Clinical situations where coronary CT angiography confers superior diagnostic information in comparison to coronary angiography

Abstract

261C oronary artery disease is responsible for millions of deaths per year in developed countries (1, 2). Early recognition of coronary artery disease is important for the prevention of its related complications and improving prognosis (3). Catheter angiography has been considered the gold standard imaging method for evaluating the coronary tree. The major advantages of conventional coronary angiography (CCA) are its high spatial and temporal resolutions and the option of directly performing interventions, such as balloon dilation or coronary stent placement (4). However, CCA is an invasive procedure that carries the risk of morbidity and mortality (3). In addition, CCA provides only luminal data and is limited in revealing changes in the vessel wall and the adjacent soft tissues. Conversely, multidetector computed tomography coronary angiography (MDCT-CA) not only provides visualization of the vessel lumen but also displays the vessel wall and surrounding soft tissues, allowing for the detection of various congenital or acquired abnormalities of the coronary arteries that may not be evident with CCA (3).In this article, on the basis of our experience with more than 15 000 MDCT-CA from seven different centers, we reviewed clinical conditions in which MDCT-CA may be more helpful compared with CCA. Coronary CT techniqueWith the advent of technological refinements in the last decade, MDCT-CA has gained widespread use for the evaluation of coronary artery diseases. Currently, state-of-the-art computed tomography (CT) systems can simultaneously acquire 64 or more submillimeter sections with a gantry rotation time of less than half a second. Previous limitations of CT for evaluating the vascular system, associated with older generation scanners, have now been eliminated. Presently, a thinner section thickness allows for isotropic voxels, which is essential for optimum high-resolution, three-dimensional (3D) reconstruction and other postprocessing displays, such as maximum projection reformatting (MPR) in any selected plane. Faster scanners have resulted in shorter scans and shorter contrast bolus durations, allowing for the use of less contrast agent at a higher flow rate to achieve greater luminal enhancement. Motion artifacts from breathing are no longer a problem since highresolution imaging of the entire heart can be obtained in a single breath hold. Electrocardiography (ECG) gating techniques improve temporal resolution and minimize imaging artifacts caused by cardiac motion. With more recent technological advances, a reduction in radiation dose, for example, by the utilization of prospective gating, has occurred without any deterioration in diagnostic image quality (5).In our centers, images were acquired using either 16-or 64-MDCT scanners. Eighty-five to one hundred milliliters of iodinated contrast medium (Ultravist 370, Schering, Berlin, Germany) was intravenously ABSTRACT In this review, we aimed to outline the clinical and pathological conditions for which multidetector computed tomography coronary angiogr...

Assessment of the coronary venous system by using cardiac CT

“…Images can be accurately, rapidly, and thoroughly interpreted due to the ability of this technique to capture fine axial images and make use of multiplanar reconstructions, interactive maximum intensity projection images, and volume rendering technique (1)(2)(3)(4). In recent years, ECG-gated MDCT has become an important noninvasive tool and has been increasingly used to evaluate coronary arteries (5)(6)(7)(8). This method enables assessment of the coronary venous system and other cardiac structures, in addition to the coronary arteries (5).…”

Computed Tomography-Based SYNTAX Score: A Case Report

“…Recently, CT angiography has been increasingly used in the assessment of coronary arteries, and there is extensive evidence that CT angiography is useful in diagnostic and prognostic aspects [5,6]. In contrast to conventional angiography, there is no scoring system that grades the complexity of coronary lesions in CT angiography.…”

Multidetector computed tomography findings of an asymptomatic levoatrial cardinal vein with an interatrial course

“…ECG-gated CT is the noninvasive method commonly used at recent period for assessment of other cardiac structures in addition to coronary arterial and venous anomalies [2, 8,9]. The high temporal resolution, multiplanar reconstruction (MPR) and 3D volume rendering technique (VRT) and maximum intensity projection (MIP) features provided by this technique enables a detailed evaluation of vascular anomalies and pathological cardiac structures.…”