Noninvasive Coronary Imaging: The Contest Between Magnetic Resonance and Computed Tomographic Coronary Angiography (original) (raw)
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Noninvasive Coronary Imaging: CT versus MR
Herz, 2003
Conventional coronary angiography is the undisputed gold standard in coronary lumenography. The small but serious risk involved in the procedure, the cost, and the necessary radiation dose have triggered the development of noninvasive alternatives such as electron-beam computed tomography, multi-slice computed tomography, and magnetic resonance Nichtinvasive Bildgebung der Koronararterien: CT vs. MR
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Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, 2011
2. The value of non-invasive cardiac imaging in patients with coronary artery disease Epicardial arteries visualization is essential for confirming coronary artery disease and for accurately establishing its severity. Over the last 40 years, coronary angiography has been the key exploration in assessing coronary artery obstruction, as well as the need for reperfusion, despite its invasive character and high costs. Nowadays, invasive coronary angiography is still considered the "gold standard" for diagnostic coronary testing, although it has a few major disadvantages and limitations (patient exposure to ionizing radiation, two-dimensional image acquisition of coronary arteries, inappropriate atherosclerotic plaques assessment). www.intechopen.com Coronary Angiography-Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease 82 16-channel computed tomography coronary angiography has recently become a leading procedure in cardiac imaging, as it allows an accurate visualization of the coronary artery lumen, as well as an appropriate assessment of stenosis severity; computed tomography coronary angiography results can now be used as an essential tool for prognosis assessment in patients with coronary heart disease (Mark et al., 2010). 2.1 The diagnostic value of non-invasive cardiac imaging in patients with coronary artery disease However, non-invasive imaging techniques (e.g. coronary multidetector computed tomography angiography and magnetic resonance imaging angiography), which are valuable and comparatively cheaper, can currently be used for studying the coronary artery wall. Both contribute to the diagnosis of coronary artery ischemic disease and the image quality produced by coronary multidetector computed tomography angiography favorably compares to that of coronary angiography. These explorations have their own limitations, including poor image acquisition due to cardiac motion or important calcium deposits, but, most of the times, good quality images are obtained. Coronary multidetector computed tomography angiography allows outer-luminal plaque visualization and can assess subsequent luminal stenosis. As with invasive coronary angiography, visual grading of coronary segment narrowing by ranges of stenosis is the current standard of practice and has been shown to provide useful clinical information relative to invasive coronary angiography (Cheng et al., 2008) (Miller et al., 2008). Quantitative coronary multidetector computed tomography angiography is a high accuracy procedure which allows noninvasive detection of suspected obstructive coronary artery disease; it has been used in some research applications but is not currently a routine part of clinical interpretation. This promising technology has potential as an additional diagnostic tool, which will most likely complement invasive coronary angiography in routine clinical care (Hoffmann et al., 2005). In a recent multicenter study, visual and quantitative assessments of stenosis severity by coronary multidetector computed tomography angiography were quite similar (Miller et al., 2008). Technical progress in coronary multidetector computed tomography technology (increased number of detectors-64, prolonged rotation time and, consequently, good spatial resolution) a careful patient selection and multi-slice coronary analysis led to a current sensitivity of 90-100%, a specificity of 95-100% (Hamon et al., 2006) and a negative predictive value of 97-100% (Yang et al., 2010) in coronary artery disease evaluation. The use of coronary multidetector computed tomography versus conventional coronary angiography and intravascular ultrasound for diagnostic purposes has been assessed in several studies and meta-analysis. In older studies, in which the computed tomography apparatus had less than 64 detection channels, coronary multidetector computed tomography seemed to provide less useful and less accurate information than conventional coronary angiography. However, the accuracy improved over the years, while the number of detectors continued to increase from 4 to 16 and then to 64, allowing a more faithful description of a larger number of coronary artery segments, previously impossible to visualize. (Hamon et al., 2007) (Vanhoenacker et al., 2007) (Janne d'Othec et al., 2008). Later studies affirmed that coronary multidetector computed tomography might allow a more accurate atherosclerosis evaluation, despite their lower efficacy in assessing stenosis severity.
