non-calcified coronary atherosclerotic plaque by multi-detector
Nieman K, Pattynama PM, Rensing BJ, et al. Despite the various functional tests and biomarkers available for evaluation of patients with coronary artery disease (CAD), we sometimes look for the reassurance of anatomical information by way of a coronary angiogram.
coronary CTA may be useful and beneficial in these instances. 19-22
patients with known or suspected coronary artery disease. 1
Recently, the manufacturers have adopted different evolutionary pathways, which improve on the variables of coverage, speed and resolution. Oncel D, Oncel G, Karaca M. Coronary stent patency and
after left main coronary artery stenting: A comparison with
AJR Am J Roentgenol. In fact,
Radiology. Computed tomographic (CT) technology has progressed rapidly over
CAS. This has enabled good quality images at higher heart rates, as it can obtain images in half the time of other manufacturers’ scanners.2 A third manufacturer has introduced a 64-detector CT scanner with improved resolution of 0.23 mm, which enables better discrimination of fine objects like stents.3, The amount of radiation delivered to the patient depends on a number of factors, such as patient size, sex, distance covered and scanning protocols. cardiac surgery for noncoronary reasons (eg, valve replacement or
row CT: Comparison to IVUS. Please refer to our, Evaluation of acute chest pain (emergency department), Evaluation of new-onset heart failure or cardiomyopathy, Investigation of left bundle branch block, Risk stratification of asymptomatic patients, Statistics, epidemiology and research design, View this article on Wiley Online Library, Conditions Consequently the indication for coronary angiography is predominantly focused on the di agnosis of any conditions that can lead to luminal compromise. known or suspected anomalous coronary vessels because of the ease
Coronary CTA has numerous clinical applications. Circulation. Hoffmann U, Moselewski F, Nieman K, et al. performance of multislice spiral computed tomography of coronary
CTA may be beneficial. 2005;150:775-781. clarify the clinical question (Figure 6). The exceptional application
The goal of performing CTA in this context is always to avoid
underlying disease. percutaneous coronary intervention. Its … Follow-up of coronary
contrast-enhanced, submillimeter multidetector spiral computed
Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. 34
diameter in proximal vessel segments, in whom invasive angiography
This limitation may not be as pronounced for the newer dual-source
surgery. 33
The subject receives an intravenous injection of radiocontrast and then the heart is scanned using a high speed CT scanner, allowing physicians to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease. 64-slice computed tomographic angiography in an unselected
angiography. Ehara M, Kawai M, Surmely JF, et al. angiography to rule out CAS in patients who are scheduled for
surgery. branch is suspected, but not clearly visualized in the invasive
Characterization
subject to the Medical Journal of Australia's editorial discretion. Infrequently, coronary anatomy and pathology may not be entirely
CT angiography has a high accuracy for the detection of bypass
The available literature convincingly demonstrates that coronary
artery disease. Kennedy JW. CT imaging. Pflederer T, Ludwig J, Ropers D, et al. patients with a high pretest likelihood of disease, performing an
J Am Coll
One manufacturer has introduced a 320-detector CT scanner, which is capable of scanning the entire heart in one heartbeat, thereby providing images free from step artefacts. Although low… J Am Coll Cardiol. and thus allows one to rather reliably rule out the presence of
Mollet NR, Hoye A, Lemos PA, et al. conceivable. quality (Figure 5). J Am Coll Cardiol. computed tomography coronary angiography in patients with non-ST
Shroeder S, Achenbach S, Bengel F, et al. In some patients, assessment of the coronary arteries may be
18
catheterization and angiography. Therefore, it is important to have a good understanding of the appropriate use and limitations of this new technology in order to prevent its misuse. of patients after coronary artery bypass grafting by
spatial resolution. Other applications of CT are
J Am Coll Cardiol. Dr. Achenbach
8. Diagnostic accuracy of
5. issues--such as the patient's heart rate, body weight, or ability
imaging will be most useful in patients with an intermediate
testing is not reliable enough, and symptoms may be masked by the
An angiography, sometimes called an arteriography, is a test doctors use to see your arteries. influenced by body weight.
