Multislice Computed Tomography Coronary Angiography at a Local Hospital: Pitfalls and Potential (original) (raw)
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Introduction to coronary imaging with 64-slice computed tomography
La Radiologia medica
The aim of this article is to illustrate the main technical improvements in the last generation of 64-row CT scanners and the possible applications in coronary angiography. In particular, we describe the new physical components (X-ray tube-detectors system) and the general scan and reconstruction parameters. We then define the scan protocols for coronary angiography with the new generation of 64-row CT scanners to enable radiologists to perform a CT study on the basis of the diagnostic possibilities.
The “Post-64” Era of Coronary CT Angiography: Understanding New Technology from Physical Principles
Radiologic Clinics of North America, 2009
Multidetector Computed Tomography (MDCT) is now an established modality for noninvasive cardiac imaging. Until recently, 64-slice CT provided state-of-the-art noninvasive coronary imaging. The 64 slices per gantry rotation can be achieved with either 64-detector rows, or 32detector rows and a strategy to double the slice number by alternating the focal spot of the xray source. These "64-generation" scanners offered considerable advantages over earlier technology: superior spatial resolution, temporal resolution, volume coverage, and lower radiation doses for patients. Improving upon these fundamental CT parameters is also the goal of the next generation, or "post-64" era of coronary CT angiography (CTA). This review highlights improvements in the post-64 era of cardiac MDCT.
Multidetector Computed Tomography (MDCT) is now an established modality for noninvasive cardiac imaging. Until recently, 64-slice CT provided state-of-the-art noninvasive coronary imaging. The 64 slices per gantry rotation can be achieved with either 64-detector rows, or 32-detector rows and a strategy to double the slice number by alternating the focal spot of the x-ray source. These " 64-generation " scanners offered considerable advantages over earlier technology: superior spatial resolution, temporal resolution, volume coverage, and lower radiation doses for patients. Improving upon these fundamental CT parameters is also the goal of the next generation, or " post-64 " era of coronary CT angiography (CTA). This review highlights improvements in the post-64 era of cardiac MDCT. The newest technology offers significant advantages, but unlike the evolution from 4-to 64-detector row coronary CTA, current CT hardware releases are far from uniform, reflecting different approaches to image acquisition in the post-64 era. No single CT scanner offers the full portfolio of the newest features. This situation underscores the importance of understanding the properties of a cardiac CT scanner. Also, CT vendors continue to eclipse the state-of-the-art from even the recent past. Thus, it is very challenging to accumulate " current " clinical evidence. This reality is reflected in two multi-center 64-era MDCT trials, each of which focused on a single CT platform. The first of these publications,1 the Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography (ACCURACY) trial, enrolled United States subjects from predominantly nonacademic (private) centers and found a (patient based) sensitivity, specificity, and positive and negative predictive values to detect >50% or >70% stenosis of 0.95, 0.83, 0.64, and 0.99, respectively, and 0.94, 0.83, 0.48, 0.99, respectively. The second publication, 2 the Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography (Core64) study was both international and included predominantly academic centers. This trial had lower test characteristics (patient based detection of >50% stenosis, sensitivity, specificity, and positive and negative predictive of 0.85, 0.90, 0.91, 0.83) but showed a similar ability of CT when compared to catheterization to identify, on the basis of obstructive coronary stenoses, patients who underwent revascularization.
Coronary artery imaging with 64-slice computed tomography from cardiac surgical perspective☆
European Journal of Cardio-Thoracic Surgery, 2006
Introduction: 64-Slice computed tomography (CT) has been introduced with high expectations. This study illustrates the value of 64-slice CT for the diagnosis of significant coronary artery stenoses when images are analysed by cardiovascular surgeons. Methods: Fifty patients (39 males, 11 females) underwent invasive coronary angiography and 64-slice CT. In these patients, 40 had coronary artery disease and 10 patients had valvular disease. Evaluation of right coronary artery (RCA), left main (LM), left anterior descending artery (LAD), diagonal branch 1 (D1), circumflex branch (CX), and 1st marginal branch was performed by two cardiovascular surgeons. All vessels with a diameter !1.5 mm were analysed and a lumen restriction of >50% was considered a significant stenosis. CT image quality was classified as excellent, reduced but still diagnostic, and not assessable. Invasive coronary angiography was taken as gold standard for calculations of diagnostic accuracy. Results: Mean heart rate during CTscan was 65 AE 11 beats per minute (bpm). Image quality of 92% (506/550) of all segments was rated as excellent, 5% (27/550) were rated as being of reduced quality but still diagnostic, and 3% (17/550) were considered not assessable. The sensitivity for diagnosing a significant stenosis with CT when including all reliably evaluated segments was 93% (106/114), specificity was 97% (381/392), positive predictive value was 91% (106/117), and negative predictive value was 98% (381/389). Conclusion: 64-Slice CT provides a high diagnostic accuracy in assessing significant coronary artery stenosis. Nevertheless, still exist some disadvantages such as strong vessel wall calcifications reducing the reliability for image interpretation. At the moment, 64-slice CT should be used as a complementary imaging modality to invasive coronary angiography.