A Prospective Study for Comparison of MR and CT Imaging for Detection of Coronary Artery Stenosis
JACC: Cardiovascular Imaging, 2011
The purpose of the present study was to directly compare the diagnostic accuracy of magnetic resonance imaging (MRI) and multislice computed tomography (CT) for the detection of coronary artery stenosis. B A C K G R O U N D Both imaging modalities have emerged as potential noninvasive coronary imaging modalities; however, CT-unlike MRI-exposes patients to radiation and iodinated contrast agent.
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JACC: Cardiovascular Imaging, 2011
In this issue of iJACC, Hamdan et al. (1) compare noninvasive coronary angiography with a state-ofthe-art magnetic resonance system (3.0-T, 32channel) and a standard 64-slice computed tomography (CT) scanner in 120 patients with stable or suspected coronary artery disease. In a selected patient population (excluding patients with acute coronary syndromes, advanced heart failure, stents, bypass surgery, arrhythmia, body mass index Ͼ40 kg/m 2 ) 95% and 97% of segments could be adequately visualized with magnetic resonance angiog-See page 50 raphy (MRA) and CT, respectively. Compared with invasive coronary angiography, the data demonstrate comparable diagnostic accuracy of the noninvasive modalities, with a slight advantage of CT (significant for the left circumflex artery).
Noninvasive assessment of coronary artery disease anatomy, physiology, and clinical outcome
JACC. Cardiovascular imaging, 2011
In this issue of iJACC, Hamdan et al. (1) compare noninvasive coronary angiography with a state-ofthe-art magnetic resonance system (3.0-T, 32channel) and a standard 64-slice computed tomography (CT) scanner in 120 patients with stable or suspected coronary artery disease. In a selected patient population (excluding patients with acute coronary syndromes, advanced heart failure, stents, bypass surgery, arrhythmia, body mass index Ͼ40 kg/m 2 ) 95% and 97% of segments could be adequately visualized with magnetic resonance angiog-See page 50 raphy (MRA) and CT, respectively. Compared with invasive coronary angiography, the data demonstrate comparable diagnostic accuracy of the noninvasive modalities, with a slight advantage of CT (significant for the left circumflex artery).
Journal of Interventional Cardiology, 2003
Magnetic resonance imaging and computed tomography (CT) have recently emerged as two techniques that can noninvasively visualize the coronary arteries. The latest generation 16-row detector multislice CT scanner is now considered the most reliable technique to visualize the coronaries. The sensitivity and specificity to detect a significant (>50% diameter stenosis) coronary stenosis is ± 94% and ± 90%, respectively. Further technical improvements are necessary to make CT a clinically reliable diagnostic tool. (J Interven Cardiol 2003;16:465-468) Address for reprints: P.J. de Feyter, M.D., Ph.D., University Hospital Rotterdam,
Cardiac MR Assessment of Coronary Arteries
Cardiovascular Imaging Asia, 2017
Imaging of coronary arteries with magnetic resonance has undergone undeniable progress during the past two decades. Although coronary computed tomography angiography detects coronary artery disease (CAD) with excellent diagnostic accuracy, the inevitable exposure to ionizing radiation and iodinated contrast administration make it less appealing in certain patient populations. Coronary magnetic resonance angiography (MRA) is now performed mostly as a whole heart, free breathing, three-dimensional study. Several factors influence quality and speed of the scan, including use of the appropriate pulse sequence according to the strength of the magnetic field, cardiac and respiratory gating, preparation pulses, multi-channel cardiac coils, parallel imaging, and contrast material injection. The use of coronary MRA is well established in coronary artery anomalies and aneurysms. While diagnostic performance has also improved markedly for the detection of CAD, coronary MRA is not yet a routine clinical study. However, coronary MRA is expected to be play a major role in the near future due to continuous research and technical achievements.