{"id":1372,"date":"2025-11-17T21:21:14","date_gmt":"2025-11-17T18:21:14","guid":{"rendered":"https:\/\/www.uzmanradyoloji.com\/?p=1372"},"modified":"2025-11-17T22:03:47","modified_gmt":"2025-11-17T19:03:47","slug":"koroner-kardiyak-bt-anjiyografi-nedir","status":"publish","type":"post","link":"https:\/\/www.uzmanradyoloji.com\/index.php\/2025\/11\/17\/koroner-kardiyak-bt-anjiyografi-nedir\/","title":{"rendered":"KORONER (KARD\u0130YAK) BT ANJ\u0130YOGRAF\u0130 NED\u0130R?"},"content":{"rendered":"\n

KALB\u0130N ANATOM\u0130S\u0130<\/h2>\n\n\n\n
\"\"<\/figure>\n\n\n\n

Kalp, iki kulakc\u0131k (atriyum), iki kar\u0131nc\u0131k (ventrik\u00fcl) olmak \u00fczere 4 odac\u0131ktan olu\u015fmaktad\u0131r. Sa\u011f taraf\u0131nda yer alan atriyum ve ventrik\u00fcl kirli kan\u0131 Pulmoner Arter vas\u0131tas\u0131 ile akci\u011ferlere pompalar. Kalbin sol taraf\u0131nda kalan atriyum ve ventirik\u00fcl ise akci\u011ferlerden pulmoner venler vas\u0131tas\u0131yla gelen temiz kan\u0131 aorta ana damar ile v\u00fccuda pompalar.
Kalpte, d\u00f6rt adet kapakc\u0131k vard\u0131r. Bunlar; atriyum ile ventrik\u00fcl aras\u0131nda sa\u011fda Trik\u00fcspid Kapak solda ise Mitral Kapak, atriyum ile ana damarlar aras\u0131nda sa\u011fda Pulmoner Kapak, solda Aort Kapa\u011f\u0131 ad\u0131 verilen kapaklard\u0131r.<\/p>\n\n\n\n

Kalbin Atardamarlar\u0131<\/strong><\/h2>\n\n\n\n

Sa\u011f koroner arter (right coronary artery veya k\u0131saca RCA) ve Sol ana koroner arter (LMCA) olarak ikiye ayr\u0131l\u0131r. Sol ana koroner arter ise k\u0131sa bir segment sonras\u0131nda ikiye ayr\u0131l\u0131r:
1. Sol \u00f6n inen arter (left anterior descending veya k\u0131saca LAD)
2. Sirkumfleks arter (circumflex artery veya k\u0131saca CX)
Dolay\u0131s\u0131yla, kalbi ikisi solda, biri sa\u011fda olmak \u00fczere \u00fc\u00e7 atardamar besler.
LAD yan dallar: Septal dallar Diagonal dallar
CX yan dallar\u0131: Obtuse marginal (OM) Posterior lateral dallar
RCA kendi i\u00e7inde dallara ayr\u0131l\u0131r.
Sinoatriyal Nod Dal\u0131 (SA NODE ARTERY) Sa\u011f Ventrik\u00fcl Dallar\u0131 (Right Ventricular Branches \u2013 RV dallar\u0131) Akut Marginal Dal Atrioventrik\u00fcler Nod (AV Nod Dal\u0131) PDA (Posterior Descending Artery) Posterior Lateral Dallar<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

KORONER (KARD\u0130YAK) BT ANJ\u0130OGRAF\u0130 NED\u0130R?<\/h1>\n\n\n\n

Kalbin etraf\u0131n\u0131 \u00e7evreleyen ve kalbi besleyen damarlar\u0131n kontrast madde verilerek hi\u00e7 bir giri\u015fimsel i\u015flem olmadan tomografi cihaz\u0131 ile g\u00f6r\u00fcnt\u00fclenmesidir.<\/p>\n\n\n\n

