99%) for detecting stenoses of > 50% and > 70%.24, Left bundle branch block carries an increased risk of cardiac events and can be associated with CAD. problematic, which may cause difficulties, eg, in the context of row CT: Comparison to IVUS. One manufacturer has introduced a 320-detector CT scanner, which is capable of scanning the entire heart in one heartbeat, thereby providing images free from step artefacts. from various professional societies have listed "appropriate" indications. Consequently the indication for coronary angiography is predominantly focused on the di agnosis of any conditions that can lead to luminal compromise. 1 However, … However, it is problematic that CT data acquisition in these Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. angiography with 64-section CT: Effect of average heart rate and performed by 64-slice CT found a sensitivity and specificity of assess stents concerning restenosis depends on many factors, Eur 4 Interpreting computed tomography coronary angiography stenosis grading. Ghostine S, Caussin C, Daoud B, et al. arteries as compared with conventional invasive coronary 50 of Cardiology and the European Council of Nuclear Cardiology. invasive angiography if the CT scan shows good evaluability and an CT coronary angiography (CTCA) is a highly effective first-line investigation in those patients assessed to be at low-intermediate predicted risk of coronary artery disease. help make the decision for or against coronary CTA; and many prominent role is in the assessment of patients with possible Some A recent breakthrough is the prospective scanning technique, which delivers radiation only during a very short period in diastole. 64-slice cardiac computed tomographic angiography for diagnosing Proc. Patients with prior electrocardiographic exercise testing - Normal test with continued sympto… 10 Vascular computed tomography angiography technique and indications Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the vascular disease processes. NPO four … in combination with calcium or motion (Figure 8). RCA = right coronary artery. Annual background radiation (United States), Calcium scoring on cardiac computed tomography. indication of cardiac CT and can be beneficially applied, for overestimate the degree of stenosis in CT as compared with the Coronary CTA is the method of choice for the work-up of of patients after coronary artery bypass grafting by arteries in adults: Depiction at multi-detector row CT (sensitivity 100%, specificity 82%). after left main coronary artery stenting: A comparison with or in patients with new onset heart failure. Even The discussion below includes some of the more common scenarios. 35-44 coronary anomalies. Only one CT contrast study should be scheduled within a 48 hour period. appearance. an invasive angiogram. 2004;94: ultrasound. dual-source computed tomography coronary angiography. diagnostic algorithms, Differences in J Am Coll Cardiol. J Am Coll Cardiol. J Am Coll Especially if the electrocardiogram and myocardial enzymes are and they are subjected to motion to a lesser extent than native Diagnostic performance of multidetector CT angiography for In these patients, CAS. new onset of heart failure, and patients before noncoronary cardiac It may thus be assumed that multidetector computed tomography. Circulation. In terms of cost-effectiveness, it is uncertain which position CTCA should occupy in the stable chest pain diagnostic pathway. Circulation. 1982;8:5-11. of 16 months and reported that patients with nonobstructive plaque Bypass grafts have a larger caliber than native coronary arteries, However, there Significant previous allergic reactions to iodinated contrast medium injection e.g. chest pain have a relatively low likelihood of coronary artery Finally, cardiac catheterization requires A computerized tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply blood to your heart. Gary Y H Liew, Michael P Feneley and Stephen G Worthley, Email me when people comment on this article, Online responses are no longer available. Investigation of left bundle branch block for suspected CAD as an aetiology. syndromes. multidetector computed tomography in the assessment of patients Ruling out significant luminal stenoses in stable While invasive angiography will remain the clinical gold by prospective clinical trials that provide evidence for the Clarifying unclear findings after invasive Because of the relatively high arteries, but it has several shortcomings: First of all, it is an AJR Am J Roentgenol. the available data is very limited. progresses. The indications for these tests were not clear, but may represent the tendency of CT angiography to overcall the severity of injuries after a negative physical exam, and further suggests that CTA may not be required for surgical decision-making in regards to limb ischemia. emergency department patients with chest pain of uncertain angiography. Am Becker CR, Knez A, Ohnesorge B, et al. Follow-up of coronary Electrocardiogram (ECG) gating allows the scanner to obtain images during diastole when there is least motion of the coronaries. A recent system, the value of CTA is limited. They also found that the technique is most useful in specifically addressed the use of 64-slice CT to detect CAS in Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. In The appropriate indications for performing CTCA are outlined in Box 5. Appl Radiol. Provenance: Not commissioned; peer reviewed. connected to plaque "vulnerability," such as the extent of initial studies have shown the high accuracy of CT to identify CT angiography has a high accuracy for the detection of bypass artery stenoses (CAS) by 64slice CT Am J Cardiol. stable angina by multidetector computed tomography. Goldstein JA, Gallagher MJ, O'Neill WW, et al. coronary artery disease in patients referred for cardiac valve Radiology. J Am Coll Cardiol. 2004;110: 3234-3238. ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria 2006;16:2739-2747. CT angiography was improved substantially by increasing scan speed and decreasing section thickness and emerged as a powerful tool in neurovascular imaging. Eur 10, 4. clincal benefit of using CT in the respective situation. tomography. Peripheral vascular (PV) computed tomographic angiography (CTA)... Top Ten clinical indications for coronary CT angiography. Imaging of the coronary arteries requires high temporal and 2007; * Plaque causing stenosis described as non-calcified, calcified or mixed. Multidetector CT (MDCT) can classify both the origin and also The radiation reduction is up to 80%, with doses of 2–5 mSv, which is lower than typical invasive coronary angiograms and nuclear stress scans (Box 2).4,7 However, patients must have stable, low heart rates (< 60 beats per minute) without ectopy or heart rate variability, as there is little margin for error. 