CT Angiography

3D
Reconstruction
• Pixel: a pixel is a single point in a graphic image.

• Voxel: Voxelization is the process of adding depth to an image

using a set of cross-sectional images known as a volumetric
dataset. These cross-sectional images (or slices) are made up of
pixels.

• Rendering: Representation of a 3D object on 2D.

• Threshold: Object selection by density.

 Maximum Intensity
Projection

MIP mode allows the visualisation of the highest voxel value.

 Minimum Intensity
Projection

MinIP is for the visualisation of the negative voxels.

SURFA
CE
SHADE
D
DISPLA
Y
(SSD)
https://www.researchgate.net/figure/Three-dimensional-surface-
shaded-display-image-a-LeFort-II-type-fracture-with-a_fig2_8069971
 Volume Rendering
(VR)
Volume Rendering is a technique
that uses the concept of Opacity.
MIP
Vessel
Trackin
g
Volume
Rendering
 Volume
Rendering
with
Transparen
t Bones
 Volume
Rendering with
bone removal
CT Angiography
Protocols
Bolus
Tracking
Tracking should be done
between heart and area of
interest.

• Circle of Willis
• Carotids
• Upper limb Angio
• Thoracic Aorta
• Abdominal Aorta
• Renal Artery Angio
• Peripheral Angio
Bolus
Tracking
• Manual bolus tracking (SmartPrep)
• More control
• Used for Pulmonary Angio
• No autovoice
• Automatic bolus tracking (Dynamic tracking)
• Autovoice
• Tracking is more consistent / repeatable.
• Radiographer can concentrate on patient.
 Slice
Thickness
• Circle of Willis (sub mm) 0.5mm / 0.63mm
• Carotids (sub mm) 0.5mm / 0.63mm
• Upper limb Angio (Upper arm 1 / 1.25mm) (Hand only
0.5/0.63mm)
• Thoracic Aorta (1 / 1.25mm or 2 / 2.5mm)
• Abdominal Aorta (1 / 1.25mm or 2 / 2.5mm)
• Renal Artery Angio (sub mm) 0.5mm / 0.63mm
• Peripheral Angio (1 / 1.25mm or 2 / 2.5mm)
Use appropriate FOV
Patient Preparation

Immobilize patient –
Prepare patient:
prevent motion artifact

Strap arms / legs / head warn patient contrast media

effect (hot flush),
not to swallow,
not to move legs.
CT
Anatomy
 Brain
Angiograph
y
Circle of
Willis
Aneurysm

Occlusion

Congenital Abnormalities

Perfusion of the brain

CircleAnterior
of Cerebral
Willis Anterior
Communicating
Arteries (ACA)
Artery

1st segment of ACA

Posterior
Communicating
Artery
Left Posterior
Cerebral
Artery

Vertebral Arteries
http://health.nytimes.com/health/guides/disease/stroke/print.ht
http://mayoresearch.mayo.edu/mayo/research/neurology/headaches.cfm
 Circle of
Willis Anterior
Cerebral
Arteries (ACA)
1st segment of
ACA (A1
segment)

Right Posterior Left Middle

Cerebral Artery Cerebral Artery
(LMCA)

Left Internal
Carotid Artery
Basilar Artery (LICA)

Image: GE Healthcare
 Anterior Cerebral Anterior Communicating
Arteries (ACA) Artery

Left Internal
Carotid Artery 1st segment of
(LIC ACA
A)

Left Middle
Left Posterior
Cerebral Artery
Cerebral
(LMCA)
Artery

Basilar Artery
Vertebral Arteries
LMCA stenosis

Right Posterior Cerebral Artery Absent

LMCA stenosis
Accessory
vessel ACA
 Occlusion COW

http://www.mghradrounds.org/index.php?src=gend
ocs&link=2004_october
http://www.med.harvard.edu/JPNM/TF03_04/Feb3/WriteUp.html
Aneurysm Ant Com
Artery
Aneurysm Anterior Communicating Artery

Images: René J Sullivan

 Nec
k
Angiograph
y
Carotid
Arteries
Soft plaque

Calcified plaque

Stenosis (50% or more)

Occlusion

Subclavian Steal Syndrome

http://www.umm.edu/patiented/articles/carotid_artery_surgery_normal_anatomy_000124.htm
http://www.heart-vessels.com/cardiovascular-diseases/stenosis-carotid-artery.php
 Left Internal Carotid
Artery (LICA)

