Angiography

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Angiography
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Outlines

• Introduction
• X-ray aniography
• CT angiography
• Ultrasound angiography
• MR angiography
• Neuclear angiography

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Introductionwhat is angiography?

• An imaging technique used to visualize the blood
  vessels

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When to be used?

• One of the reasons is to detect atherosclerotic
  (plaque) disease in a blood vessel

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Angiography imaging system

• Contrast agent
• Catheter
• Cathetarization lab

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Outlines

• Introduction
• X-ray aniography
• CT angiography
• Ultrasound angiography
• MR angiography
• Neuclear angiography

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X-ray angiography
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How does it work?

• Injecting contrast agent to blood stream
• Acquiring high contrast images .
• Excellent resolution (100 µm).
• visualize blood vessels and organs of the body

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X-ray angiography image
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X-ray angiography image
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Why is x-ray angiography done

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Why x-ray angiography is done?

• X-ray angiography is performed to specifically
  image and diagnose diseases of the blood vessels
  of the body, including the brain and heart.
• Therapeutic Angiographic Procedures.

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• X-ray angiography is performed to specifically
  image and diagnose diseases of the blood vessels
  of the body, including the brain and heart.

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• X-ray angiography is performed to specifically
  image and diagnose diseases of the blood vessels
  of the body, including the brain and heart.
• Therapeutic Angiographic Procedures.

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Contrast Agent

• Maximum contrast for minimum administrated dose.
• iodine Based contrast agent
• Iodine based contrast media are usually
  classified as ionic or non-ionic.

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X-ray parameters

• Diagnostic X-ray.
• 15 150 kV, recti?ed AC
• 50 400mA anode current
• tungsten wire (200 µm) cathode, heated to
  2200?C
• anode rotates at 3000 rpm

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Techniques

• For all structures except the heart, the images
  are usually taken using a technique called
  digital subtraction angiography (DSA).

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Digital subtraction angiography
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Complications

• Major complications
• Cardiac arrhythmias , kidney damage,
  hypotension and pericardial effusion.
• Minor complications
• Bleeding , blood vessel damage and allergic
  reaction to the contrast.

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Outlines

• Introduction
• X-ray aniography
• CT angiography
• Ultrasound angiography
• MR angiography
• Neuclear angiography

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Intravascular Ultrasound angiography(IVUS)
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Ultrasound basics

• Ultrasound is based mainly on pulse echo
  technique
• To get the source of echo---gtd c(dt)/2 ,
  c1540m/s

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IVUS introducing the problem

• What's problem with typical angiography ?

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IVUS Basic idea

• IVUS is a tomographic imaging technique

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IVUS image

• What is expected to be seen?
• 1-the adventitia
• 2-the media
• 3-the intima
• 4-the lumen

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System's hardware

• Catheter
• sizes range between 2.6-3.5 French (0.87-1.17 mm)
  compatible with a 6F guiding catheter
• Pullback device
• console

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how image is acquired?
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IVUS image,cont.

• Image modes
• Typical 2-D image

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IVUS image,cont.

• Image modes
• L-Mode image

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Image artifacts

• calcium shadow

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Image artifacts ,cont.

• Coronary pulsation (motion artifact)

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Benefits and limitations

• Benefits
• Cross sectional view
• non ionizing radiation
• No contrast agent is needed
• Limitations
• invasive
• Resolution (gt150 um)
• Catheter size

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Outlines

• Introduction
• X-ray aniography
• CT angiography
• Ultrasound angiography
• MR angiography
• Neuclear angiography

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Magnetic resonance angiography(MRA)
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MRA categories

• Its divided into 2 categories
• 1- flow dependant MRA
• 2-flow independent MRA

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Flow dependant MRA

• A- TOF MRA
• B- PC MRA

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TOF MRA pulse sequence
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TOF MRA image
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PC MRA
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Flow Independant MRA

• CE MRA
• Contrast enhanced MRA uses gd chalate as contrast
  decreases makes its transverse magnetization
  small which we will increase repetition time