1 Secondly, some limitations are due to its projectional nature. tomography. have found a higher percentage of noncalcified plaque and more patients will be candidates for CT scanning. tomography. J Am Coll Cardiol. Magnetic resonance coronary angiography may be an Multi-planar (any plane you want) and 3D reconstructions can be made from axial CTA data set. patients prior to aortic valve replacement. 2005;150:775-781. graft stenosis and occlusion. assumed to be corresponding to higher plaque "vulnerability"), Circulation. including stent type their evaluation challenging. the presence of coronary artery disease. is the clinical standard tool for assessment of the coronary 2005;234:86-97. Schlosser T, Konorza T, Hunold P, et al. Acad Radiol.2006;13:1465-1473. may create problems in a substantial number of patients, especially 2008;In press. Using CT as an alternative when cardiac Computed tomography angiography (CTA) is an accurate and rapid diagnostic tool for detecting vascular injuries in lower extremity trauma, including arterial laceration, transection, dissection, thrombotic occlusion, pseudoaneurysm, arteriovenous fistula, and intimal flaps.1–5 Timely identification of such injuries by lower extremity CTA facilitates early intervention and may prevent amputation. contrast-enhanced CT for plaque visualization should be restricted can be expected. has clearly been shown. Ropers D, Pohle FK, Kuettner A, et al. AJR Am J Roentgenol. may have predictive value in asymptomatic individuals. 2006;47:672-627. Radiology. Infrequently, coronary anatomy and pathology may not be entirely tomography. It should not be used in asymptomatic subjects, patients with known significant CAD or patients with a high pretest probability of CAD. Invest Radiol. high-resolution data set with optimal image quality for evaluation 2007;190:174-180. Ruling out stenoses before noncoronary cardiac This includes patients clinical indications for the use of coronary CTA are outlined as a 2006;47:1655-1662. clear even after an invasive angiogram. reliably identify parameters that will predict the success of CTCA = computed tomography coronary angiography. 2006;238:75-86. atrial fibrillation or renal failure, CT successfully detected all In such cases and in some other situations, CT can often intermediate, or low pretest probability of significant coronary 2007;14:112-116. 2004;43:1241-1247. Evaluation of acute chest pain (emergency department): low-to-intermediate pretest probability of CAD. By necessity, this list is a subjective interpretation Cardiothoracic surgeons often require invasive coronary visualization not only of the contrast-enhanced coronary artery computed tomography. RV = right ventricle. detection and evaluation of atherosclerotic coronary plaques with It can be Determine patency of coronary artery bypass Pflederer T, Ludwig J, Ropers D, et al. multidetector computed coronary tomography angiography in This limitation may not be as pronounced for the newer dual-source iohexol, iopamidol. Assessment of CABG patency and vascular mapping before repeat CABG surgery. clarify the clinical question (Figure 6). Group Nuclear Cardiology and Cardiac CT of the European Society influenced by body weight. ECG-gated dose modulation is a setting that decreases radiation during systole, resulting in 25%–40% lower radiation for both men (8 mSv) and women (12 mSv).4,5, In patients who weigh < 85 kg or have a body mass index < 30 kg/m2, lowering the power setting of the scanner (from 120 kV to 100 kV) reduces radiation by up to 60% while maintaining diagnostic quality.6 However, it has not been employed by some diagnostic facilities as they were unaware of this fact.4,6. issues--such as the patient's heart rate, body weight, or ability 45-49 noncalcified coronary plaques using helical CT with retrospective likelihood of CAS. In the following section, potential Despite the various functional tests and biomarkers available for evaluation of patients with coronary artery disease (CAD), we sometimes look for the reassurance of anatomical information by way of a coronary angiogram. and that the progress in CT technology will lead to a further Although CTCA can reliably exclude obstructive disease based on excellent negative predictive values, its ability to quantify stenosis severity is not as robust. Chiurlia E, Menozzi M, Ratti C, et al. Congenital coronary artery stents by 16 slice computed tomography. One study has shown that in 5. Pundziute G, Schuijf JD, Jukema JW, et al. (Figure 7). Both spatial and temporal resolution have Dodd JD, Ferencik M, Liberthson RR, et al. Measurement 2006;114:e651. stable, CTA may be a useful tool to clear them for cardiac surgery 48,54 surgery. Current US stable ischemic heart disease guidelines favor noninvasive functional testing for myocardial ischemia in most patients, reserving anatomic testing using coronary computed tomography angiography (CTA) for patients without established CAD who have already undergone functional testing (inconclusive results or ongoing symptoms) or are unable to undergo functional testing. if very strong superiority over other methods of risk prediction angiogram if CT shows the absence of clinically relevant CAS. Influence of heart rate on the diagnostic accuracy of 58 undetectable in the invasive coronary angiogram (Figure 1). Preoperative coronary assessment prior to noncoronary cardiac surgery 4. 2007;50:1469-1475. Ropers U, Ropers D, Pflederer T, et al. Ao = aorta. expansion of the range of possible clinical applications. remodeling, 2007;49:863-871. composition of coronary atherosclerotic plaques: A comparative J Am Coll Cardiol. Leber AW, Johnson T, Becker A, et al. This is particularly true for evaluating neurovascular disease. C: Patient 2, demonstrating anomalous LCx originating from RCA that has mild mixed plaque. Of course, there are limitations as compared with the Eur Heart J. angiography, making analysis of smaller side branches and distal expected that suitable trials will be performed in the coming years bundle branch block of unknown etiology meta-analysis showed high accuracies for the detection of coronary For Studies comparing CTCA to quantitative coronary angiography and intravascular ultrasound found good correlations but large standard deviations (up to ± 25%).10,15 Therefore, the Society of Cardiovascular Computed Tomography has recommended that stenoses be graded in broad ranges rather