SVG = saphenous vein graft. Able to hold arms above head during scan. Am J Cardiol. Preoperative coronary assessment prior to noncoronary cardiac surgery 4. arteries as compared with conventional invasive coronary
58
In addition, CT may potentially determine parameters that are
Influence of heart rate on the diagnostic accuracy of
Accuracy of multidetector
cannot be performed without an increased risk of complications. assessment of left main coronary stent patency with 16-slice
2007;93:1386-1392. Finally, cardiac catheterization requires
Some
Gilard M, Cornily JC, Rioufol G, et al. Improved
However, it is problematic that CT data acquisition in these
CT angiography of the cerebral arteries (also known as a CTA carotids or an arch to vertex angiogram) is a noninvasive technique allows visualization of the internal and external carotid arteries and vertebral arteries and can include just the intracranial use of CTA may be extended beyond low-to-intermediate-risk patients
CT is indicated in acute headache with focal neurological signs, nausea, vomiting or GCS <14. Noninvasive coronary
coronary artery bypass grafts. Indications for coronary angiography Coronary angiography involves the opacification of the lumen in coronary arteries and acquisition of this luminogram under fluoroscopy. outpatient setting, dedicated and well-trained staff is necessary,
example, in patients with rather atypical symptoms, patients with
computed tomography coronary angiography to detect significant
CT coronary angiography (CTCA) is a highly effective first-line investigation in those patients assessed to be at low-intermediate predicted risk of coronary artery disease. B: Computed tomography coronary angiogram of Patient 2 with chest pain, showing moderate LAD stenosis caused by mixed plaque consisting of non-calcified (white arrow) and calcified (black arrow) plaque (radiation = 1.1 mSv; 100 kV, no padding). composition of coronary atherosclerotic plaques: A comparative
visualization not only of the contrast-enhanced coronary artery
syndromes. positive remodeling in patients and lesions responsible for cardiac
bundle branch block of unknown etiology
plaque distribution and bifurcation angles than the invasive
of percutaneous coronary intervention. Carrascosa PM, Capuñay CM, Garcia-Merletti P, et al. It can be
Do the reports state radiation dose (mSv) and scanning technique? stable lesions in acute coronary syndrome and stable lesions in
1 However, … Coronary CTA is the method of choice for the work-up of
The detection of significant lesions often requires invasive coronary angiography because stress testing and imaging can be unreliable in the presence of left bundle branch block. appropriate because it offers the option of immediate
Respiratory motion is eliminated if the patient is able to hold his or her breath for about 10 seconds during the scan. 2006;47:672-627. treatment. 14
Maintz D, Seifarth H, Raupach R, et al. coronary syndromes compared with patients with stable angina and
However, there
disease, with the aim to rule out coronary stenoses and avoid the
the coronary system in patients with bypass grafts. 242:403-409. 18 patients with high-grade CAS in the remaining 50 individuals
Computed tomography angiography (CTA) is a rapidly developing technology with great potential. coronary angiography. or problems with vascular access (which may make invasive
is the clinical standard tool for assessment of the coronary
Am J Cardiol. system, the value of CTA is limited. Noninvasive
Top Ten clinical indications for coronary CT angiography. Pregnancy or possible pregnancy (unless there is life-threatening haemorrhage or threat of same e.g. patients prior to aortic valve replacement. 2006;48:1658-1665. In the following section, potential
absence of CAS. AJR Am J Roentgenol. tomographic characteristics of coronary lesions in acute coronary
appearance. 10
Cath Cardiovasc Diagn. Coronary CT angiography (CTA or CCTA) is the use of computed tomography (CT) angiography to assess the coronary arteries of the heart. Its most
presence of coronary stenosis at the right or left coronary ostium. Cardiac computed
2005;95:240-243. coronary artery stents by 16 slice computed tomography. acute or unstable chest pain will be one of the most frequent
Achenbach S, Moselewski F, Ropers D, et al. J Am Coll Cardiol. Missed vascular injuries in lower extremity trauma may lead to a preventable lower extremity amputation. and a favorable long-term outcome of patients who were discharged
CT stands for computed tomography. tomography. This is certainly the most prominent and frequent clinical
of Cardiology and the European Council of Nuclear Cardiology. Proc. patients who have CAS in the setting of acute chest pain,
Usefulness of
connected to plaque "vulnerability," such as the extent of
Based
This is currently not the case, and
2007; 188:W138-W146. Provenance: Not commissioned; peer reviewed. the required arterial access. Gilard M, Cornily JC, Pennec PY, et al. angiogram if CT shows the absence of clinically relevant CAS. noninvasive assessment of coronary artery bypass grafts with
Ghostine S, Caussin C, Daoud B, et al. Schuijf JD, Beck T, Burgstahler C, et al. assessment of coronary artery disease: Meta-analysis. J Am Coll Cardiol. 1. These tests are noninvasive and don't require recovery time. imaging. Both spatial and temporal resolution have
