Noninvasive coronary angiography using computed tomography: ready to kick it up another notch?

Direct visualization of the epicardial coronary arteries is necessary to confirm the presence and/or focal severity of coronary luminal disease. For nearly 50 years,1 invasive coronary arteriography has been the reference standard for defining epicardial coronary artery disease. While conventional coronary arteriography provides for exceptional spatial resolution and a general “road map” of the coronary system for catheter-based or surgical interventions, it is expensive, has a small but definite risk of complications, and requires either a brief hospitalization or a period of observation for several hours after the procedure in a specialized monitored unit. For many patients with known or suspected luminal coronary disease, a convenient, noninvasive, and safe means to perform coronary angiography would likely be of significant clinical and economic benefit. See p 2051 Electron beam (computed) tomography (EBT) has for some time been the only well-validated computed tomography (CT)-based imaging method that could reliably characterize cardiac mechanics and perfusion and provide insight into coronary atherosclerosis.2 The latter was accomplished initially by defining coronary artery calcification (CAC) and its relationship to atherosclerotic plaque.3 However, since the initial publications by Achenbach et al4 and Schmermund et al,5 EBT has been investigated increasingly as a means to perform noninvasive three-dimensional (3D) arteriography of the large epicardial coronary arteries, to examine coronary artery bypass grafts,6 and to characterize coronary artery anomalies.7 The published sensitivity and specificity of EBT for obstructive coronary disease as compared with invasive coronary arteriography has ranged from 85% to 90%. Recent changes in protocols to perform 1.5-mm slice imaging as opposed to the traditional 3.0-mm slice imaging, as well as development of improved post-processing methods, have further enhanced the robustness of the method and provided more reliable and more complete epicardial artery interrogation (personal experience and personal communication, Dr Matthew …

[1]  著者なし.  Mayo Clinic Practice of Cardiology, 3rd Ed. , 1997 .

[2]  David L. Hayes,et al.  Mayo Clinic Practice of Cardiology , 1996 .

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

[4]  D. Berman,et al.  State-of-the-art myocardial perfusion imaging. , 1994, Cardiology clinics.

[5]  K Bachmann,et al.  Coronary angiography by electron beam tomography. , 1996, Herz.

[6]  J. Rumberger.  Tomographic (plaque) imaging: state of the art. , 2001, The American journal of cardiology.

[7]  S. Achenbach,et al.  Visualization of coronary artery anomalies and their anatomic course by contrast-enhanced electron beam tomography and three-dimensional reconstruction. , 2001, The American journal of cardiology.

[8]  J. Rumberger,et al.  Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. , 2000, Circulation.

[9]  M. Bell,et al.  Intravenous electron-beam computed tomographic coronary angiography for segmental analysis of coronary artery stenoses. , 1998, Journal of the American College of Cardiology.

[10]  S. Achenbach,et al.  Noninvasive, three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. , 1997, The American journal of cardiology.

[11]  J. Seward,et al.  Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations. , 1995, Mayo Clinic proceedings.

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

[13]  T. Ryan,et al.  The coronary angiogram and its seminal contributions to cardiovascular medicine over five decades. , 2002, Transactions of the American Clinical and Climatological Association.

[14]  J. Rumberger,et al.  Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. , 1995, Circulation.