Right Vertebral Artery Left External Carotid

Artery (LECA)

Left Common Carotid

Artery (LCA)

Image: GE Healthcare
 Internal Carotid Artery
(LICA / RICA)

External Carotid Artery

(LECA / RECA)
Calcification

Common Carotid
Artery (RCA / LCA)

Image: GE Healthcare
Occluded RICA
Stenosis
and
Calcification
Stenosis
measuremen
t
 Subclavian Steal
Syndrome
The term subclavian steal has been used to describe retrograde blood flow in
the vertebral artery associated with proximal ipsilateral subclavian artery
stenosis or occlusion, as in the image below. This phenomenon may occur
when the subclavian artery is occluded proximal to the origin of the vertebral
artery. Although retrograde blood flow in the vertebral artery associated
with ipsilateral subclavian artery occlusion is not unusual, neurological
symptoms following ipsilateral arm exercise in this setting are uncommon.
Most patients with significant arterial occlusive lesions in the proximal
subclavian artery are asymptomatic; therefore, the term subclavian steal
syndrome should really be reserved for those patients who develop
neurological symptoms as a consequence of brain ischemia that occurs
during or immediately following exercise of the ipsilateral arm.[1]
http://www.annalspc.com/article.asp?issn=0974-2069;year=2012;volume=5;issue=2;spage=207;epage=209;aulast=Chowning
http://www.annalspc.com/article.asp?issn=0974-2069;year=2012;volume=5;issue=2;spage=207;epage=209;aulast=Chowning
 Upper
Limb
Angiograph
y
 AV
M

Upper Fistula
limb

Occlusion (cannulation)
Subclavian Artery

Brachial Artery

Radial Artery

Ulnar Artery
http://www.haodf.com/zhuanjiaguandian/swteng516_574412533.htm
 Radial Artery

Brachial Artery

Axillary Artery

Subclavian Artery

I
m
a
g
e
:

J
a
s
Arterial
Venous
fistula
of the
distal
forear
m
 Traumatic arteriovenous-fistula

http://www.intechopen.com/books/arteriovenous-fistulas-diagnosis-and-management/traumatic-arteriovenous-fistula
CTA examination clearly showed a well developed cervical rib
compressing the right subclavian artery against clavicle with thrombosis
and near total occlusion. Occlusion of right brachial artery can be
due to embolus. http://www.nrias.net/radcasemar.php
 What is the difference between
an AVM and a AV Fistula?

• Arteriovenous malformations (AVMs) are abnormal tangles

of arteries and veins.

• AV fistulas are an abnormal connection between arteries

and veins.

http://neurosurgery.med.nyu.edu/conditions-we-treat/z-conditions-guide/arterial-venous-malformations-avm%E2%80%99s-dural-avms-av-fustula%E2%80%99s-s
 Ches
t
Angiograph
y
Chest arteries

• Thoracic aorta aneurysm

• Thoracic aorta dissection

• Thoracic aorta stenosis

• Pulmonary embolism

• Lung AVM
Right
Ascending
Pulmonary Aorta Arch
Artery

Right
Ascending Aorta
Pulmonary
Artery

Right
Descending
Pulmonary Descending Aorta
Artery

http://www.online-medical-advice.com/coronary-artery-disease.html
R Ascending Pulmonary Artery

Main Pulmonary Artery

Descending Pulmonary Artery

 Pulmonary Trunk / Main
Pulmonary Artery

Right Pulmonary
Artery

Left Pulmonary
Artery
Pulmonary Embolism
Pulmonary Embolism
Pulmonary Embolism
Pulmonary Embolism
http://biology.about.com/od/anatomy/ss/brachiocephalic_artery.htm
 Carotid Arteries