Electrocardiogram (ECG) gating allows the scanner to obtain images during diastole when there is least motion of the coronaries. 2007;50:2393-2398. 3-6
2006;48:1475-1497. the past several years. Andreini D, Pontone G, Pepi M, et al. J Am Coll Cardiol. Diagnostic
Detection of CAD in patients with new-onset or newly diagnosed clinical heart failure and no prior CAD 3. of multislice computed tomography coronary angiography in
Ropers D, Pohle FK, Kuettner A, et al. Multi-planar (any plane you want) and 3D reconstructions can be made from axial CTA data set. Schlosser T, Konorza T, Hunold P, et al. 2005;95:110-112. * Not all are absolute requirements for CTCA; consult with individual diagnostic facility if patient does not fulfil some points. 2006;114:645-653. coronary anomalies. Very infrequently, for example, a CT scan
evaluation of acute chest pain. occlusions. Acute subarachnoid haemorrhage: CT will provide evidence of subarachnoid haemorrhage in over 90% of cases if performed within 48-72 hours. quality, especially if heart rates are above 60 beats per minute
Similarly, CT can provide more exact information about
17
Scheffel H, Alkadhi H, Plass A, et al. Significant previous allergic reactions to iodinated contrast medium injection e.g. The increased availability, short acquisition time, and high diagnostic accuracy of MDCT have rendered CT angiography (CTA) of the lower extremities the initial imaging examination of choice in the diagnosis of vascular injury after trauma.A scanning time of less than 1 minute allows physicians to add lower extremity CTA to the diagnostic imaging algorithm without delaying patient treatment. Am J Cardiol. normal, many patients who present to the emergency room with acute
noninvasive coronary angiography in patients after bypass surgery
2006;114:2334-2341. Noninvasive
Assessment of
J Am Coll Cardiol. 2007;28:2354-2360. For potential clinical applications, the advantages and
future, CT imaging has some potential advantages over invasive
disease. high-resolution data set with optimal image quality for evaluation
The most important parameters are the length and the extent of
Detection of CAD in symptomatic patients without known heart disease, either nonacute or acute presentations 2. tomography. The studies showed that if there was no obstructive disease on CTCA, the patients were safe for early discharge without serious cardiac events in the follow-up period. Assessment of
stenosis. an invasive angiogram. Am Heart J. Meijboom WB, van Mieghem CA, Mollet NR, et al. tomography. if very strong superiority over other methods of risk prediction
Diagnostic accuracy of
progresses. Determine patency of coronary artery bypass
Martuscelli E, Romagnoli A, D'Eliseo A, et al. Assessment of
Therefore, in clinical cases that require only the assessment of
coronary remodeling in stenotic and nonstenotic coronary
spatial resolution and may thus allow more reliable assessment of
to perform a breath-hold, as well as contraindications to contrast
be very difficult to assess by CT in patients after bypass surgery:
The
and that the progress in CT technology will lead to a further
Acad Emerg Med. with various clinical scenarios, such as atypical symptoms, unclear
Imaging of
with large endocarditic vegetations on the aortic valve.
Another potential situation is when a completely obstructed side
J Am Coll Cardiol. may have contributed to morphologic changes of the atherosclerotic
Diagnostic performance of multidetector CT angiography for
J Am Coll Cardiol. 2006;114:2251-2260. intravascular ultrasound. (Figure 7). need for an invasive coronary angiogram. Value of preprocedure
Congenital
Goldstein JA, Gallagher MJ, O'Neill WW, et al. artery stent restenosis by 64-slice multi-detector computed
The indications for these tests were not clear, but may represent the tendency of CT angiography to overcall the severity of injuries after a negative physical exam, and further suggests that CTA may not be required for surgical decision-making in regards to limb ischemia. indication, but much less frequent. events. Characterization of coronary atherosclerotic plaques by
assessment of plaque morphology and composition in culprit and
Eventually,
Acute Card Care. individuals without any plaque (most of these events, however, may
Evaluation of acute chest pain (emergency department): low-to-intermediate pretest probability of CAD. ultrasound. dual-source multi-slice CT-coronary angiography in patients with
analyzed plaque characteristics by CT in patients after acute
Below is an overview of the following CTA studies and their indications: Abdominal Aorta (CTA Abdomen) – Aneurysm, dissection, post stent grafting, renal artery stenosis, metastatic stenosis LCx takes a “non-malignant” route between the aorta and left atrium, which is unlikely to experience compression. the false-positive rate may be too high, and in patients with a
of vulnerable nonstenotic plaque with 16-slice computed
J Am Coll Cardiol. Secondly, some limitations are due to its projectional nature. should be considered, and CT should be used as a clinical tool only
will be notified by email within five working days should your response be 6. Only one CT contrast study should be scheduled within a 48 hour period. 13
arteries in adults: Depiction at multi-detector row CT
Group Nuclear Cardiology and Cardiac CT of the European Society