Koroner BT Endikasyonlar\u0131<\/h1>\n\n\n\n
    \n
  • Kalp damarlar\u0131nda darl\u0131k olu\u015fturan aterosklerotik plaklar\u0131n tespiti ve darl\u0131k derecelerinin de\u011ferlendirilmesi,<\/li>\n\n\n\n
  • TAVI de\u011ferlendirmesi (Transkateter Aort Kapak \u0130mplantasyonu)<\/li>\n\n\n\n
  • Kardiyak fonksiyonel g\u00f6r\u00fcnt\u00fcleme<\/li>\n\n\n\n
  • Konjenital (do\u011fu\u015ftan gelen) kalp hastal\u0131klar\u0131n\u0131 de\u011ferlendirme<\/li>\n\n\n\n
  • Pulmoner venleri ablasyon tedavisi y\u00f6n\u00fcnden de\u011ferlendirme<\/li>\n\n\n\n
  • Triple rule-out (KAH, PE, AORT D\u0130SEKS\u0130YONU)<\/li>\n\n\n\n
  • Miyokardiyal perf\u00fczyon g\u00f6r\u00fcnt\u00fcleme ve viabilite<\/li>\n\n\n\n
  • Fraksiyonel ak\u0131m rezervi \u00f6l\u00e7\u00fcm\u00fc Semptomatik olan d\u00fc\u015f\u00fck-orta risk gurubuna dahil hastalar<\/li>\n\n\n\n
  • Akut g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ile gelen EKG normal yada belirsiz ve kardiyak enzimler normal olan olgular<\/li>\n\n\n\n
  • KAH a\u00e7\u0131s\u0131ndan y\u00fcksek risk ta\u015f\u0131yan asemptomatik hastalar<\/li>\n\n\n\n
  • Revask\u00fclarizasyon tedavi sonras\u0131 stent ve by-pass greft de\u011ferlendirmesi<\/li>\n\n\n\n
  • \u0130nvaziv anjiografinin riskli oldu\u011fu durumlarda invaziv anjiografiye alternatif olarak<\/li>\n\n\n\n
  • Akut kalp yetmezli\u011finde koroner arter hastal\u0131\u011f\u0131n\u0131 d\u0131\u015flamak<\/li>\n\n\n\n
  • Koroner arterin invaziv anjiografide g\u00f6r\u00fcnt\u00fclenemedi\u011fi durumlar<\/li>\n\n\n\n
  • Koroner anomali varl\u0131\u011f\u0131n\u0131 d\u0131\u015flamak<\/li>\n\n\n\n
  • Kardiyak transplant olgular\u0131nda allogreft vask\u00fclopatiyi ekarte etmek (Kalp nakli sonras\u0131 geli\u015fen kronik damar daralmas\u0131)<\/li>\n<\/ul>\n\n\n\n

    TETK\u0130K \u00d6NCES\u0130 HASTA HAZIRLI\u011eI<\/h1>\n\n\n\n
      \n
    • Allerji durumu sorgulanmal\u0131 herhangi bir\u015feye y\u00fcksek allerjisi olan hastalara tetkik \u00f6ncesi premedikasyon uygulanmal\u0131<\/li>\n\n\n\n
    • \u00c7ekimin 12 saat \u00f6ncesinden ba\u015flayarak Sigara, kahve, \u00e7ay, enerji i\u00e7ece\u011fi ve soda ile diyet haplar\u0131 gibi kalp h\u0131z\u0131n\u0131 etkileyebilecek maddeler kullan\u0131lmamal\u0131d\u0131r.<\/li>\n\n\n\n
    • Sildenafil (viagra) ve Metformin (antidiyabetik ila\u00e7) kullanan hastalar\u0131n ilac\u0131n\u0131 12 saat \u00f6nceden kesmesi gerekiyor. Di\u011fer ila\u00e7lar\u0131n\u0131 kullanabilir.<\/li>\n\n\n\n
    • \u00c7ekime al\u0131nmadan \u00f6nce 4-6 saat aras\u0131 a\u00e7 olmas\u0131 gerekir<\/li>\n\n\n\n
    • Kreatin ve GFR testi yap\u0131lmas\u0131 gerekir<\/li>\n\n\n\n
    • Laboratuar sonu\u00e7lar\u0131 normal s\u0131n\u0131rlar d\u0131\u015f\u0131nda olan veya hamilelik \u015f\u00fcphesi olan hastalar \u00e7ekime al\u0131nmamal\u0131d\u0131r.<\/li>\n\n\n\n
    • \u00c7ekim yap\u0131lacak b\u00f6lgede artefakta neden olacak aksesuarlar\u0131n (Toka, k\u00fcpe, kolye, di\u015f protezi vs) \u00e7\u0131kart\u0131lmas\u0131 istenir.<\/li>\n\n\n\n
    • Mutlaka kimlik do\u011frulamas\u0131 yap\u0131l\u0131p, imzal\u0131 onam formu al\u0131n\u0131r.<\/li>\n\n\n\n
    • Beta bloker ve nitrogliserin kullan\u0131m\u0131na engel olabilecek hastal\u0131k durumu sorgulanmal\u0131<\/li>\n\n\n\n
    • Y\u00fcksek nab\u0131zl\u0131 hastalara doktor kontrol\u00fcnde \u00fc\u00e7 g\u00fcnl\u00fck beta bloker tedavisi uygulan\u0131r.<\/li>\n<\/ul>\n\n\n\n

      \u015eimdi \u00e7ekimin nas\u0131l yap\u0131ld\u0131\u011f\u0131na ge\u00e7elim:<\/h1>\n\n\n\n

