Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina

Hacker, Marcus; Jakobs, Tobias; Hack, N.; Nikolaou, Konstantin; Becker, Christoph R.; Ziegler, Franz von; Knez, Andreas; König, Andreas; Klauß, Volker; Reiser, Maximilian; Hahn, Klaus; Tiling, Reinhold

doi:10.1007/s00259-006-0207-2

Cited by 128 publications

(68 citation statements)

References 20 publications

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“…Observation from 64-slice CTA provides high-quality noninvasive coronary arteriogram that accurately delineates the presence or absence of significant stenotic lesion within entire coronary trees [4,5]. However recent reports showed that CTA does not predict the functional relevance of coronary artery stenoses in patients with stable angina in accordance with our result [7,22]. The potential clinical value of such information remains to be elucidated.…”

Section: Discussionsupporting

confidence: 73%

“…The potential clinical value of such information remains to be elucidated. Therefore, the policy of proceeding directly with CTA stenosis for the intervention results in subjecting patients to a higher number of cardiac events, since CTA stenosis is irrelevant with 14 functional ischemia, as shown in this study [3,7,22].…”

Section: Discussionmentioning

confidence: 99%

“…A physician then views SPECT images and integrates mentally myocardial perfusion imaging (MPI) and anatomical imaging such as CTA or coronary angiography [6][7]. Therefore, image registration between MPI and anatomical images should improve the diagnosis of culprit coronary lesions that cause myocardial ischemia and provide useful information for decision-making of coronary intervention [8].…”

mentioning

confidence: 99%

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Clinical usefulness of novel cardiac MDCT/SPECT fusion image

et al. 2009

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical usefulness of novel cardiac MDCT/SPECT fusion image

et al. 2009

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“…Stress testing provides additional information to predict the functional relevance of coronary stenosis with respect to myocardial ischemia. 5,6 When cCTA demonstrates coronary stenosis of uncertain hemodynamic significance, a follow-up stress test may evaluate the functional significance of CAD found by cCTA. Given the divergent emphasis of stress testing on functional physiology and cCTA on coronary anatomy, these two modalities may provide complementary information in the evaluation of CAD.…”

Section: Introductionmentioning

confidence: 99%

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Halpern¹,

Fischman²,

Savage³

et al. 2010

Academic Radiology

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“…Studies have shown that the superior performance characteristics of 64-slice CCT in terms of spatial and temporal resolution lead to measurable improvements in image quality (25). Recent studies reported sensitivities and specificities of 73%-95% and 95%-99%, respectively, for 64-slice scanners (26)(27)(28). The number of segments that cannot be evaluated has been reduced to below 10% in most studies, a finding also representing a significant improvement over the performance of older scanners (Fig.…”

Section: Coronary Angiographymentioning

confidence: 83%

Cardiac CT: Indications and Limitations

Prat‐González

Sanz

García³

2008

Journal of Nuclear Medicine Technology

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Cardiac CT (CCT) is rapidly evolving as a noninvasive imaging modality. Newer technologic developments in CCT allow the comprehensive assessment of cardiovascular anatomy, including the coronary arteries. There are special considerations regarding obtaining and accurately interpreting CCT studies. On completion of this article, the reader should be able to describe the issues related to adequate patient preparation and acquisition and interpretation of CCT studies, recognize specific limitations that impair image quality and subsequently the accuracy of diagnosis, and list the current indications and future potential applications of this technique. Coronaryart ery disease (CAD) remains the most common cause of morbidity and mortality in developed countries. Noninvasive imaging for the detection of CAD has evolved significantly over the last 50 y. Technologic advances have led to the development of newer CT systems with a substantial increase in spatial and temporal resolution as well as a shortening of the imaging acquisition time, making it possible to visualize the beating heart. This is why cardiac CT (CCT) has gained popularity for the detection and quantification of CAD (1-3). By far, CCT is the fastest-growing noninvasive diagnostic cardiac imaging modality in the United States. The percentages of uninterpretable CCT studies have gradually decreased from 20%-40% with 4-slice systems to 15%-25% with 16-slice systems and are now as low as 3%-10% with 64-slice systems. Here we review the technical considerations that are germane to operating a CCT program, including patient preparation, factors that affect interpretation, and current indications and potential applications of this rapidly evolving technique. PRESCAN CONSIDERATIONSThe most common indication for CCT is the anatomic evaluation of the coronary arteries for the presence of CAD. Before each procedure, it is important to review a patient's medical history to collect relevant clinical data that are crucial for the correct performance and interpretation of the test. Patient information required before CCT includes the following:• clinical history (symptoms such as chest pain and dyspnea); • history of allergies (e.g., iodinated contrast material and medications); • history of asthma or hyperthyroidism;• history of renal disease or multiple myeloma (recent creatinine level); • previous diagnostic examinations (stress test, electrocardiogram [ECG], and echocardiogram). Heart Rate ControlPatient selection for CCT coronary angiography is critical. A stable, low heart rate is required at the time of the procedure, because motion artifacts can occur, given the current limitations in the temporal resolution of existing scanners. Most studies have demonstrated that the highest image quality for current CCT scans is achieved at heart rates of less than 65 beats per minute (bpm) (4). In most patients with heart rates below 70 bpm, the best phase free of motion is centered on 75% of the R-R interval, corresponding to the diastasis phase of diastole (5). At higher...

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Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina

Abstract: Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients.

Cited by 128 publications

References 20 publications

Clinical usefulness of novel cardiac MDCT/SPECT fusion image

Clinical usefulness of novel cardiac MDCT/SPECT fusion image

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Cardiac CT: Indications and Limitations

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