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Coronary CT Angiography for the Detection of Obstructive Coronary Artery Disease

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Abstract

Contemporary CT scanners offer high temporal and spatial resolution, permitting visualization of the rapidly moving heart and coronary arteries. The imaging of coronary artery lumen and detection of obstructive coronary artery disease is feasible with 64-detector-row and higher generation CT scanners. The diagnostic accuracy of coronary CT angiography as compared to invasive coronary angiography is good (sensitivity of 85%–100%, specificity of 85%–99%). The major strength of coronary CT angiography is the high negative predictive value (96% to 99%) that permits excluding significant coronary artery stenosis with high accuracy, when optimal image quality is achieved. Therefore, coronary CT angiography is an appropriate diagnostic test for a selected patient population with a low to intermediate probability of coronary artery disease.

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References

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  1. • Achenbach S, Ropers U, Kuettner A, et al: Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. JACC Cardiovasc Imaging 2008, 1:177–186. This study compared diagnostic accuracy of 64-detector-row CT and dual-source CT. The use of dual-source CT permits good diagnostic accuracy even with higher heart rates. Therefore, the premedication with β-blockers seems to be less important with dual-source CT.

    Article  PubMed  Google Scholar 

  2. Rixe J, Rolf A, Conradi G, et al.: Image quality on dual-source computed-tomographic coronary angiography. Eur Radiol 2008, 18:1857–1862.

    Article  PubMed  Google Scholar 

  3. McCollough CH, Primak AN, Saba O, et al.: Dose performance of a 64-channel dual-source CT scanner. Radiology 2007, 243:775–784.

    Article  PubMed  Google Scholar 

  4. • Hausleiter J, Meyer T: Tips to minimize radiation exposure. J Cardiovasc Comput Tomogr 2008, 2:325–327. This is a review of tips and tricks for the reduction of radiation dose for everyday coronary CT angiography scanning.

    Article  PubMed  Google Scholar 

  5. Alkadhi H, Stolzmann P, Desbiolles L, et al.: Low-dose, 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode. Heart 2010, 96:933–938.

    Article  PubMed  Google Scholar 

  6. Rybicki FJ, Otero HJ, Steigner ML, et al.: Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 2008, 24:535–546.

    Article  PubMed  Google Scholar 

  7. Hsiao EM, Rybicki FJ, Steigner M: CT coronary angiography: 256-slice and 320-detector row scanners. Curr Cardiol Rep 2010, 12:68–75.

    Article  PubMed  Google Scholar 

  8. Voros S: What are the potential advantages and disadvantages of volumetric CT scanning? J Cardiovasc Comput Tomogr 2009, 3:67–70.

    Article  PubMed  Google Scholar 

  9. Min JK, Swaminathan RV, Vass M, et al.: High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomography. J Cardiovasc Comput Tomogr 2009, 3:246–251.

    Article  PubMed  Google Scholar 

  10. Marin D, Nelson RC, Schindera ST, et al.: Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm--initial clinical experience. Radiology 2010, 254:145–153.

    Article  PubMed  Google Scholar 

  11. Rist C, Johnson TR, Muller-Starck J, et al.: Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation. Invest Radiol 2009, 44:159–167.

    Article  PubMed  Google Scholar 

  12. Wang Y, Zhang Z, Kong L, et al.: Dual-source CT coronary angiography in patients with atrial fibrillation: comparison with single-source CT. Eur J Radiol 2008, 68:434–441.

    Article  PubMed  Google Scholar 

  13. Oncel D, Oncel G, Tastan A: Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experience. Radiology 2007, 245:703–711.

    Article  PubMed  Google Scholar 

  14. • Ferencik M, Ropers D, Abbara S, et al.: Diagnostic accuracy of image postprocessing methods for the detection of coronary artery stenoses by using multidetector CT. Radiology 2007, 243:696–702. This article evaluated the diagnostic accuracy of various image post-processing methods for the evaluation of coronary stenosis by CT. The paper established the importance of the interactive evaluation of CT datasets using axial images and multiplanar reformatted reconstructions for the assessment of the coronary arteries.