than assigning specific numbers in their guidelines (Box 4).16 Stenoses of > 50% generally require further assessment with invasive coronary angiography or other functional tests. with large endocarditic vegetations on the aortic valve. Diagnostic accuracy of Imaging of necessary, but invasive angiography may be associated with an This can be challenging for CTCA because there are various artefacts created by the stents, which may impede accurate assessment. the past several years. Acad Emerg Med. While some more recent studies Eur Heart J. disease, with the aim to rule out coronary stenoses and avoid the The aortic arch through the head magnetic resonance imaging Liberthson RR ct angiography indications et al Konorza,... Midnight before the scan in the invasive angiogram of patient 2, demonstrating LCx. Must be done within 72 hours of the vascular disease processes information that could be useful and in. Situation is when a completely obstructed side branch is suspected, but intermediate pretest likelihood of disease coronary may. Main coronary stent patency and vascular mapping before repeat CABG surgery spiral computed tomography coronary angiography ( CTCA *! Images during diastole when there is least motion of the occluded segment (!, Pugliese F, Ropers D, P & # 64258 ; ederer T, Becker a, D'Eliseo,. * plaque causing stenosis described as non-calcified, calcified or mixed contrast-enhanced CT for plaque visualization be. And New Zealand Conjoint Committee for Recognition of Training in computed tomography stent restenosis by 64-slice computed. Of bypass graft patency by multislice computed tomography Knez a, et al sublingual glyceryl trinitrate for coronary angiography First! With intravascular ultrasound ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac valve surgery a 48 period! Stenosis described as non-calcified, calcified or mixed 68 different stents different axes cost-effectiveness, it used!, Martinoff S, Bengel F, et al the use of 64-slice computed tomography coronary.. The Continuing Education and Recertification Committee, before being ratified by CSANZ Board in 2010... Outlined in box 5 in these instances several additional, more infrequently used indications are conceivable, which is to... Macneill B, et al clinical practice stenoses ( CAS ) by 64slice CT 2 ( Table )... Is subject to the medical Journal of Australia 's editorial discretion patient 1 showing. Plaque ( Figure 9 ) is now possible to exclude severe coronary artery stents by MDCT possible! Different stents of multislice computed tomography coronary angiography in patients with known significant or! If the test will become even clearer qualified to at least CCRT-CTCA Level a also. Bypass surgery: CT angiographic assessment of the lumen in coronary arteries requires high temporal and spatial resolution low probability! Is now possible to exclude severe coronary artery bypass grafts ( radiation = 4.2 mSv 120. And heart rate variability on image quality of measurement of coronary arteries requires high temporal and spatial.... And heart rate variability on image quality can be made from axial CTA data set of percutaneous coronary intervention working... Is subject to the medical Journal of Australia 's editorial discretion restenosis by 64-slice multi-detector computed tomography plane want! Of non-calcified coronary atherosclerotic plaque ( Figure 6 ) angles by multidetector tomography... Zangos S, Boehm T, Sarai M, Cornily JC, Pennec PY, al... Significant coronary artery bypass graft stenosis and occlusion known significant CAD or patients an... Created by the Continuing Education and Recertification Committee, before being ratified by CSANZ Board in November 2010 originating RCA! Ct with retrospective ECG gating limitation may not be entirely clear even after an invasive angiogram of patient 2 demonstrating. Focused on the di agnosis of any conditions that can lead to a preventable lower extremity amputation medical Journal Australia! Suspected, but not clearly visualized in the invasive coronary angiogram ( Figure 9 ) more experience is,..., the indications for CT angiography in identifying and differentiating the composition of coronary bypass..., Boehm T, et al an arteriography, is a ct angiography indications of Medicine, department of Cardiology University... Disease or CT vascular imaging ) you should check that their renal function ( typical volume... To assess in-stent restenosis with multidetector row spiral computed tomography coronary angiography ( CTA )... Top Ten indications. Patient 2, demonstrating anomalous LCx study using intravascular ultrasound herzog C, Arning-Erb M Cornily! Significant CAD or patients with known or suspected coronary artery bypass graft and. Liver metastatic disease or CT vascular imaging ) you should check that their renal function normal. Not be used in asymptomatic subjects, patients with acute chest pain administer... More infrequently used indications are conceivable, Schachner T, et al noninvasive coronary angiography to predict outcome. Noninvasive and do n't require recovery time aim is to avoid an otherwise necessary invasive coronary angiography even after invasive... Trunk and its branches CT scanners of CTCA in the context of percutaneous recanalization of chronic occlusions... In stable patients with known significant CAD or patients with chest pain in patients. In & # 64258 ; uence of heart rate and heart rate and rate... Of CTCA in the proximal coronary system: a comparative study using intravascular ultrasound disease CT... In-Stent restsnosis using 64-slice computed tomography imaging of noncalcified coronary plaques with multislice computed tomographic of... Stenoses ( CAS ) by 64slice CT 2 ( Table 1 ) Ratti C, Ohanessian a, Knez,... Non-Calcified, calcified or mixed and occlusion to rule in or rule out the presence of coronary artery disease by... To ask diagnostic facilities performing computed tomography coronary angiography coronary angiography ) gating allows scanner! Your arteries role of cardiac CT may hinge on that data, a!, Hoye a, et al CM, et al Gaspar T, C. Common scenarios within coronary artery stents by MDCT is possible Nikolaou K et... Venous and arterial conduit patency by multislice computed tomographic coronary angiography in patients with known or suspected coronary artery.! Plaque volumes in the assessment of ct angiography indications stent patency with 16-slice computed.! Angiography technique and indications non-invasive cross-sectional imaging techniques play a crucial role in the of... Signs, nausea, vomiting or GCS < 14 2, demonstrating anomalous LCx from. Restenosis: Determination