Coronary angiography with multi-slice computed tomography
Lancet, 2001
A new generation of subsecond multi-slice computed tomography (MSCT) scanners, which allow complete coronary coverage, are becoming widely available. We investigated the potential value of MSCT angiography in a range of coronary disorders.We studied 35 patients, including 11 who had undergone percutaneous transluminal coronary angioplasty and four who had had coronary-artery bypass grafts, by both MSCT and conventional coronary angiography. After intravenous injection of a non-ionic contrast medium with high iodine content, the entire heart was scanned within a single breath-hold. The total examination time was no more than 20 min. The retrospective electrocardiographically gated reconstruction source images and three-dimensional reconstructed volumes were analysed by two investigators, unaware of the results of conventional angiography.In the 31 patients without previous coronary surgery, 173 (73%) of the 237 proximal and middle coronary segments were assessable. In the assessable segments, 17 of 21 significant stenoses (>50% reduction of vessel diameter) were correctly diagnosed. The non-assessable segments included four lesions. Misinterpretations were mainly the result of severe calcification of the vessel wall. Segments with implanted stents were poorly visualised, but stent patency could be assessed in all cases. Of the 17 segments of bypass grafts, 15 were assessable and four of five graft lesions were detected. Two cases of anomalous coronary anatomy could be visualised well.These preliminary data suggest that MSCT allows non-invasive imaging of coronary-artery stenoses and has potential to develop into a reliable clinical technique.
Progress and Current State of Coronary CT
Annals of vascular diseases, 2011
The recent appearance of multislice computed tomography (CT) has enabled noninvasive imaging of the coronary artery. Particularly, the appearance of 64-row CT has rapidly promoted its spread into routine medical practice. In this report, progress and current state of coronary CT employing multislice CT are outlined.
CT Coronary Angiography: 256-Slice and 320-Detector Row Scanners
Current Cardiology Reports, 2010
Multidetector computed tomography (MDCT) has rapidly evolved from 4-detector row systems in 1998 to 256-slice and 320-detector row CT systems. With smaller detector element size and faster gantry rotation speed, spatial and temporal resolution of the 64-detector MDCT scanners have made coronary artery imaging a reliable clinical test. Wide-area coverage MDCT, such as the 256-slice and 320-detector row MDCT scanners, has enabled volumetric imaging of the entire heart free of stair-step artifacts at a single time point within one cardiac cycle. It is hoped that these improvements will be realized with greater diagnostic accuracy of CT coronary angiography. Such scanners hold promise in performing a rapid high quality "triple rule-out" test without high contrast load, improved myocardial perfusion imaging, and even four-dimensional CT subtraction angiography. These emerging technical advances and novel applications will continue to change the way we study coronary artery disease beyond detecting luminal stenosis.
Canadian Journal of Cardiology, 2009
M ultidetector computed tomography (MDCT) is increasingly used for the noninvasive assessment of coronary arteries. The gold standard for the diagnosis of coronary artery disease (CAD) is catheterbased coronary angiography (CCA). However, this technique is invasive, expensive and not without risks; it is associated with a major complication rate of 1.7% (1). Up to 20% of diagnostic CCAs fail to show obstructive lesions, while only one-third are associated with a concurrent intervention (2). An accurate noninvasive method to assess the coronary arteries would be a major improvement from angiography. In addition to assessing suspected CAD, MDCT has shown promise in analyzing restenosis following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The present article systematically reviews the literature regarding improvements in the diagnostic capacity of 64-slice MDCT compared with the previous generation of MDCT scanners.