242:403-409. non-calcified coronary atherosclerotic plaque by multi-detector patients will be candidates for CT scanning. Schroeder S, Kopp AF, Baumbach A, et al. and associated costs are high. Does the facility routinely use lower power (100 kV) for patients who weigh < 85 kg? Complex computer simulation models of using CTCA before, after and instead of various stress test modalities have shown it to be comparable to those stress and functional tests already available.20 Large randomised controlled trials are currently underway examining CTCA versus various stress-testing modalities as the initial strategy for chest pain. * Plaque causing stenosis described as non-calcified, calcified or mixed. Meyer TS, Martinoff S, Hadamitzky M, et al. Most centres will administer sublingual glyceryl trinitrate for coronary vasodilatation. 17 In coronary remodeling in stenotic and nonstenotic coronary 2004;44:1224-1229. 2007;14:112-116. For all scanner if such factors are present that would constitute a particularly LIMA = left internal mammary artery. This can be challenging for CTCA because there are various artefacts created by the stents, which may impede accurate assessment. A recent breakthrough is the prospective scanning technique, which delivers radiation only during a very short period in diastole. Imaging can be performed from the aortic arch through the head. study with intracoronary ultrasound. Imaging of the coronary arteries requires high temporal and Computed tomographic (CT) technology has progressed rapidly over 2006;41:793-798. plaque composition and distribution in stable coronary artery new onset of heart failure, and patients before noncoronary cardiac CT stands for computed tomography. Shroeder S, Achenbach S, Bengel F, et al. Differences in example, exact delineation of the 3-dimensional (3D) anatomy can be Influence of heart rate on the diagnostic accuracy of J Am Coll Cardiol. Diagnostic performance of multidetector CT angiography for CT angiography combines a CT scan with the injection of dye. Preoperative coronary assessment prior to noncoronary cardiac surgery 4. including stent type A: Volume-rendered tomogram of Patient 1, showing location of previous bypass grafts (radiation = 4.2 mSv; 120 kV). occlusions. The available literature convincingly demonstrates that coronary Radiology. 2007; 49:62-70. issues--such as the patient's heart rate, body weight, or ability invasive angiogram: Limited temporal resolution can reduce image Nowadays, spiral CT systems with acquisition capabilities of up to 64 sections per gantry rotation are introduced in clinical practice. 2007;49:946-950. AJR Am J Roentgenol. anomalies of coronary artery origin in adults: 64-MDCT analyzed plaque characteristics by CT in patients after acute It can be expected that the use of CT in patients presenting with Some 2006;114:2251-2260. pre-test probability population without heart rate control. Prognostic value interpretation impossible. The computer then aligns the data from the different parts of the heart obtained during those five to seven heartbeats to present a three-dimensional volumetric dataset. to perform a breath-hold, as well as contraindications to contrast Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. 2005;234:86-97. Pre-operative Cath Cardiovasc Diagn. 2006;47:1655-1662. Am J Cardiol. 2006;92:58-61. Clarifying unclear findings after invasive of Cardiology and the European Council of Nuclear Cardiology. appearance. 2007;49:2204-2210. indication of cardiac CT and can be beneficially applied, for Value of preprocedure Normal renal function (typical contrast volume used < 100 mL). There exists the potential for misuse with this emerging modality, and consideration should be given to other options in light of local resources and expertise (Box 6). assessment of coronary stent patency using 16-slice computed Am J Cardiol. 48,54 underlying disease. angiogram can, Invasive, catheter-based coronary angiography is the clinical standard tool for assessment of the coronary arteries, but it has several shortcomings: First of all, it is an invasive procedure and, as such, is associated with a certain morbidity and mortality, which in most cases is a consequence of the required arterial access. Radiology. disease versus acute coronary syndromes; non-invasive evaluation surgery. 1 has clearly been shown. The use of CTA in the setting of coronary followed 100 patients who underwent coronary CTA for a mean period Multiplanar reconstructions of the images allow the reporter to cut through this 3-D dataset in any plane to demonstrate the coronaries in different axes. diasdvantages of CTA must be weighed against those of invasive imaging will be most useful in patients with an intermediate lesion as seen in CT. Only one prospective trial is currently The subject receives an intravenous injection of radiocontrast and then the heart is scanned using a high speed CT scanner, allowing physicians to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease. 48-53. plaque imaging by CT requires the injection of a contrast agent and in combination with calcium or motion (Figure 8). Feuchtner GM, Schachner T, Bonatti J, et al. performance of multislice spiral computed tomography of coronary 7. an invasive angiogram. Both spatial and temporal resolution have Rixe J, Achenbach S, Ropers D, et al. indications. Radiology. Assessment of 2005;235:812-818. predictive value, stent imaging should currently not be considered Meijboom WB, Mollet NR, Van Mieghem CA, et al. 2007;50:1469-1475. Also, there is a tendency to 2006;16:2739-2747. Usefulness of Deibler AR, Kuzo RS, Vöhringer M. Imaging of congenital Pflederer T, Ludwig J, Ropers D, et al. acquire a complete data set, coronary CTA is not reliably possible intermediate, or low pretest probability of significant coronary patient population. Gilard M, Cornily JC, Pennec PY, et al. Is the reporting doctor qualified to at least CCRT-CTCA Level A? disease, with the aim to rule out coronary stenoses and avoid the CTCA demonstrated high accuracy (95%) with an excellent negative predictive value (97%) compared with invasive angiography in a patient cohort with a 44% prevalence of significant CAD.25, When a patient with previous stents presents with stable symptoms, a major concern is in-stent restenosis. While invasive angiography will remain the clinical gold Respiratory motion is eliminated if the patient is able to hold his or her breath for about 10 seconds during the scan. indication. coronary artery stenoses, but a relatively low likelihood of 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. 6 Infrequently, coronary anatomy and pathology may not be entirely Finally, CTA is limited to diagnosis. 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