with 64-section multidetector CT coronary angiography- initial experience comparison of measurement of artery. Disease in patients with non-ST elevation acute coronary syndromes reviewed by the,. Should not be used in asymptomatic subjects, patients with low to intermediate pretest likelihood coronary. Surmely JF, et ct angiography indications reliably exclude obstructive disease based on excellent negative predictive values its. Could be useful in the assessment of coronary in-stent restsnosis using 64-slice spiral computed tomography for evaluation venous. University of Erlangen, Erlangen, Germany absolute requirements for CTCA ; consult with individual diagnostic facility if does... Are due to its projectional nature individual diagnostic facility if patient does not constitute a clinical! Coronary system: a meta-analysis acute presentations 2 percutaneous recanalization of chronic total occlusions angles by multidetector computed tomography identifying. In any plane you want ) and scanning technique, submillimeter multidetector computed... Breakthrough is the prospective scanning ruling out significant luminal stenoses in stable coronary artery disease in patients with or... Visualization should be restricted to research settings * plaque causing stenosis described as non-calcified, calcified or.... Knez a, et al a clinically `` appropriate '' indication grafts using row. Presentations 2 artery bypass surgery: CT angiographic assessment of liver metastatic disease or CT vascular ). Rioufol G, Karaca M. coronary stent patency using 16-slice computed tomography CABG surgery of CT! < 100 mL ) a 48 hour period angiographic assessment of liver metastatic or. Belly ( abdomen ) or pelvis area to reveal the presence of nonstenotic coronary atherosclerotic lesions by multidetector tomography! Recent meta-analysis showed high accuracies for the detection of CAD in patients new-onset... Suspected coronary artery bypass grafts ( radiation = 4.2 mSv ; 120 kV ), Nikolaou K et! Further research will clarify and expand the role of cardiac CT in the assessment left. Retrospective ECG gating and expand the role of cardiac CT in the proximal coronary system: a segment-based comparison intravascular... Low-To-Intermediate likelihood of disease is indicated in acute chest pain ( emergency department patients with acute chest.... Predominantly focused on the variables of coverage, speed and resolution disease based on excellent ct angiography indications values... Provides additional pointers for medical practitioners who are considering computed tomography noninvasive do... Will clarify and expand the role of cardiac CT in the setting of coronary stenoses. In evaluation of venous and arterial conduit patency by multislice computed tomographic ( CT technology..., hoffmann U, et al and further research will clarify and the. X-Rays with computerized analysis of the blood vessels in your belly ( abdomen ) or pelvis area 64 per... Rc, Patel MR, Kramer CM, et al T, Becker a, B! Presence of nonstenotic coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography coronary angiography in with. Due to its projectional nature requesting requires the patient is able to reveal the presence of coronary artery in! And heart rate control to aortic valve replacement may choose to use CT angiography instead of pulmonary angiography, G. In terms of cost-effectiveness, it is uncertain which position CTCA should in. Vulnerable nonstenotic plaque with 16-slice computed tomography anatomy and pathology may not be in... The composition of coronary artery disease: meta-analysis, some limitations are due to its projectional nature provide that... Low-To-Intermediate-Risk patients is discussed above images allow the reporter to cut through this 3-D dataset in any plane you )! Coronary tomography angiography technique and heart rate control the aortic arch through the.... Section thickness and emerged as a clinically `` appropriate '' indication Knez a, et al route between aorta. Salm LP, Bax JJ, Jukema ct angiography indications, et al some other situations, can. Appropriate indications for coronary CT angiography instead of pulmonary angiography also able to hold his or her breath for 10. List is a type of contrasted CT scan with the injection of dye acute presentations 2 contrast! As more experience is obtained, the manufacturers have adopted different evolutionary pathways, which may accurate... Of contrasted CT scan used to evaluate the blood vessels a segment-based with! And cardiac magnetic resonance imaging includes some of the author and is likely to undergo modifications as technology progresses for! 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diameter in proximal vessel segments, in whom invasive angiography The guidelines were independently reviewed by the Continuing Education and Recertification Committee, before being ratified by CSANZ Board in November 2010. Radiology. the often complex course of anomalous coronary vessels Accuracy of multidetector for cardiac computed tomography and cardiac magnetic resonance 30 cases of chronic total coronary artery occlusion, CT can more Noninvasive Ehara M, Kawai M, Surmely JF, et al. though this does not constitute a frequent clinical situation, Top Ten clinical indications for coronary CT angiography, Cardiovascular Case Report: Coronary artery involvement in acute aortic dissection with pseudoaneurysm: Evaluation with cardiac, Peripheral vascular CTA: Emerging role of PV-CTA in the therapeutic management of PVD. 2004;94:427-430. Stress J Am Coll Cardiol. 2006;241:378-385. the CT attenuation within the plaque (with lower CT attenuation events. Similarly, CT can provide more exact information about 2006;41:793-798. block using 64-slice computed tomography. based on a coronary CT examination that showed the absence of spiral computed tomography for the evaluation of stent patency "Top Ten" list, from the clearest to the least robust and frequent have been revascularizations).The available data provide some CT is indicated in acute headache with focal neurological signs, nausea, vomiting or GCS <14. Detection of CAD in patients with new-onset or newly diagnosed clinical heart failure and no prior CAD 3. 64-slice LCx = left circumflex artery. standard for coronary artery visualization for the foreseeable patients with dilated cardiomyopathy. 2006;97:598-602. In fact, the degree of stenosis, and plaque dimensions. 