Multispiral computed tomography is a large-scale study of the cardiac arteries through the use of a special multislice sixty four-slice computed tomograph with intravenous bolus administration of radiopaque 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, only with the exception of 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 in time. But the information obtained allows us to assess the general condition of the vascular bed and walls, to determine the features or defects of 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 detected, in other words, the volume value of the number of calcium in the walls of the vessels is more than four hundred units, then it is not worthwhile to carry out studies, because the presence of palpable stenosis is obvious, which requires selective coronary angiography.
What allows you to see the procedure?
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 breast, as well as the pulmonary artery, and at the same time, quickly, without problems, eliminate or, on the contrary, confirm some conditions: aortic dissection, acute coronary syndrome and others ailments. If you quickly identify these ailments, then a person can be treated promptly and correctly, otherwise ailments can lead to quick death.
MSCT of the coronary arteries of the heart makes it possible to study valve structures, to establish whether there are myocardial lesions, to determine the general condition of the cardiac cavities and pericardium. Another procedure provides information on the determination of systolic myocardial function with the establishment of areas of impaired contractility. The procedure is still valuable in that it makes it possible to conduct a morphological evaluation of the plaque, without the use of invasive intravascular ultrasound.
Why is the procedure the best of its kind?
A large number of studies have been conducted in which independent experts participated. They took for comparison the results of multispiral computed tomography of coronary arteries and coronarography. The analysis of the obtained data demonstrated that MSCT has high sensitivity, specificity and the result is close to almost 100%. The resulting 3D model during image reconstruction is indispensable in establishing anomalies in the development of coronary arteries and other vessels, arteriovenous fistulas.
What kind of examination is MSCT? The procedure allows you to assess the condition of shunts after undergoing coronary artery bypass grafting operations, as well as under certain conditions, after stent implantation operations. It turns out that the procedure combines the capabilities of simultaneously a pair of diagnostic methodologies: coronarography, echocardiography, cardiac MRI and intravascular ultrasound studies.
What are the indications for the procedure?
For MSCT of 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 abnormality in the formation of coronary arteries;
- the establishment of significant stenosis of the coronary arteries with ischemic heart disease;
- patency monitoring of coronary stents, coronary shunts.
In what areas does this procedure apply?
You understand what kind of examination it is - MSCT, but you do not know in what areas it is applied. It:
- determination of coronary atherosclerosis for quantification of 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 limitations and contraindications?
MSCT of coronary arteries is 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 patients with overweight. The study of coronary arteries on tomographs in people with irregular heart rhythms will not bring the desired results. This may be atrial fibrillation, frequent extrasystole.
Yes, ultramodern 265-slice tomographs have been created that reduce the dose of patients due to improved temporal scanning indices, however, this did not change the diagnostic capabilities in the presence of pronounced calcium in the arteries, because the very principle of establishing the disease detectors remained the same.
The presence of calcium in the artery wall, where progressive atherosclerosis is observed, as well as a number of calcium metabolism disturbances, cause the arterial lumen to be “exposed” during the procedure, and this makes it difficult to assess the level of damage to the presented area. Therefore, MSCT of the coronary arteries is carried out with the introduction of an intravenously specialized iodine-containing contrast, which means that preliminary monitoring of renal function, and sometimes even special initial preparation, is required. If renal dysfunction is pronounced, it is best to choose an alternative study, because allergic reactions to contrast are common. Do not forget that iodine-containing contrast adversely interacts with metformin. Therefore, you will need to cancel metformin two days before and after the procedure.
It is forbidden to carry out the procedure during pregnancy, since the study is directly related to x-ray radiation.
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 do not differ in productivity from invasive studies.
Such modern diagnostics is an excellent alternative to invasive coronary angiography in the study of ailments of coronary and other arteries. The procedure also has several advantages: non-invasiveness, lack of need for hospitalization and the ability to obtain information about other cardiovascular structures. To establish indications for the procedure, a preliminary consultation with a cardiologist will be required.
In what cases is the procedure justified?
