Cardiac CT

Article information

J Korean Med Assoc. 2007;50(1):5-17
Publication date (electronic) : 2007 January 31
doi : https://doi.org/10.5124/jkma.2007.50.1.5
Department of Radiology and Imaging Science, Yonsei University College of Medicine, Korea. bchoi@yumc.yonsei.ac.kr

Abstract

Multislice computed tomography (CT) is emerging technology that enables imaging the moving heart with high resolution. The current technology of CT is represented by 64-slice CT. CT is becoming the first-line evaluation tool for the detection of significant coronary artery stenosis and is applied for the detection of plaque composition and functional imaging. Significant coronary artery stenosis can be detected with a high accuracy over 90% and can be reliably excluded with a high negative predictive value approaching 100% by using 64-slice CT. CT coronary angiography is recommended not only to exclude significant stenosis in patients with equivocal symptoms or intermediate results on stress test but also to assess obstructive disease in symptomatic patients. Quantification of coronary artery calcium with CT is helpful to select patients for lipid-lowering therapies, who have intermediate coronary artery disease risk. With technical improvement, spatial and temporal resolution of CT will reach the level enough to establish the diagnoses of in-stent restenosis, plaque composition, and ventricular and valvular function in the foreseeable future. Myocardial imaging including myocardial perfusion and viability may be possible without increasing radiation exposure. CT is a very promising technology for cardiac imaging because, with technical improvement, clinical benefits are expected to be greater than the risk of radiation exposure. This short review is for readers ① to understand CT technology for cardiac imaging, ② to understand the limitation of current technology of CT for cardiac imaging, ③ to learn the current application of CT in cardiac diseases, ④ to get a perspective on the future directions of cardiac CT.