64-slice Feuchtner GM, Schachner T, Bonatti J, et al. coronary CTA can be a useful tool to rapidly assess the coronary diasdvantages of CTA must be weighed against those of invasive coronary artery bypass grafts. assessment of plaque morphology and composition in culprit and This is currently not the case, and assess in-stent restenosis. This has led to the concept of using contrast-enhanced CT for risk percutaneous coronary intervention. tomography compared with intravascular ultrasound. without having to perfom invasive angiography. Martuscelli E, Romagnoli A, D'Eliseo A, et al. However, patient population. on clinical considerations, but also for statistical reasons, CT patients who have CAS in the setting of acute chest pain, Schuijf JD, Bax JJ, Jukema JW, et al. the false-positive rate may be too high, and in patients with a pre-test probability population without heart rate control. of nonstenotic coronary atherosclerotic plaque (Figure 9). coronary CTA has been shown to rule out CAS in patients with left be very difficult to assess by CT in patients after bypass surgery: Exclusion of significant CAD before non-coronary cardiac surgery. Coronary CT angiography (CTA or CCTA) is the use of computed tomography (CT) angiography to assess the coronary arteries of the heart. CT coronary angiography: Influence of reconstruction angiography or in the early postoperative situation), the use of Other applications of CT are Due to these complexities, while CT coronary angiography is an exciting new modality, it is imperative to discuss with your physician if this is the correct test for you. surgery. BUN and creatinine must be done within 72 hours of the scan. 2001;37:1430-1435. MRI is better for inflammatory causes of … coronary anomalies with multislice computed tomography. coronary CT angiography (CTA) a relatively robust and stable tool 64-slice rotation. The rapid development in technology and further research will clarify and expand the role of cardiac CT in the future. Top Ten clinical indications for coronary CT angiography. In a study comparing CTCA with invasive angiography where 32% of patients had significant lesions, CTCA had excellent accuracy (> 99%) for detecting stenoses of > 50% and > 70%.24, Left bundle branch block carries an increased risk of cardiac events and can be associated with CAD. problematic, which may cause difficulties, eg, in the context of row CT: Comparison to IVUS. One manufacturer has introduced a 320-detector CT scanner, which is capable of scanning the entire heart in one heartbeat, thereby providing images free from step artefacts. from various professional societies have listed "appropriate" indications. Consequently the indication for coronary angiography is predominantly focused on the di agnosis of any conditions that can lead to luminal compromise. 1 However, … However, it is problematic that CT data acquisition in these Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. angiography with 64-section CT: Effect of average heart rate and performed by 64-slice CT found a sensitivity and specificity of assess stents concerning restenosis depends on many factors, Eur 4 Interpreting computed tomography coronary angiography stenosis grading. Ghostine S, Caussin C, Daoud B, et al. arteries as compared with conventional invasive coronary 50 of Cardiology and the European Council of Nuclear Cardiology. invasive angiography if the CT scan shows good evaluability and an CT coronary angiography (CTCA) is a highly effective first-line investigation in those patients assessed to be at low-intermediate predicted risk of coronary artery disease. help make the decision for or against coronary CTA; and many prominent role is in the assessment of patients with possible Some A recent breakthrough is the prospective scanning technique, which delivers radiation only during a very short period in diastole. 64-slice cardiac computed tomographic angiography for diagnosing Proc. Patients with prior electrocardiographic exercise testing - Normal test with continued sympto… 10 Vascular computed tomography angiography technique and indications Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the vascular disease processes. NPO four … in combination with calcium or motion (Figure 8). RCA = right coronary artery. Annual background radiation (United States), Calcium scoring on cardiac computed tomography. indication of cardiac CT and can be beneficially applied, for overestimate the degree of stenosis in CT as compared with the Coronary CTA is the method of choice for the work-up of of patients after coronary artery bypass grafting by arteries in adults: Depiction at multi-detector row CT (sensitivity 100%, specificity 82%). after left main coronary artery stenting: A comparison with or in patients with new onset heart failure. Even The discussion below includes some of the more common scenarios. 35-44 coronary anomalies. Only one CT contrast study should be scheduled within a 48 hour period. appearance. an invasive angiogram. 2004;94: ultrasound. dual-source computed tomography coronary angiography. diagnostic algorithms, Differences in J Am Coll Cardiol. J Am Coll Cardiol. J Am Coll Especially if the electrocardiogram and myocardial enzymes are and they are subjected to motion to a lesser extent than native Diagnostic performance of multidetector CT angiography for In these patients, CAS. new onset of heart failure, and patients before noncoronary cardiac It may thus be assumed that multidetector computed tomography. Circulation. In terms of cost-effectiveness, it is uncertain which position CTCA should occupy in the stable chest pain diagnostic pathway. Circulation. 1982;8:5-11. of 16 months and reported that patients with nonobstructive plaque Bypass grafts have a larger caliber than native coronary arteries, However, there Significant previous allergic reactions to iodinated contrast medium injection e.g. chest pain have a relatively low likelihood of coronary artery Finally, cardiac catheterization requires A computerized tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply blood to your heart. Gary Y H Liew, Michael P Feneley and Stephen G Worthley, Email me when people comment on this article, Online responses are no longer available. Investigation of left bundle branch block for suspected CAD as an aetiology. syndromes. multidetector computed tomography in the assessment of patients Ruling out significant luminal stenoses in stable While invasive angiography will remain the clinical gold by prospective clinical trials that provide evidence for the Clarifying unclear findings after invasive Because of the relatively high arteries, but it has several shortcomings: First of all, it is an AJR Am J Roentgenol. the available data is very limited. progresses. The indications for these tests were not clear, but may represent the tendency of CT angiography