      \u00d6ncelikle tetkik \u00f6ncesi hastan\u0131n tansiyonu \u00f6l\u00e7\u00fcl\u00fcr.
      Sa\u011f koldan geni\u015f (ye\u015fil) damar yolu a\u00e7\u0131l\u0131r. Sa\u011fdan a\u00e7\u0131lmas\u0131n\u0131n sebebi ise solda L\u0130MA (Left internal mammary artery-sol i\u00e7 meme arteri) ve subklavian arter \u00fczerine gelecek kontrast artefakt\u0131n\u0131 \u00f6nlemektir.
      Hasta masaya supine pozisyonda ve hafif sa\u011fa do\u011fru kayd\u0131r\u0131larak yat\u0131r\u0131l\u0131r. B\u00f6ylece kalp tam santral noktaya gelmi\u015f olur. Masa y\u00fcksekli\u011fi biraz indirilerek yandanda kalbin tam santral noktada olmas\u0131 sa\u011flan\u0131r.<\/p>\n\n\n\n

      EKG problar\u0131 g\u00f6r\u00fcnt\u00fc alan\u0131 d\u0131\u015f\u0131nda kalacak \u015fekilde ba\u011flan\u0131r.<\/p>\n\n\n\n

        \n
      • Sa\u011f klavikula alt\u0131na k\u0131rm\u0131z\u0131<\/li>\n\n\n\n
      • Sa\u011f kot biti\u015fine siyah<\/li>\n\n\n\n
      • Sol klavikula alt\u0131na sar\u0131<\/li>\n\n\n\n
      • Sol kot biti\u015fine ye\u015fil<\/li>\n<\/ul>\n\n\n\n
        \"\"<\/figure>\n\n\n\n

        Hastan\u0131n kollar\u0131 yukar\u0131 ve geriye al\u0131n\u0131r
        Kollar geriye al\u0131nd\u0131ktan sonra mutlaka damar yolu kontrol\u00fc yap\u0131lmal\u0131d\u0131r.
        Hastaya nefes egzersizleri yapt\u0131r\u0131larak nefes tutma konusunda detayl\u0131 bilgi verilmeli ve nefes egzersizi s\u0131ras\u0131nda nab\u0131zda tabip edilmelidir. \u0130deal bir koroner anjio \u00e7ekimi i\u00e7in nab\u0131z 65\/dk alt\u0131nda olmal\u0131d\u0131r.
        Hasta ila\u00e7 verildi\u011fi s\u0131rada ya\u015faca\u011f\u0131 endikasyonlar konusunda mutlaka bilgilendirilmelidir. Mide bulant\u0131s\u0131, s\u0131cakl\u0131k basmas\u0131 ve idrar\u0131n\u0131 alt\u0131na ka\u00e7\u0131r\u0131yormu\u015f hissi.
        Gerekirse nabz\u0131 d\u00fc\u015f\u00fcrmek i\u00e7in uzman doktor takibinde iv beta bloker yani beloc 5mg ampul serumla dil\u00fce edilerek yava\u015f\u00e7a yap\u0131l\u0131r. 3 ampule kadar beloc kullan\u0131labilir.
        Koroner vazodilatasyon i\u00e7in 0,4mg sublingual nitrogliserin tablet yada sprey (isordil) kullan\u0131labilir. (\u00d6zellikle 64 slice ct cihazlar\u0131nda yap\u0131lan \u00e7ekimler i\u00e7in)<\/p>\n\n\n\n

        Beta bloker Kontrendikasyonu<\/strong><\/h2>\n\n\n\n
          \n
        • 2-3. derece Atriyoventrik\u00fcler (AV) blok (Atriyum ile ventrik\u00fcl aras\u0131 elektrik iletiminin kesilmesi veya gecikmesi)<\/li>\n\n\n\n
        • \u015eiddetli ast\u0131m<\/li>\n\n\n\n
        • \u015eiddetki KOAH<\/li>\n\n\n\n
        • Bradikardi<\/li>\n\n\n\n
        • Hipotansiyon<\/li>\n\n\n\n
        • Konjestif kalp yetmezli\u011fi<\/li>\n<\/ul>\n\n\n\n

          Kalsiyum skorlama<\/h1>\n\n\n\n

          Koroner anjiografi \u00e7ekimine ba\u015flamadan koroner arterlerdeki kalsiyum y\u00fck\u00fcn\u00fc \u00f6l\u00e7mek i\u00e7in kalsiyum skorlama yap\u0131l\u0131r.
          Kalsiyum skorlama; damar sertli\u011finin derecesini ve koroner arterlerdeki kalsiyum y\u00fck\u00fcn\u00fc \u00f6l\u00e7mek i\u00e7in kontrast madde verilmeden anjio \u00f6ncesi yap\u0131lan taramad\u0131r. Tarama sonucunda damarlardaki kire\u00e7 yo\u011funlu\u011funun ifadesi rakamlar ile tan\u0131mlanmaktad\u0131r. Kire\u00e7lenmenin olmad\u0131\u011f\u0131 damar s\u0131f\u0131r ile ifade edilir.
          40 ya\u015f alt\u0131na ve Koroner arter bypass greft (CABG) operasyonu ge\u00e7irenlerde yap\u0131lmaz.
          Prospektif EKG tetiklemeli genellikle 3mm kesit kal\u0131nl\u0131\u011f\u0131nda d\u00fc\u015f\u00fck dozla yap\u0131l\u0131r.
          Karina ile kalp taban\u0131 aras\u0131nda kalbin tamam\u0131 al\u0131n\u0131r.<\/p>\n\n\n\n

