Cardiac Multislice Computed Tomography: Screening and Diagnosis of Chronic Heart Disease

Abstract

Coronary artery disease (CAD) is the leading killer in Europe and the United States. CAD accounted for almost 600,000 deaths in Europe in 1998. Although many patients initially present with symptoms, about half of all patients have no symptoms before their sudden death. Thus, a screening test for CAD might help stratify coronary risk in asymptomatic adults. Since its introduction in 1983, electron beam computed tomography scanning (EBCT) has been proposed as a means of coronary calcium assessment for screening. However, direct visualization of the epicardial coronary arteries is necessary to establish the presence and focal severity of lumen disease. Selective coronary angiography is the only clinical method to accurately visualize and quantify coronary artery anatomy in vivo. This. method provides exceptional spatial resolution and a general road map of the coronary system. More than one million diagnostic catheterizations are performed in the United States each year. Selective coronary angiography is expensive and requires at least a brief hospital stay and a period of observation for several hours after the procedure. A convenient noninvasive and safe means to perform coronary angiography clearly would be of clinical benefit. Promising results have been reported for EBCT with a decent sensitivity and specificity in the detection of coronary artery stenoses [12, 16]. A major caveat of this method is, however, the high incidence of motion artifacts, leading to uninterpretable images [1, 4]. This limitation might now be overcome by the emergence of superfast multislice CT (MSCT) technology with spiral scanning at high temporal (125 ms) and superior spatial (10 1p/cm) resolution [11].