References

1. Alfidi RJ, MacIntyre WJ, Haaga JR. The effects of biological motion on CT resolution. AJR Am J Roentgenol 1976. 12711–15.
2. Omran H, Schmidt H, Hackenbroch M, Illien S, Bernhardt P, Sommer T, von der Recke , Fimmers R, Flacke S, Layer G, Pohl C, Luderitz B, Schild H, Sommer T. Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 2003. 3611241–1246.
3. Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Brundage BH, Kennedy J, Wolfkiel C, Stanford W, Shields P, Lewis RJ, Janowitz WR, Rich S, Brundange BH. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation 1996. 93898–904.
4. Stein PD, Beemath A, Kayali F, Skaf E, Sanchez J, Olson RE. Multidetector computed tomography for the diagnosis of coronary artery disease: a systematic review. Am J Med 2006. 119203–216.
5. Schuijf JD, Bax JJ, Shaw LJ, de Roos A, Lamb HJ, von der Wall EE, Wijns W. Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography. Am Heart J 2006. 151404–411.
6. Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005. 46552–557.
7. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006. 1141761–1791.
8. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Adv Data 2004. 1–34.
9. Hoffmann U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, Cury RC, Butler J, Abbara S, Brown DF, Manini A, Nichols JH, Achenbach S, Brady TJ. Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain. Circulation 2006. 1142251–2260.
10. White CS, Kuo D, Kelemen M, Jain V, Musk A, Zaidi E, Read K, Sliker C, Prasad R, Prasad R. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol 2005. 185533–540.
11. Mollet NR, Hoye A, Lemos PA, Cademartiri F, Sianos G, McFadden EP, Krestin GP, Serruvs PW, de Feyter PJ. Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions. Am J Cardiol 2005. 95240–243.
12. Pache G, Saueressig U, Frydrychowicz A, Foell D, Ghanem N, Kotter E, Geibel-Zehender A, Bode C, Langer M, Bley T, Bley T. Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts. Eur Heart J 2006. 27976–980.
13. Malagutti P, Nieman K, Meijboom WB, van Mieghem CA, Pugliese F, Cademartiri F, Mollet NR, Boersma E, de Jaeqere PD, de Feyter PJ. Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries. Eur Heart J 2006.
14. Gilard M, Cornily JC, Pennec PY, Joret C, Le Gal G, Mansourati J, Blanc JJ, Boschat J. Accuracy of multislice computed tomography in the preoperative assessment of coronary disease in patients with aortic valve stenosis. J Am Coll Cardiol 2006. 472020–2024.
15. Holmes DR Jr, Leon MB, Moses JW, Popma JJ, Cutlip D, Fitzgerald PJ, Brown C, Fischell T, Wong SC, Midei M, Snead D, Kuntz RE. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004. 109634–640.
16. Rixe J, Achenbach S, Ropers D, Baum U, Kuettner A, Ropers U, Bautz W, Daniel WG, Anders K. Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 2006. 27567–572.
17. Van Mieghem CA, Cademartiri F, Mollet NR, Malagutti P, Valgimigli M, Meijboom WB, Pugliese F, McFadden EP, Ligthart J, Runza G, Bruining N, Smits PC, Regar E, van der Giessen WJ, Sianos G, van Domburg R, de Jaegere P, Krestin GP, Serruys PW, de Feyter PJ. Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasound. Circulation 2006. 114645–653.
18. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990. 15827–832.
19. Detrano RC, Anderson M, Nelson J, Wong ND, Carr JJ, McNitt-Gray M, Bild DE. Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility-MESA study. Radiology 2005. 236477–484.
20. Wang L, Jerosch-Herold M, Jacobs DR Jr, Shahar E, Detrano R, Folsom AR. Coronary artery calcification and myocardial perfusion in asymptomatic adults: the MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2006. 481018–1026.
21. Moselewski F, O'Donnell CJ, Achenbach S, Ferencik M, Massaro J, Nguyen A, Cury RC, Abbara S, Jang IK, Brady TJ, Hoffmann U. Calcium concentration of individual coronary calcified plaques as measured by multidetector row computed tomography. Circulation 2005. 1113236.
22. Van Mieghem CA, McFadden EP, de Feyter PJ, Bruining N, Schaar JA, Mollet NR, Cademartiri F, Goedhart D, de Winter S, Granillo GR, Valgimigli M, Mastik F, van der Steen AF, van der Giessen WJ, Sianos G, Backx B, Morel MA, van Es GA, Zalewski A, Serruys PW. Noninvasive detection of subclinical coronary atherosclerosis coupled with assessment of changes in plaque characteristics using novel invasive imaging modalities: the Integrated Biomarker and Imaging Study (IBIS). J Am Coll Cardiol 2006. 471134–1142.
23. Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, Ohnesorge B, Fayad ZA, Becker CR, Reiser M, Steinbeck G, Boekstegers P. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 2006. 47672–677.
24. Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, Cury RC, Abbara S, Joneidi-Jafari H, Achenbach S, Brady TJ. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 2006. 471655–1662.
25. George RT, Silva C, Cordeiro MA, DiPaula A, Thompson DR, McCarthy WF, Ichihara T, Lima JA, Lardo AC. Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 2006. 48153–160.
26. Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde JL. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 2006. 113823–833.
27. Baks T, Cademartiri F, Moelker AD, Weustink AC, van Geuns RJ, Mollet NR, Krestin GP, Duncker DJ, de Feyter PJ. Multislice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. J Am Coll Cardiol 2006. 48144–152.
28. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, Hare JM, Lima JA. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 2006. 113394–404.
29. Belge B, Coche E, Pasquet A, Vanoverschelde JL, Gerber BL. Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography: comparison with cine magnetic resonance imaging. Eur Radiol 2006. 161424–1433.
30. Feuchtner GM, Dichtl W, Friedrich GJ, Frick M, Alber H, Schachner T, Bonatti J, Mallouhi A, Frede T, Pachinger O, zur Nedden D, Muller S. Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol 2006. 471410–1417.
31. Messika-Zeitoun D, Serfaty JM, Laissy JP, Berhili M, Brochet E, Iunq B, Vahanian A. Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography. J Am Coll Cardiol 2006. 48411–413.
32. Coles DR, Smail MA, Negus IS, Wilde P, Oberhoff M, Karsch KR, Baumbach A. Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 2006. 471840–1845.
33. Zanzonico P, Rothenberg LN, Strauss HW. Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward. J Am Coll Cardiol 2006. 471846–1849.
34. Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, Kastrati A, Schomig A. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 2006. 1131305–1310.
35. Johnson TR, Nikolaou K, Wintersperger BJ, Leber AW, von Ziegler F, Rist C, Buhmann S, Knez A, Reiser MF, Becker CR. Dual-source CT cardiac imaging: initial experience. Eur Radiol 2006. 161409–1415.
36. Ehara M, Surmely JF, Kawai M, Katoh O, Matsubara T, Terashima M, Tsuchikane E, Kinoshita Y, Suzuki T, Ito T, Takeda Y, Nasu K, Tanaka N, Murata A, Suzuki Y, Sato K, Suzuki T. Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circ J 2006. 70564.
37. Fine JJ, Hopkins CB, Ruff N, Newton FC. Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease. Am J Cardiol 2006. 97173–174.
38. Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, Wintersperger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005. 46147–154.
39. Leschka S, Alkadhi H, Plass A, Desbiolles L, Grunenfelder J, Marincek B, Wildermuth S. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 2005. 261482–1487.
40. Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, Serruys PW, Krestin GP, de Feyter PJ. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 2005. 1122318–2323.
41. Pugliese F, Mollet NR, Runza G, van Mieghem C, Meijboom WB, Malagutti P, Baks T, Krestin GP, deFeyter PJ, Cademartiri F. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 2006. 16575–582.
42. Ropers D, Rixe J, Anders K, Kuttner A, Baum U, Bautz W, Daniel WG, Achenbach S. Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 2006. 97343–348.
43. Leber AW, Knez A, Becker A, Becker C, von Ziegler F, Nikolaou K, Rist C, Reiser M, White C, Steinbeck G, Boekstegers P. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 2004. 431241–1247.
44. Viles-Gonzalez JF, Poon M, Sanz J, Rius T, Nikolaou K, Fayad ZA, Fuster V, Badimon JJ. In vivo 16-slice, multidetector-row computed tomography for the assessment of experimental atherosclerosis: comparison with magnetic resonance imaging and histopathology. Circulation 2004. 1101467–1472.
45. Schroeder S, Kuettner A, Leitritz M, Janzen J, Kopp AF, Herdeg C, Heuschmid M, Burgstahler C, Baumbach A, Wehrmann M, Claussen CD. Reliability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography: a comparison with histology. J Comput Assist Tomogr 2004. 28449–454.
46. Becker CR, Nikolaou K, Muders M, Babaryka G, Crispin A, Schoepf UJ, Loehrs U, Reiser MF. Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol 2003. 132094–2098.
47. Schroeder S, Kopp AF, Baumbach A, Meisner C, Kuettner A, Georg C, Ohnesorge B, Herdeg C, Claussen CD, Karsch KR. Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol 2001. 371430–1435.

