Abstract
As an important tool for diagnosing acute coronary syndrome and stable angina, coronary CT angiography has been increasingly being performed in patients presenting with atypical chest pain. In order to help treating patients more efficiently, it is crucial for radiologists to have a comprehensive understanding about mechanisms and clinical aspects as well as CT findings of coronary atherosclerosis per se. A thorough understanding and optimal performance of coronary CT angiography may lead to reduction of unjustified downstream testing. This article provides a clinical and radiological overview of coronary atherosclerosis, and a practical guideline about how to interpret degree of stenosis on coronary CT angiography.
Similar content being viewed by others
References
Abbate A, Biondi-Zoccai GG, Agostoni P et al (2007) Recurrent angina after coronary revascularization: a clinical challenge. Eur Heart J 28(9):1057–1065
Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52(21):1724–1732
Lin FY, Shaw LJ, Dunning AM et al (2011) Mortality risk in symptomatic patients with nonobstructive coronary artery disease: a prospective 2-center study of 2,583 patients undergoing 64-detector row coronary computed tomographic angiography. J Am Coll Cardiol 58(5):510–519
Raff GL, Gallagher MJ, O’Neill WW et al (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46(3):552–557
Zhang LJ, Wu SY, Wang J et al (2010) Diagnostic accuracy of dual-source CT coronary angiography: the effect of average heart rate, heart rate variability, and calcium score in a clinical perspective. Acta Radiol 51(7):727–740
Libby P (2013) Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 368(21):2004–2013
Hattori K, Ozaki Y, Ismail TF et al (2012) Impact of statin therapy on plaque characteristics as assessed by serial OCT, grayscale and integrated backscatter-IVUS. JACC Cardiovasc Imaging 5(2):169–177
Libby P (2005) The forgotten majority: unfinished business in cardiovascular risk reduction. J Am Coll Cardiol 46(7):1225–1228
Nidorf SM, Eikelboom JW, Budgeon CA et al (2013) Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol 61(4):404–410
Lee J (2011) Coronary artery calcium scoring and its impact on the clinical practice in the era of multidetector CT. Int J Cardiovasc Imaging 27(Suppl 1):9–25
Hoffmann U, Brady TJ, Muller J (2003) Cardiology patient page. Use of new imaging techniques to screen for coronary artery disease. Circulation 108(8):e50–e53
Budoff MJ, Shaw LJ, Liu ST et al (2007) Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 49(18):1860–1870
Wong ND, Budoff MJ, Pio J et al (2002) Coronary calcium and cardiovascular event risk: evaluation by age- and sex-specific quartiles. Am Heart J 143(3):456–459
Budoff MJ, Gul KM (2008) Expert review on coronary calcium. Vasc Health Risk Manag 4(2):315–324
Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56(22):1864–1894
Rumberger JA, Brundage BH, Rader DJ et al (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74(3):243–252
Lee HY, Song IS, Yoo SM et al (2010) Can the extent of epicardial adipose tissue thickness or the presence of descending thoracic aortic calcification predict significant coronary artery stenosis in patients with a zero coronary calcium score on multi-detector CT? Atherosclerosis 212(2):495–500
Budoff MJ, Nasir K, McClelland RL et al (2009) Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 53(4):345–352
Meijs MF, Meijboom WB, Prokop M et al (2009) Is there a role for CT coronary angiography in patients with symptomatic angina? Effect of coronary calcium score on identification of stenosis. Int J Cardiovasc Imaging 25(8):847–854
The Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score reference values. http://www.mesa-nhlbi.org/Calcium/input.aspx. Cited 16 Feb 2013
Muhlenbruch G, Klotz E, Wildberger JE et al (2007) The accuracy of 1- and 3-mm slices in coronary calcium scoring using multi-slice CT in vitro and in vivo. Eur Radiol 17(2):321–329
Budoff MJ, Hokanson JE, Nasir K et al (2010) Progression of coronary artery calcium predicts all-cause mortality. JACC Cardiovasc Imaging 3(12):1229–1236
Hong C, Bae KT, Pilgram TK (2003) Coronary artery calcium: accuracy and reproducibility of measurements with multi-detector row CT-assessment of effects of different thresholds and quantification methods. Radiology 227(3):795–801
Techasith T, Cury RC (2011) Stress myocardial CT perfusion: an update and future perspective. JACC Cardiovasc Imaging 4(8):905–916
Min JK, Leipsic J, Pencina MJ et al (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308(12):1237–1245
Sundaram B, Patel S, Agarwal P et al (2009) Anatomy and terminology for the interpretation and reporting of cardiac MDCT: part 2, CT angiography, cardiac function assessment, and noncoronary and extracardiac findings. AJR Am J Roentgenol 192(3):584–598
American College of Cardiology Foundation Task Force on Expert, Consensus D, Mark DB, Berman DS et al (2010) ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 55(23):2663–2699
Raff GL, Abidov A, Achenbach S et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3(2):122–136
Kerl JM, Hofmann LK, Thilo C et al (2007) Coronary CTA: image acquisition and interpretation. J Thorac Imaging 22(1):22–34
Ferencik M, Ropers D, Abbara S et al (2007) Diagnostic accuracy of image postprocessing methods for the detection of coronary artery stenoses by using multidetector CT. Radiology 243(3):696–702
Li M, Zhang J, Pan J et al (2013) Obstructive coronary artery disease: reverse attenuation gradient sign at CT indicates distal retrograde flow—a useful sign for differentiating chronic total occlusion from subtotal occlusion. Radiology 266(3):766–772
Tacelli N, Remy-Jardin M, Flohr T et al (2010) Dual-source chest CT angiography with high temporal resolution and high pitch modes: evaluation of image quality in 140 patients. Eur Radiol 20(5):1188–1196
Renker M, Nance JW Jr, Schoepf UJ et al (2011) Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction. Radiology 260(2):390–399
Min JK, Shaw LJ, Devereux RB et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50(12):1161–1170
Motoyama S, Kondo T, Sarai M et al (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50(4):319–326
Motoyama S, Sarai M, Harigaya H et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54(1):49–57
Otsuka K, Fukuda S, Tanaka A et al (2013) Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging 6(4):448–457
Virmani R, Kolodgie FD, Burke AP et al (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20(5):1262–1275
Hur J, Kim YJ, Lee HJ et al (2009) Quantification and characterization of obstructive coronary plaques using 64-slice computed tomography: a comparison with intravascular ultrasound. J Comput Assist Tomogr 33(2):186–192
Halliburton SS, Schoenhagen P, Nair A et al (2006) Contrast enhancement of coronary atherosclerotic plaque: a high-resolution, multidetector-row computed tomography study of pressure-perfused, human ex vivo coronary arteries. Coron Artery Dis 17(6):553–560
Cademartiri F, Mollet NR, Runza G et al (2005) Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography. Eur Radiol 15(7):1426–1431
Achenbach S, Goroll T, Seltmann M et al (2011) Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging 4(4):328–337
Mettler FA Jr, Huda W, Yoshizumi TT et al (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248(1):254–263
Schuhbaeck A, Achenbach S, Layritz C et al (2013) Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose < 0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction. Eur Radiol 23(3):597–606
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, H.R., Yoo, S.M., Rho, J.Y. et al. MDCT evaluation of atherosclerotic coronary artery disease: What should radiologists know?. Int J Cardiovasc Imaging 30 (Suppl 1), 1–11 (2014). https://doi.org/10.1007/s10554-014-0411-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-014-0411-2