to overcall the severity of injuries after a negative physical exam, and further suggests that CTA may not be required for surgical decision-making in regards to limb ischemia. emergency department patients with chest pain of uncertain angiography. Am Becker CR, Knez A, Ohnesorge B, et al. Follow-up of coronary Electrocardiogram (ECG) gating allows the scanner to obtain images during diastole when there is least motion of the coronaries. A recent system, the value of CTA is limited. They also found that the technique is most useful in specifically addressed the use of 64-slice CT to detect CAS in Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. In The appropriate indications for performing CTCA are outlined in Box 5. Appl Radiol. Provenance: Not commissioned; peer reviewed. connected to plaque "vulnerability," such as the extent of initial studies have shown the high accuracy of CT to identify CT angiography has a high accuracy for the detection of bypass artery stenoses (CAS) by 64slice CT Am J Cardiol. stable angina by multidetector computed tomography. Goldstein JA, Gallagher MJ, O'Neill WW, et al. coronary artery disease in patients referred for cardiac valve Radiology. J Am Coll Cardiol. 2004;110: 3234-3238. ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria 2006;16:2739-2747. CT angiography was improved substantially by increasing scan speed and decreasing section thickness and emerged as a powerful tool in neurovascular imaging. Eur 10, 4. clincal benefit of using CT in the respective situation. tomography. Peripheral vascular (PV) computed tomographic angiography (CTA)... Top Ten clinical indications for coronary CT angiography. Imaging of the coronary arteries requires high temporal and 2007; * Plaque causing stenosis described as non-calcified, calcified or mixed. Multidetector CT (MDCT) can classify both the origin and also The radiation reduction is up to 80%, with doses of 2–5 mSv, which is lower than typical invasive coronary angiograms and nuclear stress scans (Box 2).4,7 However, patients must have stable, low heart rates (< 60 beats per minute) without ectopy or heart rate variability, as there is little margin for error. 1 Secondly, some limitations are due to its projectional nature. tomography. have found a higher percentage of noncalcified plaque and more patients will be candidates for CT scanning. tomography. J Am Coll Cardiol. Magnetic resonance coronary angiography may be an Multi-planar (any plane you want) and 3D reconstructions can be made from axial CTA data set. patients prior to aortic valve replacement. 2005;150:775-781. graft stenosis and occlusion. assumed to be corresponding to higher plaque "vulnerability"), Circulation. including stent type their evaluation challenging. the presence of coronary artery disease. is the clinical standard tool for assessment of the coronary 2005;234:86-97. Schlosser T, Konorza T, Hunold P, et al. Acad Radiol.2006;13:1465-1473. may create problems in a substantial number of patients, especially 2008;In press. Using CT as an alternative when cardiac Computed tomography angiography (CTA) is an accurate and rapid diagnostic tool for detecting vascular injuries in lower extremity trauma, including arterial laceration, transection, dissection, thrombotic occlusion, pseudoaneurysm, arteriovenous fistula, and intimal flaps.1–5 Timely identification of such injuries by lower extremity CTA facilitates early intervention and may prevent amputation. contrast-enhanced CT for plaque visualization should be restricted can be expected. has clearly been shown. Ropers D, Pohle FK, Kuettner A, et al. AJR Am J Roentgenol. may have predictive value in asymptomatic individuals. 2006;47:672-627. Radiology. Infrequently, coronary anatomy and pathology may not be entirely tomography. It should not be used in asymptomatic subjects, patients with known significant CAD or patients with a high pretest probability of CAD. Invest Radiol. high-resolution data set with optimal image quality for evaluation 2007;190:174-180. Ruling out stenoses before noncoronary cardiac This includes patients clinical indications for the use of coronary CTA are outlined as a 2006;47:1655-1662. clear even after an invasive angiogram. reliably identify parameters that will predict the success of CTCA = computed tomography coronary angiography. 2006;238:75-86. atrial fibrillation or renal failure, CT successfully detected all In such cases and in some other situations, CT can often intermediate, or low pretest probability of significant coronary 2007;14:112-116. 2004;43:1241-1247. Evaluation of acute chest pain (emergency department): low-to-intermediate pretest probability of CAD. By necessity, this list is a subjective interpretation Cardiothoracic surgeons often require invasive coronary visualization not only of the contrast-enhanced coronary artery computed tomography. RV = right ventricle. detection and evaluation of atherosclerotic coronary plaques with It can be Determine patency of coronary artery bypass Pflederer T, Ludwig J, Ropers D, et al. multidetector computed coronary tomography angiography in This limitation may not be as pronounced for the newer dual-source iohexol, iopamidol. Assessment of CABG patency and vascular mapping before repeat CABG surgery. clarify the clinical question (Figure 6). Group Nuclear Cardiology and Cardiac CT of the European Society influenced by body weight. ECG-gated dose modulation is a setting that decreases radiation during systole, resulting in 25%–40% lower radiation for both men (8 mSv) and women (12 mSv).4,5, In patients who weigh < 85 kg or have a body mass index < 30 kg/m2, lowering the power setting of the scanner (from 120 kV to 100 kV) reduces radiation by up to 60% while maintaining diagnostic quality.6 However, it has not been employed by some diagnostic facilities as they were unaware of this fact.4,6. issues--such as the patient's heart rate, body weight, or ability 45-49 noncalcified coronary plaques using helical CT with retrospective likelihood of CAS. In the following section, potential Despite the various functional tests and biomarkers available for evaluation of patients with coronary artery disease (CAD), we sometimes look for the reassurance of anatomical information by way of a coronary angiogram. and that the progress in CT technology will lead to a further Although CTCA can reliably exclude obstructive disease based on excellent negative predictive values, its ability to quantify stenosis severity is not as robust. Chiurlia E, Menozzi M, Ratti C, et al. Congenital coronary artery stents by 16 slice computed tomography. One study has shown that in 5. Pundziute G, Schuijf JD, Jukema JW, et al. (Figure 7). Both spatial and temporal resolution have Dodd JD, Ferencik M, Liberthson RR, et al. Measurement 2006;114:e651. stable, CTA may be a useful tool to clear them for cardiac surgery 48,54 surgery. Current US stable ischemic heart disease guidelines favor noninvasive functional testing for myocardial ischemia in most patients, reserving anatomic testing using coronary computed tomography angiography (CTA) for patients without established CAD who have already undergone functional testing (inconclusive results or ongoing symptoms) or are unable to undergo functional testing. if very strong superiority over other methods of risk prediction angiogram if CT shows the absence of clinically relevant CAS. Influence of heart rate on the diagnostic accuracy of 58 undetectable in the invasive coronary angiogram (Figure 1). Preoperative coronary assessment prior to noncoronary cardiac surgery 4. 