hours before the procedure, it is better to refrain from eating, smoking and caffeine. If at the same time the patient takes special antihypertensive or antiarrhythmic drugs, then he takes them as expected.
It is best to calm down before the procedure: the optimal heart rate for the study should be no more than seventy beats per minute.
Preliminary measures:
- Is the patient's pulse high? Then you need to correct it with drug therapy, contact a cardiologist with a problem.
- Is the person allergic to iodine? Then you will need to consult an allergist and agree with the doctor.taking antiallergic drugs.
- Before the procedure, you need to undress, remove all jewelry.
- The nurse will insert a catheter into the cubital vein, through which the contrast will be injected.
During the procedure, you will need to lie still on the CT scanner table on your back. The duration of the study takes from ten to fifteen seconds, while the patient will have to hold his breath. During the procedure, a special ECG synchronization will be used, a pulse oximeter will be connected.
Important nuance! During the procedure, you need to try not to move, not to worry, the heart muscle should contract at a calm and even pace.
When conducting a study, there is no one in the office except the patient himself, the doctor observes with the help of two-way communication. If a person has discomfort, he can tell the doctor about it.
The results of the procedure are given to the patient in the form of images and a description of the information obtained is also attached, which are recorded on a CD.
What does the transcript show?
Deciphering the results of MSCT of the coronary arteries does not take much time, it all depends on which department or organ was scanned. The pictures taken are decoded from one hour to a day, in many cases the procedure takes a couple of hours.
The study shows all the signs of pathological changes in any organ at the initial stage, allows you to track the consequences of injuries or observe the dynamics of treatment. Decryption is carried out exclusivelyqualified doctor, you will not be able to do it yourself, you will need to know the nuances. For example, the main features of the presence of cirrhosis of the liver are the uneven edges of this organ and its increased size. However, a non-specialist will most likely not notice cirrhosis on negatives at all.
Where can I go for help?
MSCT of the coronary arteries in Moscow is not the most common thing. There are good clinics where specialists perform this procedure. You will need to pre-register for the study, because there is a line of people who also need this study for one reason or another. If necessary, you can read reviews about the procedure on the website of the clinic where MSCT of the coronary arteries is performed, and then navigate them: use the services of this institution or you should look for a better option. The choice of institutions is quite extensive.