          \"\"<\/figure>\n\n\n\n

          KONTRAST MADDE<\/h1>\n\n\n\n

          Y\u00fcksek iyot konsantrasyonu ihtiva eden non-iyonik kontrast maddeler kullan\u0131l\u0131r (350 veya 400mg\/ml)
          Y\u00fcksek h\u0131zlarda verilmeli 5-6 ml\/sn
          Bifazik veya Trifazik y\u00f6ntemle verilebilir.<\/p>\n\n\n\n

          \"\"<\/figure>\n\n\n\n
          \"\"<\/figure>\n\n\n\n

          \u00c7ekim protokol\u00fc se\u00e7imi<\/h1>\n\n\n\n

          Hastan\u0131n nab\u0131z durumuna g\u00f6re 3 farkl\u0131 \u00e7ekim protokol\u00fc uygulanabilir. Bunlar:<\/p>\n\n\n\n

            \n
          • Prospective ECG-gated high-pitch acquisition<\/li>\n\n\n\n
          • Prospective ECG-gated acquisition<\/li>\n\n\n\n
          • Retrospective ECG-gated acquisition<\/li>\n<\/ul>\n\n\n\n

            Prospective ECG-gated high-pitch acquisition<\/strong><\/h1>\n\n\n\n

            \u00d6zellikle dual-source (\u00c7ift T\u00fcpl\u00fc) BT cihazlar\u0131nda kullan\u0131lan, en h\u0131zl\u0131 ve en d\u00fc\u015f\u00fck radyasyon dozuna sahip \u00e7ekim tekni\u011fidir. Flash mode veya High-Pich spiral mode olarak adland\u0131r\u0131l\u0131r.<\/p>\n\n\n\n

            EGK ile senkronize olarak kalbin belirli bir faz\u0131nda \u00e7ok h\u0131zl\u0131 bir \u015fekilde veri toplayan bir y\u00f6ntemdir. “High-pitch” k\u0131sm\u0131, pitch de\u011ferinin (masa h\u0131z\u0131n\u0131n) \u00e7ok y\u00fcksek (3.0\u20133.4 civar\u0131) olmas\u0131 anlam\u0131na gelir. T\u00fcp ve masa \u00e7ok h\u0131zl\u0131 hareket eder, kalbin bir faz\u0131 boyunca tek nefes tutmada \u00e7ok d\u00fc\u015f\u00fck doz ile t\u00fcm kalp taranabilir.<\/p>\n\n\n\n

            \u00c7al\u0131\u015fma Prensibi<\/strong><\/p>\n\n\n\n

              \n
            • EKG ile senkronize \u00e7al\u0131\u015f\u0131r.<\/li>\n\n\n\n
            • Cihaz kalp at\u0131\u015flar\u0131n\u0131 izler ve kalbin en az hareketli faz\u0131n\u0131 hesaplar.<\/li>\n\n\n\n
            • Belirlenen fazda t\u00fcp ve dedekt\u00f6rler devreye girerek masa \u00e7ok h\u0131zl\u0131 \u015fekilde ilerler.<\/li>\n\n\n\n
            • Tek kalp at\u0131m\u0131 i\u00e7inde t\u00fcm kalp g\u00f6r\u00fcnt\u00fclenir.<\/li>\n\n\n\n
            • Tarama sadece 0,25 \u2013 0,35 sn s\u00fcrer ve al\u0131nan doz 1 mSv daha azd\u0131r.<\/li>\n\n\n\n
            • Siemens dual source CT cihazlar\u0131nda \u00e7ok y\u00fcksek temporal \u00e7\u00f6z\u00fcn\u00fcrl\u00fck sayesinde motion artifact minimum olur.<\/li>\n<\/ul>\n\n\n\n

