Pitfalls in 16-detector row CT of the coronary arteries.

Recently developed 16-detector row computed tomography (CT) has been introduced as a reliable noninvasive imaging modality for evaluating the coronary arteries. In most cases, with appropriate premedication that includes beta-blockers and nitroglycerin, ideal data sets can be acquired from which to obtain excellent-quality coronary CT angiograms, most often with multiplanar reformation, thin-slab maximum intensity projection, and volume rendering. However, various artifacts associated with data creation and reformation, postprocessing methods, and image interpretation can hamper accurate diagnosis. These artifacts can be related to pulsation (nonassessable segments, pseudostenosis) as well as rhythm disorders, respiratory issues, partial volume averaging effect, high-attenuation entities, inappropriate scan pitch, contrast material enhancement, and patient body habitus. Some artifacts have already been resolved with technical advances, whereas others represent partially inherent limitations of coronary CT angiography. Familiarity with the pitfalls of coronary angiography with 16-detector row CT, coupled with the knowledge of both the normal anatomy and anatomic variants of the coronary arteries, can almost always help radiologists avoid interpretive errors in the diagnosis of coronary artery stenosis.

[1]  Borut Marincek,et al.  Thoracic aorta: motion artifact reduction with retrospective and prospective electrocardiography-assisted multi-detector row CT. , 2002, Radiology.

[2]  Werner Moshage,et al.  Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT. , 2000 .

[3]  Pedro A. Lemos,et al.  Reliable Noninvasive Coronary Angiography With Fast Submillimeter Multislice Spiral Computed Tomography , 2002, Circulation.

[4]  P. V. van Ooijen,et al.  Coronary artery imaging with multidetector CT: visualization issues. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[5]  K Miyasaka,et al.  Virtual endoscopy of coronary arteries using contrast-enhanced ECG-triggered electron beam CT data sets. , 2000, AJR. American journal of roentgenology.

[6]  Matthijs Oudkerk,et al.  Coronary angiography with multi-slice computed tomography , 2001, The Lancet.

[7]  M. Reiser,et al.  Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. , 2000, Radiology.

[8]  W. Bautz,et al.  Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral Computed Tomography and Multiplanar Reconstruction , 2003, Circulation.

[9]  D. Kimbiris.  Anomalous origin of the left main coronary artery from the right sinus of Valsalva. , 1985, The American journal of cardiology.

[10]  P. Serruys,et al.  Large thrombus entrapped in a patent foramen ovale of the atrial septum, which apparently “disappeared” without embolic events , 2002, Heart.

[11]  Elliot K Fishman,et al.  Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[12]  Werner Moshage,et al.  Detection of Coronary Artery Stenoses by Contrast-Enhanced, Retrospectively Electrocardiographically-Gated, Multislice Spiral Computed Tomography , 2001, Circulation.

[13]  R. Turner,et al.  Echo-planar imaging: magnetic resonance imaging in a fraction of a second. , 1991, Science.

[14]  Rüdiger Blindt,et al.  Coronary Artery Stents in Multislice Computed Tomography: In Vitro Artifact Evaluation , 2004, Investigative radiology.

[15]  Thomas Flohr,et al.  Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique. , 2003, Investigative radiology.

[16]  B. Desjardins,et al.  ECG-gated cardiac CT. , 2004, AJR. American journal of roentgenology.

[17]  M. Reiser,et al.  Noninvasive detection of coronary artery stenosis by multislice helical computed tomography. , 2000, Circulation.

[18]  C. Leier,et al.  Changes in Diastolic Time with Various Pharmacologic Agents: Implication for Myocardial Perfusion , 1979, Circulation.

[19]  P. Serruys,et al.  Usefulness of multislice computed tomography for detecting obstructive coronary artery disease. , 2002, The American journal of cardiology.