    Article  PubMed  Google Scholar 

  15. Austen WG, Edwards JE, Frye RL, et al: A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975, 51(4 Suppl):5–40.

    CAS  PubMed  Google Scholar 

  16. Leschka S, Alkadhi H, Plass A, et al.: Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 2005, 26:1482–1487.

    Article  PubMed  Google Scholar 

  17. Raff GL, Gallagher MJ, O’Neill WW, et al: Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005, 46:552–557.

    Article  PubMed  Google Scholar 

  18. Herzog C, Zwerner PL, Doll JR, et al.: Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography. Radiology 2007, 244:112–120.

    Article  PubMed  Google Scholar 

  19. Ropers D, Rixe J, Anders K, et al.: Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 2006, 97:343–348.

    Article  PubMed  Google Scholar 

  20. Shapiro MD, Butler J, Rieber J, et al.: Analytic approaches to establish the diagnostic accuracy of coronary computed tomography angiography as a tool for clinical decision making. Am J Cardiol 2007, 99:1122–1127.

    Article  PubMed  Google Scholar 

  21. Hausleiter J, Meyer T, Hadamitzky M, et al.: Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial. Eur Heart J 2007, 28:3034–3041.

    Article  PubMed  Google Scholar 

  22. Brodoefel H, Reimann A, Burgstahler C, et al.: Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy. Eur J Radiol 2008, 66:134–141.

    Article  CAS  PubMed  Google Scholar 

  23. Shabestari AA, Abdi S, Akhlaghpoor S, et al.: Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects. Am J Cardiol 2007, 99:1656–1661.

    Article  PubMed  Google Scholar 

  24. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al.: Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 2007, 244:419–428.

    Article  PubMed  Google Scholar 

  25. Abdulla J, Abildstrom SZ, Gotzsche O, et al.: 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J 2007, 28:3042–3050.

    Article  PubMed  Google Scholar 

  26. Mowatt G, Cook JA, Hillis GS, et al.: 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 2008, 94:1386–1393.

    Article  CAS  PubMed  Google Scholar 

  27. •• Budoff MJ, Dowe D, Jollis JG, et al.: 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 2008, 52:1724–1732. This large multicenter trial demonstrated the diagnostic accuracy of coronary CT angiography using 64-detector-row CT scanners. The investigators enrolled 230 subjects. The study showed high negative predictive value of 99% in the assessment of coronary stenosis.

    Article  PubMed  Google Scholar 

  28. •• Miller JM, Rochitte CE, Dewey M, et al.: Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008, 359:2324–2336. This large multicenter trial demonstrated the diagnostic accuracy of coronary CT angiography using 64-detector-row CT scanners. The investigators enrolled 291 subjects. The prevalence of obstructive CAD was 56% (per patient basis). The negative predictive value was only 83%, mostly driven by the analysis focused on specificity (90%).

    Article  CAS  PubMed  Google Scholar 

  29. •• Meijboom WB, Meijs MF, Schuijf JD, et al.: Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 2008, 52:2135–2144. This large multicenter trial demonstrated the diagnostic accuracy of coronary CT angiography using 64-detector-row CT scanners. The investigators enrolled 360 subjects. The study confirmed high negative predictive value of 97%.

    Article  PubMed  Google Scholar 

  30. Weustink AC, Meijboom WB, Mollet NR, et al.: Reliable high-speed coronary computed tomography in symptomatic patients. J Am Coll Cardiol 2007, 50:786–794.

    Article  PubMed  Google Scholar 

  31. Ropers U, Ropers D, Pflederer T, et al.: Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol 2007, 50:2393–2398.

    Article  PubMed  Google Scholar 

  32. Alkadhi H, Scheffel H, Desbiolles L, et al.: Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 2008, 29:766–776.

    Article  PubMed  Google Scholar 

  33. Cury RC, Pomerantsev EV, Ferencik M, et al.: Comparison of the degree of coronary stenoses by multidetector computed tomography versus by quantitative coronary angiography. Am J Cardiol 2005, 96:784–787.

    Article  PubMed  Google Scholar 

  34. Leber AW, Knez A, von Ziegler F, et al.: Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005, 46:147–154.

    Article  PubMed  Google Scholar 

  35. Husmann L, Gaemperli O, Schepis T, et al.: Accuracy of quantitative coronary angiography with computed tomography and its dependency on plaque composition: plaque composition and accuracy of cardiac CT. Int J Cardiovasc Imaging 2008, 24:895–904.