Aorta Arch

Image: GE Healthcare
Thoracic
Aorta
Descending Aorta Stenosis -
VR

Images: René J Sullivan

Descending Aorta Stenosis – Lumen
View

Images: René J Sullivan

 http://www.escardio.org/communities/councils/ccp/e-
journal/volume7/Pages/vol7n4.aspx#.U7qyX_mSx28
Thoracic Aorta

http://cardiophile.org/2008/10/x-ray-quiz-7-2/
Aneurysm
 Thoracic Aorta
Dissection

http://www.radpod.org/2007/10/20/type-a-aortic-dissection/ http://en.wikipedia.org/wiki/Aortic_dissection
 The DeBakey classification of
aortic dissection
• Type I:dissections propagate from ascending aorta, extend to
aortic arch, and beyond arch distally.
• Type II: dissections confined to ascending portion of aorta.
• Type III: dissections limited to descending aorta. Class III also includes
dissections that start in descending aorta that extend proximally to arch and
ascending aorta.
 Heart/Cardiac

Angiography
Coronary
Vessels/Cardiac

• Stenosis

• Calcified plaque

• Soft plaque
http://www.texheartsurgeons.com/cad.htm
http://www.drchander.com/diagnoseCAD.html
 Left Main
Coronary Artery

Right
Coronary
Artery Circumflex Artery

Left
Anterior
Descending
Coronary
Artery
Image: GE
Healthcare
Right
Coronary Circumflex Artery
Artery

Left
Anterior
Descending
Coronary
Artery

Images: GE Healthcare
Image: Alison Hartley
 Abdomina
l
Angiograph
y
Abdominal
Vessels
• AAA (Abdominal Aorta Aneurysm)

• Occlusion SMA (superior mesenteric artery) or IMA

(inferior mesenteric artery)

• Renal artery stenosis

http://www.vascularultrasound.net/abdominal-arteries-and-pelvic-arteries
R L
Aorta

Celiac Trunk
Splenic artery
Hepatic artery

Renal arteries

Superior
mesenteric
artery (SMA)

Common
Illiac arteries
 Right Renal Artery
Aorta

Hepatic Artery Splenic Artery

Gastric Artery
Celiac Trunk
Abdominal Aorta

Celiac Trunk
Superior
Mesenteric
Artery (SMA)

Inferior Mesenteric
Artery (IMA)
 Splenic
Hepatic Artery
Artery

Liver

Celiac Trunk
 Left Renal
Artery
Right Renal
(occluded by
Artery
thrombus)

Abdominal
Aorta
Right
Common
Illiac

Superior Mesenteric Artery

 Right
Renal
Arteries

Superior Mesenteric Artery

1
Right Renal Arteries

2
3

Stenosis
Aorta Stent
Images: Jasion Chimbindi
Abdominal Aorta Aneurysm
(AAA)
Abdominal Aorta Aneurysm
(AAA)
Marked asymmetry of kidneys but no
obvious stenosis at origin of Left Renal
Artery
MBA – Blunt trauma to right side of
abdomen
Almost complete transection of lower pole of right kidney. Accessory right
renal artery originating from aorta is noted supplying transected lower
pole.
 Lower
Limb
Angiograph
y
Leg
Arteries
• Claudication

• Diabetes (peripheral vasculopathy)

• Graft patency

• Gangrene (occlusion)
http://www.carolinavascular.com/CVSD%20main%20site/Vascular%20diagrams.html
 Abdominal Aorta

Left Common
Illiac Artery

Left Internal
Illiac Artery

Left External
Illiac Artery

Right
Profunda
Femoralis

Right Superficial Femoral Artery

Left External
Illiac Artery

Left Profunda
Femoralis

Left Superficial
Femoral Artery
 Peripheral
Outflow

VR with
Transparent
Bone

MIP without bone

 MIP without
bone

with Calcification without

Calcification
 MIP without
bone

without
with Calcification Calcification
Lumen
view
R Popliteal Arteries
L

Peroneal Arteries
(PA)

Posterior Tibial
Arteries
(PTA)

Anterior Tibial Arteries

(ATA)
Right Popliteal Artery

Right Anterior
Tibial Artery

Right Peroneal
Artery

Right Posterior
Tibial Artery
 Right
Left
Anterior
Anterior
Tibial
Peroneal Arteries Tibial
Artery
Artery

Posterior Tibial Arteries

Peroneal
Artery
 Anterior
Tibial
Artery
Posterior
Tibial
Artery
 Occlusion

Cut of right common femoral

artery. Filling of profunda
femoris via collaterals.

Left common femoral artery

and profunda femoralis
filling. Abrupt cut off in
relation to the origin of the
superficial femoral artery.
The End