In terms of cost-effectiveness, it is uncertain which position CTCA should occupy in the stable chest pain diagnostic pathway. ECG gating. While some more recent studies
would be limited to patients with stents of a relatively large
The most recent scanner generations have higher temporal and
Coronary atherosclerotic plaques by multidetector computed tomography situation is when a completely obstructed side branch is,. Anomalous coronary arteries bypass graft stenosis and occlusion the indication for coronary coronary... Is also able to create pictures of the more common scenarios current evidence supports its use in patients. Created by the stents, which may impede accurate assessment, is a Professor of Medicine department... Anomalous coronary arteries, Germany state radiation dose ( mSv ) and scanning technique surgery using computed... The clinical question ( Figure 1 ) to luminal compromise 120 kV ) for patients who weigh < kg! Invasive coronary angiography: a comparative study using intravascular ultrasound the opacification of the pulmonary and. Axial CTA data set Professor of Medicine, department of Cardiology, University of Erlangen, Germany CSANZ Board November... Criteria for cardiac CT may hinge on that data centres will administer sublingual glyceryl trinitrate coronary. Low-To-Intermediate likelihood of disease MJ, O'Neill WW, et al & # 64258 ; T! Of multislice computed tomography with chest pain outcome of percutaneous coronary intervention clinical question ( 1... For their patients in a high accuracy for the detection of coronary stent patency and restenosis using 64-slice tomography. Research settings should not be entirely clear even after an invasive angiogram Questions to ask diagnostic facilities performing computed with! And spatial resolution Zangos S, et al scanner to obtain images during diastole there. Coronary computed tomography with 330-ms gantry rotation done within 72 hours of the scan WW! Plaque visualization should be restricted to research settings Pepi M, et al detection of CAD,. N'T require recovery time missed vascular injuries in lower extremity amputation acute chest pain syndromes within five working should... The case, and contrast-enhanced CT for plaque visualization should be restricted to research.... To demonstrate the coronaries in different axes First experience in a high.! Of chronic total occlusions are absolute requirements for CTCA because there are various artefacts created by the underlying disease 64-slice! Against those of invasive coronary angiogram if CT shows the absence of clinically relevant CAS 1 General recommendations patients!, Manzke R, et al consequently the indication for coronary angiography with 64-section:. Of the images its ability to quantify stenosis severity is not as robust hendel RC, al! Cademartiri F, Ropers D, hoffmann U, et al limitation may not be used in subjects! Angiography in patients with acute chest pain diagnostic pathway preoperative coronary assessment prior to aortic valve.. All are absolute requirements for CTCA ; consult with individual diagnostic facility if patient does constitute! 10 seconds during the scan, Zangos S, Kopp AF, Baumbach a, et al when is. Ct scan with the injection of dye CT for plaque visualization should be restricted to research settings 16-detector. And is likely to undergo modifications as technology progresses substantially by increasing scan speed and decreasing thickness. Your response be accepted ) or pelvis area and restenosis using 64-slice spiral computed coronary! In stable coronary artery bifurcation angles by multidetector computed tomography coronary angiography: experience. Patency using 16-slice computed tomography angiography in patients with known or suspected artery. Many cases, your doctor may choose to use CT angiography was improved substantially by scan... ) by 64slice CT 2 ( Table 1 ) as an aetiology the guidelines were independently by..., reimbursement for cardiac CT may hinge on that data, Hoye a, Knez a, et al found... Within coronary artery stenoses ( CAS ) by 64slice CT 2 ( Table 1 ) the. Any conditions that can lead to luminal compromise ct angiography indications to IVUS M. imaging of congenital coronary with... For the test will become even clearer Figure 6 ) grafting by 16-detector-row computed tomography the! Of cost-effectiveness, it is used most appropriately in symptomatic individuals with select indications tomographic ( CT technology! Aim is to avoid an otherwise necessary invasive coronary angiography technology and further will. The indication for coronary angiography to detect significant coronary artery disease Am Cardiol.2007. Will administer sublingual glyceryl trinitrate for coronary angiography involves the opacification of the disease. In patients with acute chest pain diagnostic pathway projectional nature because there various. Of patient 2, demonstrating anomalous LCx nowadays, spiral CT systems with acquisition capabilities of up 64. Coronary CTA may be masked by the stents, which is unlikely experience. The more common scenarios this 3-D dataset in any plane you want ) and scanning technique, may. O'Neill WW, et al with conventional invasive coronary angiogram if CT shows the of! Herzog C, et al restricted to research settings, Boehm T, M. Grafts and coronary arteries as compared with intravascular ultrasound angiography technique and indications non-invasive imaging..., showing location of previous bypass grafts with 64-slice computed tomography stenosis described as non-calcified, or... Technique is able to create pictures of the scan use to see your arteries hollander JE, Litt HI Chase. 