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Current status of cardiac CT for the detection of myocardial ischemia

Gegenwärtiger Stand der Ischämiediagnostik mit der Kardio-CT

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Abstract

Stress and rest myocardial perfusion imaging using computed tomography (CT) can be accurately and safely performed. CT angiography allows for the anatomic visualization of coronary lesions and the components of atherosclerotic plaque, whereas according to currently available data, CT perfusion imaging improves the diagnostic accuracy for detecting ischemic lesions. However, the radiation exposure and contrast load that are involved cannot be neglected. Owing to the limited number of trials that have been published so far, and the fact that they used a wide variety of image acquisition and stress protocols, a standard acquisition protocol for CT perfusion imaging still needs to be found and evaluated in larger multicenter trials. Therefore, CT perfusion imaging, as opposed to other modalities such as magnetic resonance perfusion, SPECT, or positron emission tomography, cannot yet be regarded as clinical routine, but may be considered in patients with contraindications for other imaging modalities.

Zusammenfassung

Ischämiediagnostik kann zuverlässig und sicher mit der kardialen Computertomographie (CT) durchgeführt werden. Die CT-Koronarangiographie ermöglicht die anatomische Darstellung von Koronarstenosen und die Zusammensetzung atherosklerotischer Plaque. Aktuelle Daten weisen darauf hin, dass die diagnostische Genauigkeit zur Detektion hämodynamisch relevanter Koronarstenosen durch eine zusätzliche CT-Perfusionsbildgebung verbessert werden kann. Hierbei sollte jedoch nicht die Strahlenbelastung und die eingesetzte Kontrastmittelmenge vernachlässigt werden. Da bisher nur eine begrenzte Anzahl von Studien veröffentlicht wurde und viele verschiedene Bildakquisitions- und Stressprotokolle verwendet wurden, gilt es, ein Standardakquisitionsprotokoll noch festzulegen und in größeren multizentrischen Studien zu testen. Aus diesem Grund kann die Ischämiediagnostik mit der Kardio-CT im Vergleich zu anderen etablierten bildgebenden Verfahren wie der Magnetresonanztomographie, der SPECT (Einzelphotonenemissions-CT) und der Positronenemissionstomographie noch nicht als klinische Routinediagnostik angesehen werden, könnte aber bei Patienten mit Kontraindikationen für andere bildgebende Verfahren zum Einsatz kommen.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    A. Schuhbäck, M. Marwan & S. Achenbach

  2. Baptist Health South Florida and Baptist Cardiac and Vascular Institute, Miami, Florida, USA

    R.C. Cury

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  1. A. Schuhbäck
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  2. M. Marwan
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  3. R.C. Cury
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  4. S. Achenbach
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Correspondence to A. Schuhbäck.

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Schuhbäck, A., Marwan, M., Cury, R. et al. Current status of cardiac CT for the detection of myocardial ischemia. Herz 38, 359–366 (2013). https://doi.org/10.1007/s00059-013-3805-3

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