Functional CT Imaging of Coronary Heart Disease

Explore functional CT imaging techniques for coronary heart disease in this comprehensive lecture by Dr. U. Joseph Schoepf, Associate Professor at the Medical University of South Carolina. Delve into the accuracy of standard dose CCTA and learn about advancements in reduced dose imaging, including prospective ECG triggering and low kV techniques. Discover the benefits of iterative image reconstruction and how it improves specificity for stenosis detection. Examine the prognostic value of CT imaging and compare anatomical vs. functional testing approaches. Investigate various CT modalities for myocardial perfusion imaging, including dual-energy CT (DECT) and its applications in detecting subtle pathologies and quantifying myocardial blood flow. Gain insights into novel CT markers like extracellular volume fraction for fibrosis assessment. Understand the clinical implications of CT perfusion imaging, its cost-effectiveness compared to SPECT, and the emerging role of CT-FFR in diagnosing coronary artery disease. Conclude with an overview of AI and deep machine learning applications in CT-FFR analysis, providing a comprehensive understanding of the latest developments in functional CT imaging for coronary heart disease.

Intro
Disclosures
Standard Dose CCTA - Accuracy
Core 64
Accuracy - CT vs Other Non-Invasive Tests for CAD DX
Improving on the Baseline
Reduced Dose - Prospective ECG Triggering
Radiation Protection - Low kV
Simple Measures Go a Long Way
Iterative Image Reconstruction
Reduced Calcium Blooming Artifacts
Improved Specificity for Stenosis
Gentle Techniques - TAVR Workup with 40cc Contrast
Prognostic Value
Prognosis: MUSC Outcomes in 458 Patients
Anatomical vs. Functional Testing: PROMISE
CT of Cardiac Function (not that)
Perfusion CT: An Old Idea...
CT Modalities for MPI
CT Myocardial Perfusion Protocols: DECT
Dual-Source CT Based DECT
DECT for Myocardial Ischemia
Morphology and Function: DECT
DECT Post-processing
3rd Gen. DSCT-Based DECT: Radiation-Dose
DECT Can Detect Subtle Pathology
Delayed Enhancement DECT
Extracellular Volume Fraction (ECVF), Novel CT marker for fibrosis
Adenosine vs Regadenoson
Automated Evaluation Software
Quantitative DECT Perfusion
Dynamic Time Resolved Perfusion
Structure / Function: Comprehensive Dx
Absolute MBF Quantification
Solving Clinical Dilemmas...
Monitoring Therapeutic Effects...
3-Vessel Disease: Balanced Ischemia
CT Perfusion vs SPECT - Cost Effectiveness
CT-FFR: Current Approaches - CFD
CT-FFR: The PLATFORM Trial
Cost-Effectiveness & Quality of Life
CT-FFR: AI - Deep Machine Learning
Summary
Thank you!