Abstract
Recent technological advances in MDCT enabled the introduction of the noninvasive technique for the routine workup of the coronary arteries in daily clinical practice. Patients with a low to intermediate likelihood of coronary artery disease (CAD) and having equivocal findings at electrocardiogram (ECG) or stress tests are the optimal candidates to undergo noninvasive coronary imaging with CT. In order to gain high diagnostic accuracy, the CT scanner system should provide high temporal and spatial resolutions. This is necessary to compensate for motion of the coronary arteries and to allow for multiplanar reformations without artifacts. The CT data need to be synchronized to the simultaneously recorded ECG, and both retrospective ECG gating or prospective ECG triggering can be used for data acquisition and reconstruction. When implementing the technique of ECG pulsing for reducing the radiation dose, flexible adjustments of the pulsing widths at different heart rates are recommended. With regard to the image quality, the dependency on the average heart rate and variability decreases with the increasing temporal resolution of the CT system. When using 64-slice CT, average heart rate and heart rate variability should be diminished through the foregoing administration of β-blockers. With dual-source CT, a reduction of heart rate and variability is no longer necessary. Severe arterial wall calcification still hamper the diagnostic capabilities of CT, even when using the most recent technology. With every new CT scanner generation, the robustness increases, while the rate of nondiagnostic coronary artery segments decreases.
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References
Achenbach S, Daniel WG (2001) Noninvasive coronary angiography—an acceptable alternative? N Engl J Med 345:1909–1910
Achenbach S, Ropers D, Holle J et al. (2000) In-plane coronary arterial motion velocity: measurement with electron-beam CT. Radiology 216:457–463
Achenbach S, Ropers D, Kuettner A et al. (2006) Contrast-enhanced coronary artery visualization by dual-source computed tomography—initial experience. Eur J Radiol 57:331–335
Alkadhi H, Scheffel H, Desbiolles L, et al. (2008) Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 29:766–776
Arnett EN, Isner JM, Redwood DR et al. (1979) Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Int Med 91:350–356
Budoff MJ, Achenbach S, Blumenthal RS et al. (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791
Flohr T, Ohnesorge B (2001) Heart rate adaptive optimization of spatial and temporal resolution for electrocardiogram-gated multislice spiral CT of the heart. J Comput Assist Tomogr 25:907–923
Flohr TG, McCollough CH, Bruder H et al. (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268
Fox K, Garcia MA, Ardissino D et al. (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27:1341–1381
Galbraith JE, Murphy ML, Desoyza N (1981) Coronary angiogram interpretation: interobserver variability. JAMA 240:2053–2059
Hamon M, Morello R, Riddell JW, Hamon M (2007) Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography—meta-analysis. Radiology 245:720–731
Hendel RC, Patel MR, Kramer CM et al. (2006) 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 48:1475–1497
Herzog C, Nguyen SA, Savino G et al. (2007) Does two-segment image reconstruction at 64-section CT coronary angiography improve image quality and diagnostic accuracy? Radiology 244:121–129
Heuschmid M, Burgstahler C, Reimann A et al. (2007) Usefulness of noninvasive cardiac imaging using dual-source computed tomography in an unselected population with high prevalence of coronary artery disease. Am J Cardiol 100:587–592
Hoffmann MH, Shi H, Manzke R et al. (2005) Noninvasive coronary angiography with 16-detector row CT: effect of heart rate. Radiology 234:86–97
Hong C, Becker CR, Huber A et al. (2001) ECG gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on image quality. Radiology 220:712–717
Hsieh J, Londt J, Vass M et al. (2006) Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography. Med Phys 33:4236–4248
Husmann L, Leschka S, Desbiolles L et al. (2007) Coronary artery motion and cardiac phases: dependency on heart rate—implications for CT image reconstruction. Radiology 245:567–576
Jakobs TF, Becker CR, Ohnesorge B et al. (2002) Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG controlled tube current modulation. Eur Radiol 12:1081–1086
Johnson TR, Nikolaou K, Busch S et al. (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691
Johnson TR, Nikolaou K, Wintersperger BJ et al. (2006) Dual-source CT cardiac imaging: initial experience. Eur Radiol 16:1409–1415
Leber AW, Johnson T, Becker A et al. (2007) Diagnostic accuracy of dual-source multi-slice CT coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J doi:10.1093/eurheartj/ehm294
Leber AW, Knez A, von Ziegler F et al. (2005) 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 46:147–154
Leschka S, Alkadhi H, Plass A et al. (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487
Leschka S, Wildermuth S, Boehm T et al. (2006) Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. Radiology 241:378–385
Leschka S, Scheffel H, Desbiolles L et al. (2007) Combining Dual-Source Computed Tomography Coronary Angiography and Calcium Scoring: Added Value for the Assessment of Coronary Artery Disease. Heart doi:10.1136/hrt.2007.124800
Leschka S, Scheffel H, Desbiolles L et al. (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG pulsing windowing. Invest Radiol 42:543–549
Lu B, Mao SS, Zhuang N et al. (2001) Coronary artery motion during the cardiac cycle and optimal ECG triggering for coronary artery imaging. Invest Radiol 36:250–256
Maier W, Abay M, Cook S et al. (2005) The 2002 European registry of cardiac catheter interventions. Int J Cardiol 113:299–304
Matt D, Scheffel H, Leschka S et al. (2007) Dual-source CT coronary angiography: image quality, mean heart rate, and heart rate variability. AJR Am J Roentgenol 189:567–573
McNitt-Gray MF (2002) AAPM/RSNA Physics Tutorial for Residents: Topics in CT. Radiation dose in CT. Radiographics 22:1541–1553
Mollet NR, Cademartiri F, van Mieghem CA et al. (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323
Ong TK, Chin SP, Liew CK et al. (2006) Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:1323, e1321–1326
Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557
Ropers U, Ropers D, Pflederer T, et al. (2007) Influence of heart rate on the diagnostic accuracy of dualsource computed tomography coronary angiography. J Am Coll Cardio 50:2393–2398
Scheffel H, Alkadhi H, Leschka S, et al. (2008) Low-Dose CT Coronary Angiography in the Step-and-Shoot Mode: Diagnostic Performance. Heart
Scheffel H, Alkadhi H, Plass A, et al. (2006) Accuracy of dual-source CT coronary angiography: first experience in a high pretest probability population without heart rate control. Eur Radiol 16:2739–2747
Thom T, Haase N, Rosamond W et al. (2006) Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113:e85–e151
Vlodaver Z, Frech R, Van Tassel RA, Edwards JE (1973) Correlation of the antemortem coronary arteriogram and the postmortem specimen. Circulation 47:162–169
Weustink AC, Meijboom WB, Mollet NR, et al. (2007) Reliable high-speed coronary computed tomography in symptomatic patients. J Am Coll Cardio 50:786–794
White CW, Wright CB, Doty DB et al. (1984) Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 310:819–824
Wintersperger BJ, Nikolaou K, von Ziegler F et al. (2006) Image quality, motion artifacts, and reconstruction timing of 64-slice coronary computed tomography angiography with 0.33-second rotation speed. Invest Radiol 41:436–442
Zanzonico P, Rothenberg LN, Strauss HW (2006) Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward. J Am Coll Cardiol 47:1846–1849
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Alkadhi, H., Stolzmann, P. (2009). Noninvasive Coronary Artery Imaging. In: Reiser, M., Becker, C., Nikolaou, K., Glazer, G. (eds) Multislice CT. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-33125-4_15
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DOI: https://doi.org/10.1007/978-3-540-33125-4_15
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