    Article  PubMed  Google Scholar 

  36. Joshi SB, Okabe T, Roswell RO, et al.: Accuracy of computed tomographic angiography for stenosis quantification using quantitative coronary angiography or intravascular ultrasound as the gold standard. Am J Cardiol 2009, 104:1047–1051.

    Article  PubMed  Google Scholar 

  37. Voros S, et al.: Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in lesions with non-obstructive fractional flow reserve: results from the ATLANTA I study. JACC Cardiovasc Interv, In press.

  38. Cheng V, Gutstein A, Wolak A, et al.: Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician. JACC Cardiovasc Imaging 2008, 1:460–471.

    Article  PubMed  Google Scholar 

  39. Korosoglou G, Mueller D, Lehrke S, et al.: Quantitative assessment of stenosis severity and atherosclerotic plaque composition using 256-slice computed tomography. Eur Radiol 2010, 20:1841–1850.

    Article  PubMed  Google Scholar 

  40. Boogers MJ, Schuijf JD, Kitslaar PH, et al.: Automated quantification of stenosis severity on 64-slice CT: a comparison with quantitative coronary angiography. JACC Cardiovasc Imaging 2010, 3:699–709.

    Article  PubMed  Google Scholar 

  41. •• Mark DB, Berman DS, Budoff MJ, et al.: 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 2010, 55:2663–2699. This is the most recent joint document of multiple professional and scientific societies that summarizes the use, indications, and limitations of coronary CT angiography. This document serves as a guideline document while there is not a sufficient level of evidence for the formal guidelines for coronary CT angiography.

    Article  PubMed  Google Scholar 

  42. •• Hendel RC, Patel MR, Kramer CM, et al.: ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006, 48:1475–1497. The appropriateness criteria document summarizes all clinical indications for cardiac and coronary CT imaging. It grades all indications as appropriate, uncertain, and inappropriate (score 1—least appropriate to 10—most appropriate).

    Article  PubMed  Google Scholar 

  43. • Bluemke DA, Achenbach S, Budoff M, et al.: Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Circulation 2008, 118:586–606. This earlier scientific statement document summarizes the indications and recommendations for the use of cardiac CT in the assessment of patients with a suspected cardiac problem.

    Article  PubMed  Google Scholar 

  44. • Raff GL, Abidov A, Achenbach S, et al.: SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 2009, 3:122–136. These guidelines from the Society of Cardiovascular Computed Tomography very nicely summarize CT technology and requirements and recommendations for the set up of the cardiac CT laboratory. The guidelines provide excellent recommendations for CT scan protocols and evaluation of coronary CT angiography. The document also provides summary of scientific evidence for coronary CT angiography.

    Article  PubMed  Google Scholar 

  45. Schroeder S, Achenbach S, Bengel F, et al.: Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 2008, 29:531–556.

    Article  PubMed  Google Scholar 

  46. Achenbach S, Moselewski F, Ropers D, et al.: Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 2004, 109:14–17.

    Article  PubMed  Google Scholar 

  47. Leber AW, Becker A, Knez A, et al.: Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 2006, 47:672–677.

    Article  PubMed  Google Scholar 

  48. Ostrom MP, Gopal A, Ahmadi N, et al.: Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol 2008, 52:1335–1343.

    Article  PubMed  Google Scholar 

  49. • Min JK, Shaw LJ, Devereux RB, et al.: Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 2007, 50:1161–1170. This is the first large trial that showed prognostic value of coronary CT angiography. The authors demonstrated that coronary stenosis and severity of CAD predict future death. Further, the authors showed that the extent of coronary atherosclerosis as assessed by CT is also a very good predictor of future death.

    Article  PubMed  Google Scholar 

  50. Motoyama S, Sarai M, Harigaya H, et al: Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 2009, 54:49–57.

    Article  PubMed  Google Scholar 

  51. Gilard M, Le Gal G, Cornily JC, et al.: Midterm prognosis of patients with suspected coronary artery disease and normal multislice computed tomographic findings: a prospective management outcome study. Arch Intern Med 2007, 167:1686–1689.

    Article  PubMed  Google Scholar 

  52. Ropers D, Pohle FK, Kuettner A, et al.: Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation. Circulation 2006, 114:2334–2341; quiz 2334.

    Article  PubMed  Google Scholar 

  53. Malagutti P, Nieman K, Meijboom WB, et al.: Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries. Eur Heart J 2007, 28:1879–1885.