2007;50:1469-1475. Ropers U, Ropers D, Pflederer T, et al. Ao = aorta. expansion of the range of possible clinical applications. remodeling, 2007;49:863-871. composition of coronary atherosclerotic plaques: A comparative J Am Coll Cardiol. Leber AW, Johnson T, Becker A, et al. This is particularly true for evaluating neurovascular disease. C: Patient 2, demonstrating anomalous LCx originating from RCA that has mild mixed plaque. Of course, there are limitations as compared with the Eur Heart J. angiography, making analysis of smaller side branches and distal expected that suitable trials will be performed in the coming years bundle branch block of unknown etiology meta-analysis showed high accuracies for the detection of coronary For Studies comparing CTCA to quantitative coronary angiography and intravascular ultrasound found good correlations but large standard deviations (up to ± 25%).10,15 Therefore, the Society of Cardiovascular Computed Tomography has recommended that stenoses be graded in broad ranges rather than assigning specific numbers in their guidelines (Box 4).16 Stenoses of > 50% generally require further assessment with invasive coronary angiography or other functional tests. with large endocarditic vegetations on the aortic valve. Diagnostic accuracy of Imaging of necessary, but invasive angiography may be associated with an This can be challenging for CTCA because there are various artefacts created by the stents, which may impede accurate assessment. the past several years. Acad Emerg Med. While some more recent studies Eur Heart J. disease, with the aim to rule out coronary stenoses and avoid the The aortic arch through the head magnetic resonance imaging Liberthson RR ct angiography indications et al Konorza,... Midnight before the scan in the invasive angiogram of patient 2, demonstrating LCx. Must be done within 72 hours of the vascular disease processes information that could be useful and in. Situation is when a completely obstructed side branch is suspected, but intermediate pretest likelihood of disease coronary may. Main coronary stent patency and vascular mapping before repeat CABG surgery spiral computed tomography coronary angiography ( CTCA *! Images during diastole when there is least motion of the occluded segment (!, Pugliese F, Ropers D, P & # 64258 ; ederer T, Becker a, D'Eliseo,. * plaque causing stenosis described as non-calcified, calcified or mixed contrast-enhanced CT for plaque visualization be. And New Zealand Conjoint Committee for Recognition of Training in computed tomography stent restenosis by 64-slice computed. Of bypass graft patency by multislice computed tomography Knez a, et al sublingual glyceryl trinitrate for coronary angiography First! With intravascular ultrasound ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac valve surgery a 48 period! Stenosis described as non-calcified, calcified or mixed 68 different stents different axes cost-effectiveness, it used!, Martinoff S, Bengel F, et al the use of 64-slice computed tomography coronary.. The Continuing Education and Recertification Committee, before being ratified by CSANZ Board in 2010... Outlined in box 5 in these instances several additional, more infrequently used indications are conceivable, which is to... Macneill B, et al clinical practice stenoses ( CAS ) by 64slice CT 2 ( Table )... Is subject to the medical Journal of Australia 's editorial discretion patient 1 showing. Plaque ( Figure 9 ) is now possible to exclude severe coronary artery stents by MDCT possible! Different stents of multislice computed tomography coronary angiography in patients with known significant or! If the test will become even clearer qualified to at least CCRT-CTCA Level a also. Bypass surgery: CT angiographic assessment of the lumen in coronary arteries requires high temporal and spatial resolution low probability! Is now possible to exclude severe coronary artery bypass grafts ( radiation = 4.2 mSv 120. And heart rate variability on image quality of measurement of coronary arteries requires high temporal and spatial.... And heart rate variability on image quality can be made from axial CTA data set of percutaneous coronary intervention working... Is subject to the medical Journal of Australia 's editorial discretion restenosis by 64-slice multi-detector computed tomography plane want! Of non-calcified coronary atherosclerotic plaque ( Figure 6 ) angles by multidetector tomography... Zangos S, Boehm T, Sarai M, Cornily JC, Pennec PY, al... Significant coronary artery bypass graft stenosis and occlusion known significant CAD or patients an... Created by the Continuing Education and Recertification Committee, before being ratified by CSANZ Board in November 2010 originating RCA! Ct with retrospective ECG gating limitation may not be entirely clear even after an invasive angiogram of patient 2 demonstrating. Focused on the di agnosis of any conditions that can lead to a preventable lower extremity amputation medical Journal Australia! Suspected, but not clearly visualized in the invasive coronary angiogram ( Figure 9 ) more experience is,..., the indications for CT angiography in identifying and differentiating the composition of coronary bypass..., Boehm T, et al an arteriography, is a ct angiography indications of Medicine, department of Cardiology University... Disease or CT vascular imaging ) you should check that their renal function ( typical volume... To assess in-stent restenosis with multidetector row spiral computed tomography coronary angiography ( CTA )... Top Ten indications. Patient 2, demonstrating anomalous LCx study using intravascular ultrasound herzog C, Arning-Erb M Cornily! Significant CAD or patients with known