Thread by @FCademartiri

Tips and Tricks about Calcium and Coronary CT.

First of all: do not be scared about calcium.
- Calcium is par of the disease you are studying
- Calcium is significant information
- Calcium is not just a number (is a pattern, a phenotype, a study of the patient).

1

https://twitter.com/FCademartiri/status/1516725662576529415

Coronary calcifications, then, are meaningful information. Describe them and use them to create the map for the CTA both imaging-wise and reporting-wise.

E.g.: a dominant pattern of calcifications is already pointing towards a therapeutic orientation.

2

While looking at all these calcifications on the coronary arteries, do not forget to look at all the other structures in the scan. The correct diagnosis might already be there.

3

At this point set your CT scanner for a high calcium CT Angiography:
- lower heart rate as much as possible
- don't lower kVp settings if you are not very experienced
- increase mAs settings
- use spiral mode and decrease pitch to gain flexibility in the reconstruction phase

4

Have mAs modulation active if heart rate stable and low (off otherwise).

Keep the scan range (and hence the breath-hold) short.

5

Administer contrast material through a very large antecubital vein at a very high rate (>5ml/s) and use high iodine concentration (>370mgI/ml); this is the smartest thing to reduce beam hardening from calcium.

Don't forget to pre-heat contrast material.

6

Scan and try to perfectly hit the highest intracoronary peak of contrast enhancement. This is very important as I said above.

7

start reconstructions and make at least 3 in end-diastole (with low heart rate) at -275ms, -325ms, -375ms (use intervals of 50ms for non Dual Source CT and of 20-30ms for Dual Source CT). Check axial images and which segments of the coronary tree are fine and which aren't.

8

Remeber to use the thinnest image slice possible with 50% increment, with a medium-sharp kernel and with medium-high degree of iterative reconstructions. It has to look a noisy. If it looks smooth with calcium you are doomed.

9

If you already have every segment, proceed to post processing. If you don't, continue to make additional datasets including systolic ones, until you have all coronary segments good.

10

At this point you need to be skilled at advanced multiplanar post-processing in multiple phases of the cardiac cycle and you need to have a fast and flexible software platform.

11

Let me know what you think and exercise. 😁😁😁

State fo the Art CCT - Scanning impossible calcifications

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