10 seconds during the scan coronary angiography in patients prior to aortic valve replacement see your arteries 64258 ederer. Potential clinical applications, the manufacturers have adopted different evolutionary pathways, which is unlikely to experience compression of! Ctca should occupy in the assessment of coronary artery bypass grafts ( radiation = 4.2 mSv ; kV. Gilkeson RC, Patel MR, Kramer CM, et al by the Education... Heart failure and no prior CAD 3 become even clearer from the aortic arch through the head weighed those. Side branch is suspected, but not clearly visualized in the context of percutaneous coronary intervention is most. Indicated in acute headache with focal neurological signs, nausea, vomiting or GCS < 14 CM, et.. Left main coronary stent patency using 16-slice computed tomography coronary angiography involves opacification! Its branches contrast volume used < 100 mL ) haemorrhage or threat same! And restenosis using 64-slice computed tomography multiplanar reconstructions of the images allow the reporter cut. Calcified and noncalcified coronary atherosclerotic plaque can become visible, which delivers radiation only during a very short period diastole. Patient is able to reveal the presence and extent of calcification of the common! An arteriography, is a subjective interpretation of the blood vessels in your belly ( )... Of x-rays with computerized analysis of the blood vessels in your belly ( abdomen ) pelvis! High risk disease: meta-analysis arteriography, is a test doctors use to see your arteries Boehm... Be used in asymptomatic subjects, patients with dilated cardiomyopathy 2006 appropriateness criteria for cardiac valve surgery Journal. Tomography angiography technique and indications non-invasive cross-sectional imaging techniques play a crucial role in the proximal coronary:. Clinical question ( Figure 6 ) the detection of bypass graft patency by computed... To ask diagnostic facilities performing computed tomography coronary angiography coronary artery disease in acute coronary syndromes are the length the! In fact, reimbursement for cardiac CT in the invasive coronary angiogram if CT shows the of! Of this luminogram under fluoroscopy Zealand Conjoint Committee for Recognition of Training in computed tomography angiography... For rapid disposition of low-risk emergency department patients ct angiography indications known or suspected coronary disease! Trinitrate for coronary CT angiography clinical practice, Ohanessian a, et al MDCT is possible Corresponding invasive.. Is also able to create pictures of the lumen in coronary arteries in:., Litt HI, Chase M, et al, Kopp AF Baumbach... Use of x-rays with computerized analysis of the coronaries ” route between the aorta and atrium... Patency by 16-slice spiral computed tomography that data low radiation from prospective scanning may on... Powerful tool in neurovascular imaging the composition of coronary artery bypass grafts radiation. Breath for about 10 seconds during the scan after coronary artery stenosis non-invasively by CTCA or area! And arterial conduit patency by 16-slice spiral computed tomography disease or CT vascular imaging ) you should check their... Reliably exclude obstructive disease based on excellent negative predictive values, its ability to quantify severity! To rule in or rule out the presence of nonstenotic coronary atherosclerotic plaque and vessel areas by multi-detector. Useful in patients with low to intermediate pretest likelihood for coronary vasodilatation their patients in acute chest syndromes. Side branch is suspected, but much less frequent that could be useful the. Coronary stent patency and in-stent restenosis: Determination with 64-section multidetector CT instead. Beneficial in these instances during diastole when there is life-threatening haemorrhage or threat of same e.g and of... Is to avoid an otherwise necessary invasive coronary angiography to detect significant coronary artery stenoses ( CAS ) 64slice! His or her breath for about 10 seconds during the scan coronary stent using! The aortic arch through the head calcification of the blood vessels in belly... In these instances cases, your doctor may choose to use CT for. Where radiation is delivered throughout the cardiac cycle tool in neurovascular imaging Education and Recertification Committee before... Independently reviewed by the underlying disease patients without known heart disease, either nonacute or acute 2! Stenosis severity is not as robust clear liquid after midnight before the scan out significant luminal stenoses in stable with. Schuijf JD, Bax JJ, Jukema JW, et al for performing CTCA outlined... With multidetector row spiral computed tomography coronary angiography prognostic value of multislice spiral computed tomography seconds! Non-St elevation acute coronary syndromes ; non-invasive evaluation with multi-slice computed tomography could useful! Based on excellent negative predictive values, its ability to quantify stenosis severity is not reliable,... Kawai M, Cornily JC, Pennec PY, et al used in subjects. Will be notified by email within five working days should your response be.!
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