CT Kardiak

CT Kardiak
Screening PJK
Cepat dan non invasif

Sutton D. Textbook of Radiology and Imaging. 7th edition. London: Elsevier Science; 2003.

Jenis
Calcium score screening heart scan
Coronary CT angiography (CT)
Total body CT scan.

Web MD. Diagnosing Heart Disease With Cardiac Computed Tomography (CT) [internet]. [cited
2014 Jul 21]. Available from: http://www.webmd.com/heart-disease/guide/ct-heart-scan.

Gambar 1 : CT
scan nonkontras
thoraks.
Terdapat
kalsifikasi pada
left anterior
descending
artery/LAD
(tanda panah).
Selain itu,
terdapat hiatus
hernia dan
kalsifikasi
pleura yang
mengindikasika
n paparan
terhadap asbes

Sutton D. Textbook of Radiology and Imaging. 7th edition. London: Elsevier Science; 2003.

Gambar 2 : Gambaran CT
potongan aksial
menunjukkan penyakit
aterosklerosis pada left
anterior descending/LAD dan
arteri sirkumfleksa
sinistra/LCX (tanda panah)
yang merupakan bukti
adanya kalsium

Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011

Indikasi

Nuclear stress test tidak membantu

Anomali koroner atau jantung
Patensi bypass graft
Aterosklerosis, emboli paru, diseksi
aorta (three scan)

Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011.
Herring W. Learning Radiology: Recognizing the Basics. 2 nd edition. Philadelphia: Mosby
Elsevier; 2007.

Kontras

Patensi PD, thrombus, plak

Kelainan anatomi : diseksi, emboli
4-5 ml/detik
IV Catheter uk. 18/20

Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd edition. New York: McGraw Hill; 2011.
Herring W. Learning Radiology: Recognizing the Basics. 2 nd edition. Philadelphia: Mosby
Elsevier; 2007.

Tipe plak
Non-calcified
Gambar 3 : CT angiografi
koroner pada plak yang tidak
mengalami kalsifikasi. Plak
non-kalsifikasi ditemukan
pada segmen tengah dari left
anterior descending artery

Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges.
The British Journal of Radiology 2012. 85: 495510.

 Calcified

Sun Z, Choo GH,

Ng KH. Coronary
CT angiography:
current status and
continuing
challenges.
The
British Journal of
Radiology 2012.
85: 495510.

Gambar 4 : CT
angiografi koroner
pada plak yang
mengalami
kalsifikasi. Proeksi
CT menunjukkan
plak kalsifikasi fokal
di segmen proksimal
arteri koronaria
dekstra (a).
Angiografi koroner
menunjukkan
stenosis ringan
lumen koroner
[tanda panah di (b)].
Plak kalsifikasi yang
ekstensif dapat
ditemukan pada
segmen proksimal
dan tengah dari left
anterior descending
(LAD) (c) dan (d).
Stenosis di LAD
pada saat dilakukan

 Mixed

Sun Z, Choo GH, Ng KH.

Coronary
CT
angiography:
current
status and continuing
challenges. The British
Journal of Radiology
2012. 85: 495510.

Gambar 5 : CT
angiografi koroner
menunjukkan plak
campuran. Plak
campuran dapat
ditemukan di segmen
proksimal dari left
anterior descending
(LAD) dengan stenosis
> 50% (tanda panah
di a). Angiografi
koroner
mengkonfirmasi
stenosis LAD (tanda
panah di b).

Cara kerja CT

Gambar : 10-20 dt
Durasi : 15-30 menit
HR : 60-65x/menit
KI : aritmia, tachycardia
-blocker kontras IV nitrogliserin
sublingual
Interval R-R (mid to late diastole) lambat
Fokus : lumen dan dinding
Plak > 1 mm
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the
investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal
2011. 41: 5-13.

Kelebihan
Biaya << ICA
Komplikasi << ICA (kerusakan PD,
plak terlepas)

Lazoura O, Vlychou M, Vassiou K, Rountas C, Ioannis F. 128-Detector-Row Computed

Tomography Coronary Angiography Evaluating Coronary Artery Disease: Who Avoids Cardiac
Catheterization?. Angiology 2010. 2(61): 174-178.
Rajani R, Brum RL, Preston R, Carr-White G, Berman DS. Coronary computed tomography
angiography for the evaluation of patients with acute chest pain. The Int J Clin Pract 2011.
65(12): 1267-1273.

Kekurangan
Resolusi spasial terbatas
keparahan stenosis
KI : aritmia, fibrilasi, alergi
Artefak (kalsifikasi tebal, gerak nafas
dan jantung)
Hanya kelainan anatomis
Kontras : toksisitas renal, alergi
Lazoura O, Vlychou M, Vassiou K, Rountas C, Ioannis F. 128-Detector-Row Computed Tomography Coronary Angiography Evaluating Coronary
Artery Disease: Who Avoids Cardiac Catheterization?. Angiology 2010. 2(61): 174-178.
Rajani R, Brum RL, Preston R, Carr-White G, Berman DS. Coronary computed tomography angiography for the evaluation of patients with acute
chest pain. The Int J Clin Pract 2011. 65(12): 1267-1273.
Yerramasu A, Venuraju S, Lahiri A. Evolving role of cardiac CT in the diagnosis of coronary artery disease. Postgrad Med J 2011. 87:180-188.

Sensitivitas & Spesifisitas

18 studi 1313 sampel
CT angio 64-slice
Sensitivitas : 99%
Spesifisitas : 89%
NPV : 100%

Sensitivitas
LCX : 85%
Ledt coroner : 95%

Spesifisitas
LAD & LCX : 96%
Left coroner : 100%
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have
coronary heart disease?. Internal Medicine Journal 2011. 41: 5-13.

Gambar 6 : Penyempitan moderat (50-70%) pada arteri koronaria

dekstra dengan plak non kalsifikasi yang ekstensif pada CT angiografi
(a). Rekonstruksi CT angiogram (b). Invasive Coronary Angiogram (c).
Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the
investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal
2011. 41: 5-13.

Gambar 7 : Stenosis difus pada arteri koronaria dekstra. CT angiografi

menunjukkan kalsifikasi ekstensif dan plak non kalsifikasi (a).
Invasive Coronary Angiogram (b).

Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the
investigation of patients suspected to have coronary heart disease?. Internal Medicine Journal
2011. 41: 5-13.