              Avantajlar\u0131<\/strong>
              \u00c7ok d\u00fc\u015f\u00fck radyasyon dozu Genelde <1 mSv, bazen 0.2\u20130.5 mSv gibi \u00e7ok d\u00fc\u015f\u00fck de\u011ferler elde edilir.
              Tek nefes tutmada tarama t\u00fcm kalp 0.25 sn i\u00e7inde g\u00f6r\u00fcnt\u00fclenebilir.
              Kalp ve solunum hareketi etkisi minimumdur.
              Hastan\u0131n uzun s\u00fcre nefes tutmas\u0131na gerek kalmaz.
              H\u0131zl\u0131 \u00e7ekim Acil hastalarda avantaj sa\u011flar.
              D\u00fc\u015f\u00fck kalp h\u0131z\u0131nda \u00f6zellikle \u00e7ok net koroner g\u00f6r\u00fcnt\u00fcler verir.
              Dezavantajlar\u0131<\/strong>
              Kalp h\u0131z\u0131 <60 bpm \u00f6nerilir. Y\u00fcksek kalp h\u0131z\u0131nda motion artifact artar.
              Atrial fibrilasyon veya aritmi varsa g\u00fcvenilir de\u011fildir.
              Sadece bir fazda g\u00f6r\u00fcnt\u00fc al\u0131nd\u0131\u011f\u0131 i\u00e7in fonksiyonel analiz yap\u0131lamaz.
              Kilolu hastalarda g\u00f6r\u00fcnt\u00fc kalitesi d\u00fc\u015fer.
              Kullan\u0131m Alan\u0131<\/strong>
              \u00d6zellikle d\u00fc\u015f\u00fck doz koroner \u00e7ekimler i\u00e7in
              Pediatrik kardiyak BT
              Takip \u00e7ekimleri (\u00f6rne\u011fin stent sonras\u0131 kontrol)<\/p>\n\n\n\n

              Prospective ECG-gated acquisition<\/strong><\/h1>\n\n\n\n

              \u00c7ekim s\u0131ras\u0131nda hastan\u0131n EKG’si ile senkronize olarak sadece se\u00e7ilen kalp faz\u0131nda (genellikle diyastol, R-R intervalinin %70-80 aral\u0131\u011f\u0131) radyasyon verilen bir tekniktir. G\u00f6r\u00fcnt\u00fcleme sadece bu zaman aral\u0131\u011f\u0131nda yap\u0131l\u0131r. Bu y\u00f6ntemle hareket artefakt\u0131 azalt\u0131l\u0131r ve radyasyon dozu d\u00fc\u015f\u00fcr\u00fcl\u00fcr.<\/p>\n\n\n\n

              Ayn\u0131 zamanda \u201cstep-and-shoot\u201d (ad\u0131m at ve \u00e7ek) tekni\u011fi olarak da bilinir.<\/p>\n\n\n\n

              \u00c7al\u0131\u015fma Prensibi<\/strong><\/p>\n\n\n\n

                \n
              • Hastaya EKG kablolar\u0131 ba\u011flan\u0131r.<\/li>\n\n\n\n
              • BT cihaz\u0131, EKG sinyali \u00fczerinden R-R dalgalar\u0131n\u0131 takip eder.<\/li>\n\n\n\n
              • Belirlenen optimal faz (\u00f6rne\u011fin %70 R-R intervali) geldi\u011finde X-ray t\u00fcp\u00fc aktifle\u015fir ve g\u00f6r\u00fcnt\u00fc al\u0131n\u0131r.<\/li>\n\n\n\n
              • Belirlenen faz d\u0131\u015f\u0131nda X-ray kapal\u0131d\u0131r.<\/li>\n\n\n\n
              • E\u011fer kalp b\u00fcy\u00fckse veya tek taramada s\u0131\u011fm\u0131yorsa masa her kalp at\u0131m\u0131nda bir sonraki pozisyona ad\u0131m ad\u0131m ilerler.<\/li>\n<\/ul>\n\n\n\n

                Avantajlar\u0131<\/strong>
                D\u00fc\u015f\u00fck radyasyon dozu. Radyasyon s\u00fcrekli de\u011fil, sadece kalp belirlenen faza geldi\u011finde verilir. Toplam doz 2\u20135 mSv, bazen 1 mSv\u2019nin alt\u0131na inebilir.
                Hareket artefakt\u0131n\u0131n azalt\u0131lmas\u0131 \u00d6zellikle d\u00fc\u015f\u00fck kalp h\u0131z\u0131nda \u00e7ok net koroner g\u00f6r\u00fcnt\u00fcler elde edilir.
                Tek nefes tutmada tarama tamamlan\u0131r.
                Y\u00fcksek g\u00f6r\u00fcnt\u00fc kalitesi Koroner arterlerde keskin s\u0131n\u0131rlar ve minimal blur.
                Dezavantajlar\u0131<\/strong>
                Kalp h\u0131z\u0131 60 bpm alt\u0131nda olmas\u0131 \u00f6nerilir. Y\u00fcksek h\u0131zda artefakt artar.
                Ritim d\u00fczensizli\u011fi (Aritmi) Atrial fibrilasyon gibi durumlar\u0131nda g\u00fcvenilir de\u011fildir.
                Tek faz g\u00f6r\u00fcnt\u00fcleme Sadece se\u00e7ilen faz g\u00f6r\u00fcnt\u00fclendi\u011fi i\u00e7in ejeksiyon fraksiyonu (EF) veya kapak hareketi gibi fonksiyonel bilgiler elde edilemez.
                “Step-and-shoot” hareketi nedeniyle \u00e7ekim “High-pitch” tekni\u011fine g\u00f6re biraz daha uzun s\u00fcrer.
                Uygulama Alanlar\u0131<\/strong>
                Koroner BT anjiyografi (standart kullan\u0131m alan\u0131)
                Pre-op kardiyak cerrahi planlamas\u0131
                D\u00fc\u015f\u00fck radyasyon gereken hasta gruplar\u0131
                \u00c7ocuklar
                Gen\u00e7 hastalar
                Tekrarlayan BT kontrol\u00fc gereken ki\u015filer<\/p>\n\n\n\n