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Flow independent MRA image
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Outlines

• Introduction
• X-ray aniography
• CT angiography
• Ultrasound angiography
• MR angiography
• Neuclear angiography

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Neuclear angiography
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Introduction

• A Nuclear angiography  is a time-proven nuclear
  medicine test designed to evaluate the function
  of the right and left ventricles of the heart,
  thus allowing informed diagnostic intervention
  in heart failure.
• Nuclear angiography is typically ordered for the
  following patients
• Known or suspected coronary artery disease, to
  diagnose the disease and predict outcomes
• With lesions in their heart valves
• With congestive heart failure
• Who have had a cardiac transplant

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Introduction,cont.

• Nuclear angiography involves two techniques
• First pass radionuclide angiography (FPRNA)
• Gated blood-pool imaging (GBPI)
• GBPI is more widely used than FPRNA because
  multiple projections are possible and because the
  effects of various interventions can be assessed.
  Also, most laboratories have a single-crystal
  Anger camera, which is better suited to GBPI.

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First pass radionuclide angiography (FPRNA)

• radionuclide technetium 99m pertechnetate is used
  in FPRNA because it remains in the intravascular
  and extracellular spaces.
• The camera is appropriately positioned against
  the chest and a bolus of radionuclide injected
  rapidly into a vein.
• The bolus passes freely through the right side of
  the heart, lungs, left atrium and left ventricle
• The changes in radioactivity with passage of the
  bolus through the heart can be stored in a
  computer, which can then be instructed to display
  a time-activity curve of the particular section
  of the heart under study.
• Analysis of these time activity or recirculation
  curves facilitates detection of both
  left-to-right and right-to-left shunts

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First pass radionuclide angiography (FPRNA),cont.

• With FPRNA, pulmonary transit times can be
  measured by recording the time between the
  appearance of the bolus of radionuclide in the
  right ventricle and its appearance in the left
  ventricle.
• FPRNA can also be used to determine right-left
  stroke-count ratios and ventricular volumes at
  different stages of the cardiac cycle.
• On first pass the highest resolution for
  assessing regional wall motion is obtained with a
  multi crystal camera, which has a high temporal
  but a poor spatial resolution

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Gated blood-pool imaging

• Patients are injected first with a tin
  preparation that adheres to the red blood cells
  and then with 99mTc, which labels those cells.
• Gated studies can be performed in conjunction
  with, but following, FPRNA.
• A high count rate permits high spatial
  resolution.
• Separation of the images of the cardiac chambers
  depends critically on the position of the patient
  and the camera.
• In GBPI, data collection is "gated" to the R wave
  of the electrocardiogram, and the time from one R
  wave to the next is divided into a series of
  intervals or frames.
• The main use of GBPI is in the evaluation of many
  facets of coronary artery disease, such as the
  detection of myocardial ischemia with stress.

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Gated blood-pool imaging,cont.

• The assessment of biventricular performance
  during exercise is one of the more exciting uses
  of nuclear cardiology. It can be performed with
  the patient either upright or supine on a bicycle
  and is the first technique to allow continuous
  assessment of ventricular function while many
  different interventions are made.
• The patient exercises for 3 minutes at increasing
  workloads the first minute allows for
  stabilization of the heart rate the next 2
  minutes allows for data collection.

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Advantages and drawbacks of Nuclear Angiography

• Radionuclide techniques are useful alternatives
  or complements to conventional and invasive
  investigations of the heart.
• One advantage of measurements from FPRNA is an
  acceptably low intrinsic variability (5) for
  sequential long-term evaluation of patients with
  cardiac diseases.
• evaluation of many facets of coronary artery
  disease, such as the detection of myocardial
  ischemia with stress.
• A major limitation of GBPI is the need for an
  appropriate correction for background activity,
  which can be up to 50 of the activity from
  regions of the left ventricle.
• Serial studies require repeated injections, which
  increase background activity and the patient's
  exposure to radiation, thus limiting the ability
  to use multiple projections or multiple
  physiologic or pharmacologic interventions.

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Thanks for listening