Article information Continued

Figure 1

The mid to distal left anterior descending artery is almost occluded by an eccentric noncalcified plaque (arrows), which measures 20 HU suggesting lipid-rich composition

Figure 2

The left internal thoracic artery graft (black arrows) is connected to the distal left anterior descending artery. A Y-shape connection using a radial graft from the left internal thoracic artery graft to the first obtuse marginal branch shows a focal stenosis (white arrow)

Figure 3

The proximal right coronary artery is totally occluded. CT coronary angiography excellently reveals the extent of occlusion (arrows), distal contrast-filling by collateral flow, plaque density, and vascular remodeling

Figure 4

A stent in the proximal left anterior descending artery shows patent lumen without evidence of restenosis by using 64-slice CT

Figure 5

The 10-minute delayed CT scan after contrast administration (left panel) shows high enhancement of the septum, apex and lateral wall (white arrows). A dark poorly enhanced band-like region is noted sub-endocardially at the apex, which is considered as microvascular occlusion. The magnetic resonance image (right panel) obtained by delayed enhancement protocol shows transmural hyperenhancement at the same area as CT shows

Table 1

Accuracy of 64-slice CT for detection of significant coronary artery stenosis (≥50% in diameter)

Table 1

Table 2

Measurement of CT density according to the composition of plaque

Table 2