                Retrospective ECG-gated acquisition<\/h1>\n\n\n\n

                BT cihaz\u0131n\u0131n t\u00fcm kalp siklusu boyunca s\u00fcrekli \u00e7ekim yaparak veri toplad\u0131\u011f\u0131 ve bu verilerin EKG sinyali ile senkronize edilerek daha sonra istenilen kalp faz\u0131nda g\u00f6r\u00fcnt\u00fclendi\u011fi bir tekniktir. \u201cRetrospective\u201d kelimesi, \u00e7ekim s\u0131ras\u0131nda kesintisiz veri topland\u0131\u011f\u0131n\u0131 ve istenen fazlar\u0131n sonradan se\u00e7ilerek rekontstr\u00fcksiyon yap\u0131labildi\u011fini ifade eder.<\/p>\n\n\n\n


                \u00c7al\u0131\u015fma Prensibi<\/strong><\/p>\n\n\n\n

                  \n
                • Hastaya EKG elektrotlar\u0131 ba\u011flan\u0131r.<\/li>\n\n\n\n
                • X-ray t\u00fcp\u00fc s\u00fcrekli a\u00e7\u0131kt\u0131r ve masa yava\u015f ve sabit \u015fekilde hareket eder.<\/li>\n\n\n\n
                • T\u00fcm kalp siklusu boyunca veri toplan\u0131r.<\/li>\n\n\n\n
                • Cihaz, EKG ile senkronize ederek verileri farkl\u0131 fazlara ay\u0131r\u0131r.<\/li>\n\n\n\n
                • \u00c7ekim tamamland\u0131ktan sonra radyolog veya tekniker, verilerden istenilen fazlar\u0131 se\u00e7erek g\u00f6r\u00fcnt\u00fc olu\u015fturur (\u00d6r. Diyastol %70\u2013%80 veya sistol %30-40 gibi).<\/li>\n\n\n\n
                • Kalbin farkl\u0131 fazlardaki hareketi g\u00f6r\u00fcnt\u00fclenebilir.<\/li>\n<\/ul>\n\n\n\n

                  Avantajlar\u0131<\/strong>
                  Fonksiyonel analiz yap\u0131labilir. EF (ejeksiyon fraksiyonu), kapak hareketleri, kardiyak vol\u00fcmler hesaplanabilir.
                  Ritim d\u00fczensizli\u011fi tolerans\u0131 vard\u0131r. Atrial fibrilasyon veya aritmi durumlar\u0131nda g\u00fcvenilir g\u00f6r\u00fcnt\u00fc al\u0131nabilir.
                  Kalp h\u0131z\u0131 y\u00fcksek hastalarda kullan\u0131labilir.
                  \u00c7ekim sonras\u0131 en uygun faz\u0131 se\u00e7erek artefaktlar\u0131 azaltma imk\u00e2n\u0131 vard\u0131r.
                  Dezavantajlar\u0131<\/strong>
                  Radyasyon dozu y\u00fcksek 10-20 mSv, bazen daha da y\u00fcksek olabilir.
                  Nefes tutma s\u00fcresi uzundur.
                  Hasta uzun s\u00fcre nefes tutamazsa motion artefaktlar\u0131 artar.
                  Kullan\u0131m Alanlar\u0131<\/strong>
                  Fonksiyonel de\u011ferlendirme (EF)
                  Kapak hastal\u0131klar\u0131
                  Kalp h\u0131z\u0131n\u0131n y\u00fcksek veya d\u00fczensiz oldu\u011fu durumlar
                  Post-op bypass ve stent kontrolleri<\/p>\n\n\n\n

                  \"\"<\/figure>\n\n\n\n
                  \"\"<\/figure>\n\n\n\n
                  \"\"<\/figure>\n\n\n\n
                  \"\"<\/figure>\n\n\n\n

                  AP ve LATERAL scout al\u0131n\u0131r.<\/h2>\n\n\n\n
                  \"\"<\/figure>\n\n\n\n

                  Tarama, karina seviyesinden ba\u015flayarak kalp taban\u0131na kadar t\u00fcm kalbi i\u00e7ine alacak \u015fekilde yap\u0131l\u0131r.<\/strong><\/p>\n\n\n\n