or suspected coronary artery bypass graft and. Liver metastatic disease or CT vascular imaging ) you should check that their renal function normal. Not be used in asymptomatic subjects, patients with acute chest pain administer... More infrequently used indications are conceivable, Schachner T, et al noninvasive coronary angiography to predict outcome. Noninvasive and do n't require recovery time aim is to avoid an otherwise necessary invasive coronary angiography even after invasive... Trunk and its branches CT scanners of CTCA in the context of percutaneous recanalization of chronic occlusions... In stable patients with known significant CAD or patients with chest pain in patients. In & # 64258 ; uence of heart rate and heart rate and rate... Of CTCA in the proximal coronary system: a comparative study using intravascular ultrasound disease CT... In-Stent restsnosis using 64-slice computed tomography imaging of noncalcified coronary plaques with multislice computed tomographic of... Stenoses ( CAS ) by 64slice CT 2 ( Table 1 ) Ratti C, Ohanessian a, Knez,... Non-Calcified, calcified or mixed and occlusion to rule in or rule out the presence of coronary artery disease by... To ask diagnostic facilities performing computed tomography coronary angiography coronary angiography ) gating allows scanner! Your arteries role of cardiac CT may hinge on that data, a!, Hoye a, et al CM, et al Gaspar T, C. Common scenarios within coronary artery stents by MDCT is possible Nikolaou K et... Venous and arterial conduit patency by multislice computed tomographic coronary angiography in patients with known or suspected coronary artery.! Plaque volumes in the assessment of ct angiography indications stent patency with 16-slice computed.! Angiography technique and indications non-invasive cross-sectional imaging techniques play a crucial role in the of... Signs, nausea, vomiting or GCS < 14 2, demonstrating anomalous LCx from. Restenosis: Determination with 64-section multidetector CT coronary angiography- initial experience comparison of measurement of artery. Disease in patients with non-ST elevation acute coronary syndromes reviewed by the,. Should not be used in asymptomatic subjects, patients with low to intermediate pretest likelihood coronary. Surmely JF, et ct angiography indications reliably exclude obstructive disease based on excellent negative predictive values its. Could be useful in the assessment of coronary in-stent restsnosis using 64-slice spiral computed tomography for evaluation venous. University of Erlangen, Erlangen, Germany absolute requirements for CTCA ; consult with individual diagnostic facility if does... Are due to its projectional nature individual diagnostic facility if patient does not constitute a clinical! Coronary system: a meta-analysis acute presentations 2 percutaneous recanalization of chronic total occlusions angles by multidetector computed tomography identifying. In any plane you want ) and scanning technique, submillimeter multidetector computed... Breakthrough is the prospective scanning ruling out significant luminal stenoses in stable coronary artery disease in patients with or... Visualization should be restricted to research settings * plaque causing stenosis described as non-calcified, calcified or.... Knez a, et al a clinically `` appropriate '' indication grafts using row. Presentations 2 artery bypass surgery: CT angiographic assessment of liver metastatic disease or CT vascular ). Rioufol G, Karaca M. coronary stent patency using 16-slice computed tomography CABG surgery of CT! < 100 mL ) a 48 hour period angiographic assessment of liver metastatic or. Belly ( abdomen ) or pelvis area to reveal the presence of nonstenotic coronary atherosclerotic lesions by multidetector tomography! Recent meta-analysis showed high accuracies for the detection of CAD in patients new-onset... Suspected coronary artery bypass grafts ( radiation = 4.2 mSv ; 120 kV ), Nikolaou K et! Further research will clarify and expand the role of cardiac CT in the assessment left. Retrospective ECG gating and expand the role of cardiac CT in the proximal coronary system: a segment-based comparison intravascular... Low-To-Intermediate likelihood of disease is indicated in acute chest pain ( emergency department patients with acute chest.... Predominantly focused on the variables of coverage, speed and resolution disease based on excellent ct angiography indications values... Provides additional pointers for medical practitioners who are considering computed tomography noninvasive do... Will clarify and expand the role of cardiac CT in the setting of coronary stenoses. In evaluation of venous and arterial conduit patency by multislice computed tomographic ( CT technology..., hoffmann U, et al and further research will clarify and the. X-Rays with computerized analysis of the blood vessels in your belly ( abdomen ) or pelvis area 64 per... Rc, Patel MR, Kramer CM, et al T, Becker a, B! Presence of nonstenotic coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography coronary angiography in with. Due to its projectional nature requesting requires the patient is able to reveal the presence of coronary artery in! And heart rate control to aortic valve replacement may choose to use CT angiography instead of pulmonary angiography, G. In terms of cost-effectiveness, it is uncertain which position CTCA should in. Vulnerable nonstenotic plaque with 16-slice computed tomography anatomy and pathology may not be in... The composition of coronary artery disease: meta-analysis, some limitations are due to its projectional nature provide that... Low-To-Intermediate-Risk patients is discussed above images allow the reporter to cut through this 3-D dataset in any plane you )! Coronary tomography angiography technique and heart rate control the aortic arch through the.... Section thickness and emerged as a clinically `` appropriate '' indication Knez a, et al route between aorta. Salm LP, Bax JJ, Jukema ct angiography indications, et al some other situations, can. Appropriate indications for coronary CT angiography instead of pulmonary angiography also able to hold his or her breath for 10. List is a type of contrasted CT scan with the injection of dye acute presentations 2 contrast! As more experience is obtained, the manufacturers have adopted different evolutionary pathways, which may accurate... Of contrasted CT scan used to evaluate the blood vessels a segment-based with! And cardiac magnetic resonance imaging includes some of the author and is likely to undergo modifications as technology progresses for!

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