Retrospectively ECG-gated MDCT shows a high correlation and acceptable agreement of left-ventricular functional parameters compared to MR imaging. Thus, in addition to the non-invasive evaluation of coronary arteries, further important additional information of left-ventricular functional parameters with clinical and prognostic relevance can be achieved by one single MDCT examination. For assessment of myocardial viability, low-dose CT late enhancement scanning is feasible, and preliminary results look promising. CT late enhancement adds valuable diagnostic information on the haemodynamical significance of coronary stenoses or prior to interventional procedures.

Objective: To report an initial experience with multislice spiral computed tomography (MSCT) coronary imaging, as well as differences in diagnostic accuracy between 4 slice and 16 slice MSCT technology. Methods and results: 210 patients underwent MSCT coronary angiography (4 slices, n = 120; 16 slices, n = 90; suspicion of coronary artery disease, n = 158; suspicion of restenosis, n = 52). Recommendations for further diagnostic tests were based on the MSCT results. Patients were interviewed by telephone after a mean (SD) of 449 (169) days to evaluate their further clinical course. MSCT detected significant lesions in 90 of 210 (43%) patients and invasive coronary angiography (ICA) was recommended. MSCT excluded significant lesions in 120 of 210 (57%) patients. ICA was actually performed in 44 of 210 (21%) patients (corresponding results, 27 of 44 (61%); false positive, 11 of 44 (25%); false negative, 6 of 44 (14%)). No significant differences were found between 4 and 16 slice imaging. No major cardiac event occurred during follow up. Conclusions: MSCT was found to be useful to evaluate the need for invasive diagnostic procedures. However, the false negative results underline that further improvements of image quality are required before MSCT can replace ICA in carefully selected patients. C onventional invasive coronary angiography (ICA) is still the reference standard for the diagnosis of coronary artery disease (CAD) and the detection of coronary artery stenoses. Despite the invasiveness and possible related complications of ICA, the absolute number of ICAs is rising annually, although only about one third of all diagnostic ICAs are followed by percutaneous coronary intervention. Thus, interest is growing in non-invasive imaging modalities for evaluation of non-invasive diagnosis or exclusion of CAD. 3In 1999, multislice spiral computed tomography (MSCT) systems with simultaneous acquisition of four slices and half second scanner rotation became available for non-ICA. Initial experiences have shown that coronary stenoses can be detected with promising sensitivity and specificity. [3][4][5][6][7][8] In 2002, the second MSCT scanner generation with faster gantry rotation speed (370-420 ms) and 16 detector slices became available. A significantly improved image quality led to more accurate detection of coronary artery stenoses. Owing to this technical progress and growing experience of physicians, a sensitivity of 95% and specificity of 98% were reported for the detection . 50% diameter stenoses. 9-11Several studies have been published comparing 4 slice and 16 slice MSCT with ICA. However, the use of MSCT has been little reported as the first line imaging technique in clinical practice without additional ICA.The objective of the present study was to evaluate the usefulness of MSCT coronary angiography as a first line imaging technique to evaluate the need for invasive diagnostic procedures in patients with unclear chest pain because of suspected or progressive CAD after percutaneous transluminal coronary angiopla...

Background: Cardiac multislice spiral computed tomography (MSCT) scanners permit visualization of the coronary arteries with an overall good sensitivity (sens) and specificity (spec). However, in obese patients (pts), who are at higher risk to develop coronary artery disease (CAD), image quality of MSCT is supposed to be limited. At present, there are no data whether the accuracy of MSCT depends on the body mass index (BMI). Thus, we compared the catheter-controlled MSCT results from normal weight and obese pts in a cohort of 117 pts with regard to sens, spec, positive predictive value (PPV), negative predictive value (NPV) and image quality. 3 pts (group I 1, group II 2) had to be excluded from analysis due to technical problems. Group I had significantly less risk factors (Po0.001) and image quality was significantly better than in group II and III (Po0.05). Group II and III did not differ with regard to risk factors or image quality. Conclusions: Overweight and obesity have an impact on MSCT image quality but did not hamper the diagnostic accuracy. Thus, MSCT is a noninvasive method to detect or rule out CAD also in pts with higher BMI. These retrospective data have to be confirmed in larger prospective trials.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the Western world. Since the majority of all invasive diagnostic coronary angiography procedures are not followed by therapeutic interventions, interest is growing in noninvasive technologies to diagnose and visualize CAD. The most promising of these is multislice spiral computed tomography (MSCT), which can visualize human coronary arteries in vivo noninvasively. Since 1999, this technique has improved rapidly, offering faster gantry rotation times and smaller voxel sizes. The image quality has become significantly more stable and MSCT has become a robust imaging modality. Beginning with 4-slice scanners in 1999, the latest scanner generation employs 64 slices. The present article summarizes the technical principles, image protocols and possible clinical applications of the current 64-row scanners.

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