                  \"\"<\/figure>\n\n\n\n

                  By-pass veya greft ameliyat\u0131 ge\u00e7irmi\u015f hastalarda ne yapmal\u0131?<\/strong><\/h2>\n\n\n\n

                  By-pass veya greft ameliyat\u0131 ge\u00e7irmi\u015f hastalarda normalden farkl\u0131 bir protokol gerekir. <\/p>\n\n\n\n

                  \u00c7ekimde ama\u00e7:<\/strong><\/p>\n\n\n\n

                    \n
                  • Nativ koronerleri (kendi damarlar\u0131)<\/li>\n\n\n\n
                  • Greft damarlar\u0131n\u0131 (LIMA, Safen Ven Greft, RIMA VE RAD\u0130AL ARTER)<\/li>\n\n\n\n
                  • Poksimal ve distal anastomoz b\u00f6lgelerini birlikte de\u011ferlendirmek<\/li>\n\n\n\n
                  • En uygun tarama tipi: Retrospective EKG-gated acquisition<\/li>\n\n\n\n
                  • Avantaj\u0131: Hem greftler hem nativ koronerler her fazda g\u00f6r\u00fcnt\u00fclenir.<\/li>\n\n\n\n
                  • Alternatif olarak kalp h\u0131z\u0131 d\u00fczenli ve d\u00fc\u015f\u00fckse Prospective step-and-shoot tercih edilebilir.<\/li>\n\n\n\n
                  • Uzun tarama alan\u0131 gerektirdi\u011fi i\u00e7in Prospective ECG-gated high-pitch tercih edilmez.<\/li>\n<\/ul>\n\n\n\n

                    Tarama alan\u0131<\/strong><\/h1>\n\n\n\n

                    \u00dcst s\u0131n\u0131r:<\/strong> Klavikula \u00fczeri (Subklavian arter d\u00fczeyi)<\/p>\n\n\n\n

                    Alt s\u0131n\u0131r:<\/strong> Diyafram alt\u0131 yani kalp taban\u0131. B\u00f6ylece LIMA, RIMA ve safen greftlerin tamam\u0131 \u00e7ekime dahil edilmi\u015f olur.<\/p>\n\n\n\n

                    \"\"<\/figure>\n\n\n\n

                    Teknik olarak bolus tracking veya test bolus yap\u0131l\u0131r.<\/h2>\n\n\n\n


                    Bolus tracking:<\/strong> cihaz\u0131n, belirtilen roi de\u011ferine ula\u015ft\u0131\u011f\u0131nda otomatik olarak \u00e7ekime ba\u015flamas\u0131 metodudur.<\/p>\n\n\n\n


                    Test bolus:<\/strong> Belirlenen alana koyulan roi ile damardaki kontrast yo\u011funlu\u011fu takip edilerek manuel \u00e7ekime ba\u015flamakt\u0131r.<\/p>\n\n\n\n

                    Al\u0131nan scoutlar \u00fczerinden ayarlama yap\u0131larak karina seviyesinden tek kesitlik smart prep g\u00f6r\u00fcnt\u00fcs\u00fc al\u0131n\u0131r.<\/p>\n\n\n\n

                    \"\"<\/figure>\n\n\n\n

                    Roi descending aorta koyulur.<\/strong><\/h2>\n\n\n\n
                    \"\"<\/figure>\n\n\n\n

                    Bolus tracking i\u00e7in damar i\u00e7indeki kontrast yo\u011funlu\u011fu 220 hu de\u011feri olarak tan\u0131mlan\u0131r. Ortalama kilodaki bir hasta i\u00e7in 90ml \u0130la\u00e7 ve pe\u015finden 40ml serum 5-6 ml\/sn h\u0131zda gidecek \u015fekilde cihazla ayn\u0131 anda start verilir. Pulmoner arter renklenmeye ba\u015flad\u0131\u011f\u0131nda hastaya nefes tutturularak \u00e7ekim yap\u0131l\u0131r.<\/p>\n\n\n\n

                    G\u00f6r\u00fcnt\u00fc Kalitesini Etkileyen Fakt\u00f6rler<\/strong><\/h2>\n\n\n\n
                      \n
                    • Y\u00fcksek nab\u0131z<\/li>\n\n\n\n
                    • Aritmi olmas\u0131<\/li>\n\n\n\n
                    • Y\u00fcksek CACS (Koroner arter kalsiyum skoru)<\/li>\n\n\n\n
                    • Koroner stentler<\/li>\n\n\n\n
                    • Metal objeler (protez kapak, pacemaker)<\/li>\n\n\n\n
                    • Obesite<\/li>\n\n\n\n
                    • Hareket artefakt\u0131<\/li>\n<\/ul>\n\n\n\n