MSCT of coronary arteries with contrast is performed to determine calcification and is justified in such situations:
- A study is being conducted of men who are now from forty-five to sixty-five years old, and women from fifty-five to seventy-five years old. Also, they should not have cardiovascular ailments installed. The procedure is used to early establish the initial features of coronary atherosclerosis.
- Coronary calcification screening can be used as a routine diagnostic test in an outpatient clinic for patients who are up to sixty-five years old and have uncharacteristic chest pain in the absence of a diagnosis of coronary artery disease.
- Coronary calcification screening can be used as an adjuvant for patients who are not yet sixty-five years old with unconfirmed results of stress tests and in the absence of a diagnosis of coronary artery disease.
- The presented technique can be used to make a differential diagnosis.
Actual problem
The procedure makes it possible not only to consider the scheme of the coronary arteries of the heart, but also to assess the patency of the coronary stents. The stents are pretty well visible during the procedure, but they have metal parts that complicate the internal lumen during the study. Now, new models of devices are applying in practice the thinnest sections and improved image-building algorithms, and this significantly improves the visualization of all stent gaps, and at the same time you can see the full detailed diagram of the coronary arteries of the heart.
MSCT or CT?
According to the principle, the procedure for going to conventional computed tomography. The methodology is based on x-ray scanning through tissues and the establishment of a reflected signal thanks to special detectors. MSCT is now a more accurate and safer study than spiral CT, because MSCT scans organs very quickly, and the radiation dose is reduced by 30%. Today, the Scandinavian Health Center uses a unique AquillionPrime tomography scanner, which makes it possible to obtain good images with minimal load.
High sensitivity and excellent accuracy of readings are achieved through the use of the apparatus, which makes a layered scan of the heart and blood vessels. The emitter moves in a circle, along and thus describes a spiral. Such a survey from all angles allows the doctor to get 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. Contrast is introduced to the patient, and the drug itself increases the reflective abilities of the rays, which improves the information content of the study.
How is the procedure?
Are you curious about how MSCT of coronary arteries is performed? The first thing that is required is a referral from the attending doctor or from a cardiologist. Particular preparation is not required, but six hours before the start of 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 muscle contractions for the study should be no more than seventy beats per minute.
Preliminary measures:
- Does the patient have a high pulse? Then you need to adjust it with drug therapy, consult a cardiologist with a problem.
- Is a person allergic to iodine? Then you will need to consult an allergist and agree with a doctor on taking antiallergic drugs.
- Before the procedure, you need to undress, remove all jewelry.
- The nurse will insert a catheter into the ulnar vein, through which the contrast will be conducted.
During the procedure, you will need to lie still on the tomograph table on your back. The duration of the study takes from ten to fifteen seconds, the patient will have to hold his breath. During the procedure, a special ECG synchronization will be applied, a pulse oximeter will be connected.
An important nuance! During the procedure, you need to try not to move, not to worry, the heart muscle should contract at a calm and uniform pace.
When conducting a study in the office there is nobody but the patient himself, the doctor observes with the help of two-way communication. If a person has unpleasant sensations, he can tell the doctor about it.
The results of the procedure are given to the patient in the form of pictures and a description of the received information is also attached, which is recorded on a CD.
What does the transcript show?
Deciphering the results of MSCT of coronary arteries does not take much time, it all depends on which department or organ was scanned. The taken pictures are decrypted from one hour to a day, in many cases the procedure takes a couple of hours in time.
The study shows all the signs of pathological changes in any organ at the initial stage, allows you to track the effects of injuries or observe the dynamics of treatment. Decryption is carried out exclusively by a qualified doctor, you can not do it yourself, you will need to know the nuances. For example, the main features of the presence of cirrhosis are uneven edges of this organ and its increased size. However, a layman with a high degree of probability will not at all notice cirrhosis on the negatives.
Where to go for help?
MSCT of coronary arteries in Moscow is not the most common thing. There are good clinics where specialists carry out this procedure. It will be required to pre-register for the study, because there is a queue of people who also require this study for one reason or another. If necessary, you can read reviews of the procedure on the website of the clinic where the 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.