    Article  PubMed  Google Scholar 

  54. Meyer TS, Martinoff S, Hadamitzky M, et al.: Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population. J Am Coll Cardiol 2007, 49:946–950.

    Article  PubMed  Google Scholar 

  55. • Hamon M, Lepage O, Malagutti P, et al.: Diagnostic performance of 16- and 64-section spiral CT for coronary artery bypass graft assessment: meta-analysis. Radiology 2008, 247:679–686. This is a large meta-analysis of available studies on the diagnostic accuracy of coronary CT angiography in the assessment of coronary artery grafts.

    Article  PubMed  Google Scholar 

  56. Nieman K, Pattynama PM, Rensing BJ, et al.: Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries. Radiology 2003, 229:749–756.

    Article  PubMed  Google Scholar 

  57. Nazeri I, Shahabi P, Tehrai M, et al.: Assessment of patients after coronary artery bypass grafting using 64-slice computed tomography. Am J Cardiol 2009, 103:667–673.

    Article  PubMed  Google Scholar 

  58. Rixe J, Achenbach S, Ropers D, et al.: Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 2006, 27:2567–2572.

    Article  PubMed  Google Scholar 

  59. Ehara M, Kawai M, Surmely JF, et al.: Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography. J Am Coll Cardiol 2007, 49:951–959.

    Article  PubMed  Google Scholar 

  60. Cademartiri F, Schuijf JD, Pugliese F, et al.: Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis. J Am Coll Cardiol 2007, 49:2204–2210.

    Article  PubMed  Google Scholar 

  61. Pflederer T, Marwan M, Renz A, et al.: Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomography. Am J Cardiol 2009, 103:812–817.

    Article  PubMed  Google Scholar 

  62. Gilard M, Cornily JC, Rioufol G, et al.: Noninvasive assessment of left main coronary stent patency with 16-slice computed tomography. Am J Cardiol 2005, 95:110–112.

    Article  PubMed  Google Scholar 

  63. Maintz D, Grude M, Fallenberg EM, et al.: Assessment of coronary arterial stents by multislice-CT angiography. Acta Radiol 2003, 44:597–603.

    CAS  PubMed  Google Scholar 

  64. Kumbhani DJ, Ingelmo CP, Schoenhagen P, et al.: Meta-analysis of diagnostic efficacy of 64-slice computed tomography in the evaluation of coronary in-stent restenosis. Am J Cardiol 2009, 103:1675–1681.

    Article  PubMed  Google Scholar 

  65. Einstein AJ, Moser KW, Thompson RC, et al.: Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007, 116:1290–1305.

    Article  PubMed  Google Scholar 

  66. Scheffel H, Alkadhi H, Leschka S, et al.: Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 2008, 94:1132–1137.

    Article  CAS  PubMed  Google Scholar 

  67. Schueler BA: Incorporating radiation dose assessments into the ACR appropriateness criteria. J Am Coll Radiol 2008, 5:775–776.

    Article  PubMed  Google Scholar 

  68. Blankstein R, Okada DR, Mamuya WW: Ultra low radiation dose cardiac CT. Int J Cardiol 2009 Apr 1 (Epub ahead of print).

  69. Gutstein A, Dey D, Cheng V, et al.: Algorithm for radiation dose reduction with helical dual source coronary computed tomography angiography in clinical practice. J Cardiovasc Comput Tomogr 2008, 2:311–322.

    Article  PubMed  Google Scholar 

  70. Hausleiter J, Meyer T, Hadamitzky M, et al.: Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 2006, 113:1305–1310.

    Article  PubMed  Google Scholar 

  71. Gudjonsdottir J, Svensson JR, Campling S, et al.: Efficient use of automatic exposure control systems in computed tomography requires correct patient positioning. Acta Radiol 2009, 50:1035–1041.

    Article  CAS  PubMed  Google Scholar 

  72. Silva AC, Lawder HJ, Hara A, et al.: Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol 2010, 194:191–199.

    Article  PubMed  Google Scholar 

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Maurovich-Horvat, P., Ghoshhajra, B. & Ferencik, M. Coronary CT Angiography for the Detection of Obstructive Coronary Artery Disease. Curr Cardiovasc Imaging Rep 3, 355–365 (2010). https://doi.org/10.1007/s12410-010-9045-5

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