                      TETK\u0130K SONRASI YAPILMASI GEREKENLER<\/strong><\/h2>\n\n\n\n
                        \n
                      • Damar yolu hemen \u00e7\u0131kar\u0131lmamal\u0131 ve hasta bir s\u00fcre g\u00f6zlem alt\u0131nda tutulmal\u0131<\/li>\n\n\n\n
                      • Kontrast maddenin v\u00fccuttan at\u0131l\u0131mas\u0131n\u0131 h\u0131zland\u0131rmak i\u00e7in bol bol su i\u00e7mesi s\u00f6ylenir<\/li>\n\n\n\n
                      • Beta bloker veya nitrogliserin uygulanan hastalar\u0131n belli bir s\u00fcre yaln\u0131z kalmamas\u0131 ve ara\u00e7 kullanmamas\u0131 tavsiye edilir.<\/li>\n<\/ul>\n\n\n\n

                        \u00d6nemli notlar:<\/strong><\/p>\n\n\n\n

                        \u00d6ncelikle anjio denilince genel hasta kitlesinin g\u00f6z\u00fcnde, \u00e7ok b\u00fcy\u00fck bir olay olarak alg\u0131lanmaktad\u0131r. Bu alg\u0131 sonucu hastalar \u00e7ekime al\u0131nd\u0131klar\u0131nda heyecan veya panik yapt\u0131klar\u0131 i\u00e7in \u00e7ekim kalitesi olumsuz olarak etkilenmektedir.
                        M\u00fcmk\u00fcn oldu\u011funca sakin bir ses tonu ile hasta her konuda mutlaka bilgilendirilmeli onun g\u00fcvende oldu\u011funu hissetmesi sa\u011flanmal\u0131d\u0131r.
                        \u00c7ekime ba\u015flanmadan \u00f6nce bir ka\u00e7 defa nefes egzersizi yap\u0131lmal\u0131d\u0131r. Nefes egzersizleri hastan\u0131n \u00e7ekim s\u0131ras\u0131nda daha profosyonel davranmalar\u0131n\u0131 sa\u011flar. Ayr\u0131ca nefes tutuldu\u011funda nab\u0131z yava\u015flar. Bu s\u0131rada ekg monit\u00f6r takibi yaparak ka\u00e7\u0131nc\u0131 saniyede nabz\u0131n stabil hale geldi\u011fini g\u00f6r\u00fcp \u00e7ekim kalitesini art\u0131rmam\u0131za yard\u0131m edecek ek bir bilgide sa\u011flam\u0131\u015f oluruz.<\/p>\n\n\n\n

                        Reformat<\/strong><\/h2>\n\n\n\n
                          \n
                        • \u0130nce kesit axial parankim<\/li>\n\n\n\n
                        • Retrospective protokol\u00fc kullan\u0131lm\u0131\u015fsa nab\u0131z durumuna g\u00f6re se\u00e7ilen faz<\/li>\n\n\n\n
                        • Vrt (volume rendering technique)<\/li>\n\n\n\n
                        • \u0130ste\u011fe ba\u011fl\u0131 M\u0130P<\/li>\n<\/ul>\n\n\n\n
                          \n
                          \n
                          \n
                          \"\"<\/figure>\n\n\n\n
                          \"\"<\/figure>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n
                          \"\"<\/figure>\n\n\n\n
                          \"\"<\/figure>\n\n\n\n
                          \"\"<\/figure>\n\n\n\n
                          \"\"<\/figure>\n \n","protected":false},"excerpt":{"rendered":"

                          KALB\u0130N ANATOM\u0130S\u0130 Kalp, iki kulakc\u0131k (atriyum), iki kar\u0131nc\u0131k (ventrik\u00fcl) olmak \u00fczere 4 odac\u0131ktan olu\u015fmaktad\u0131r. Sa\u011f taraf\u0131nda yer alan atriyum ve ventrik\u00fcl kirli kan\u0131 Pulmoner Arter vas\u0131tas\u0131 ile akci\u011ferlere pompalar. Kalbin sol taraf\u0131nda kalan atriyum ve ventirik\u00fcl ise akci\u011ferlerden pulmoner venler vas\u0131tas\u0131yla gelen temiz kan\u0131 aorta ana damar ile v\u00fccuda pompalar.Kalpte, d\u00f6rt adet kapakc\u0131k vard\u0131r. Bunlar; […]<\/p>\n","protected":false},"author":1,"featured_media":1390,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[39],"tags":[],"class_list":["post-1372","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bt-anjiografi-kontrastli-anjiografi-bilgisayarli-tomografi-anjio-tomografi-cekim-teknikleri-hasta-pozisyonu"],"views":3542,"_links":{"self":[{"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/posts\/1372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/comments?post=1372"}],"version-history":[{"count":3,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/posts\/1372\/revisions"}],"predecessor-version":[{"id":1400,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/posts\/1372\/revisions\/1400"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/media\/1390"}],"wp:attachment":[{"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/media?parent=1372"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/categories?post=1372"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.uzmanradyoloji.com\/index.php\/wp-json\/wp\/v2\/tags?post=1372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}