Integrative Computed Tomographic Imaging of Cardiac Structure, Function, Perfusion, and Viability

Recent advances in multidetector-row computed tomography (MDCT) technology have created new opportunities in cardiac imaging and provided new insights into a variety of disease states. Use of 64-slice coronary computed tomography angiography has been validated for the evaluation of clinically relevant coronary artery stenosis with high negative predictive values for ruling out significant obstructive disease. This technology has also advanced the care of patients with acute chest pain by simultaneous assessment of acute coronary syndrome, pulmonary embolism, and acute aortic syndrome (“triple rule out”). Although MDCT has been instrumental in the advancement of cardiac imaging, there are still limitations in patients with high or irregular heart rates. Newer MDCT scanner generations hold promise to improve some of these limitations for noninvasive cardiac imaging. The evaluation of coronary artery stenosis remains the primary clinical indication for cardiac computed tomography angiography. However, the use of MDCT for simultaneous assessment of coronary artery stenosis, atherosclerotic plaque formation, ventricular function, myocardial perfusion, and viability with a single modality is under intense investigation. Recent technical developments hold promise for accomplishing this goal and establishing MDCT as a comprehensive stand-alone test for integrative imaging of coronary heart disease.

[1]  L. McLain,et al.  Sudden death in young athletes. , 2003, Pediatric annals.

[2]  Filippo Cademartiri,et al.  Prevalence of coronary artery intramyocardial course in a large population of clinical patients detected by multislice computed tomography coronary angiography , 2008, Acta radiologica.

[3]  O. Simonetti,et al.  Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. , 1999, Circulation.

[4]  W. Heindel,et al.  Assessment of coronary arterial stents by multislice-CT angiography. , 2003, Acta radiologica.

[5]  M. Hamon,et al.  Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysis , 2008, European Radiology.

[6]  T. Fujii,et al.  Noninvasive assessment of coronary stents in patients by 16-slice computed tomography. , 2006, International journal of cardiology.

[7]  C. Becker,et al.  Strategies to reduce the risk of contrast-induced nephropathy. , 2006, The American journal of cardiology.

[8]  A. Taştan,et al.  Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control. , 2008, AJR. American journal of roentgenology.

[9]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[10]  Masashi Komeda,et al.  Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. , 2005, Radiology.

[11]  J. Blanc,et al.  Assessment of coronary artery stents by 16 slice computed tomography , 2005, Heart.

[12]  W. Bautz,et al.  Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. , 2006, European heart journal.

[13]  Georg Mühlenbruch,et al.  Automated vs. manual assessment of left ventricular function in cardiac multidetector row computed tomography: comparison with magnetic resonance imaging , 2006, European Radiology.

[14]  Hirofumi Anno,et al.  Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. , 2009, Journal of the American College of Cardiology.

[15]  K. Sim,et al.  Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. , 2006, American heart journal.

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

[17]  G. Feuchtner,et al.  Diagnostic performance of 64-slice computed tomography in evaluation of coronary artery bypass grafts. , 2007, AJR. American journal of roentgenology.

[18]  R. Cury,et al.  Coronary CT angiography. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  G. Guyatt,et al.  The rational clinical examination. Is this patient having a myocardial infarction? , 1998, JAMA.

[20]  R. Jabara,et al.  Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts. , 2007, The American journal of cardiology.

[21]  J. Leipsic,et al.  Radiation dose in cardiac CT. , 2009, AJR. American journal of roentgenology.

[22]  R. Günther,et al.  Dynamic multi-section CT imaging in acute myocardial infarction: preliminary animal experience , 2006, European Radiology.

[23]  Konstantin Nikolaou,et al.  Assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detector-row computed tomography of the heart: preliminary results , 2005, European Radiology.

[24]  S. Achenbach,et al.  Detection of Calcified and Noncalcified Coronary Atherosclerotic Plaque by Contrast-Enhanced, Submillimeter Multidetector Spiral Computed Tomography: A Segment-Based Comparison With Intravascular Ultrasound , 2003, Circulation.

[25]  T. Ohtsuka,et al.  Ultrafast computed tomography for minimally invasive coronary artery bypass grafting. , 1998, The Journal of thoracic and cardiovascular surgery.

[26]  J. Lima,et al.  Multidetector computed tomography myocardial perfusion imaging during adenosine stress. , 2006, Journal of the American College of Cardiology.

[27]  Yujie Zhou,et al.  Identification and quantification of coronary atherosclerotic plaques: a comparison of 64-MDCT and intravascular ultrasound. , 2008, AJR. American journal of roentgenology.

[28]  Konstantin Nikolaou,et al.  Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. , 2005, Journal of the American College of Cardiology.

[29]  R. Cury,et al.  Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. , 2009, Journal of the American College of Cardiology.

[30]  W. Heindel,et al.  Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. , 2004, Radiology.

[31]  Konstantin Nikolaou,et al.  Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. , 2004, Journal of the American College of Cardiology.

[32]  Harlan M Krumholz,et al.  Exposure to low-dose ionizing radiation from medical imaging procedures. , 2009, The New England journal of medicine.

[33]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[34]  Yasuyuki Suzuki,et al.  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. , 2006, Circulation journal : official journal of the Japanese Circulation Society.

[35]  Elmar Spuentrup,et al.  Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. , 2005, Journal of the American College of Cardiology.

[36]  Yen-Wen Wu,et al.  Estimation of global and regional cardiac function using 64-slice computed tomography: a comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonance. , 2008, International journal of cardiology.

[37]  Jeroen J. Bax,et al.  Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. , 2006, The American journal of cardiology.

[38]  S. Wildermuth,et al.  Accuracy of MSCT coronary angiography with 64-slice technology: first experience. , 2005, European heart journal.

[39]  Udo Hoffmann,et al.  Reperfused myocardial infarction: contrast-enhanced 64-Section CT in comparison to MR imaging. , 2008, Radiology.

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

[41]  C. Claussen,et al.  Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: determination of transmurality in comparison to magnetic resonance imaging and histopathology. , 2007, European journal of radiology.

[42]  U. Schoepf,et al.  Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. , 2009, The American journal of cardiology.

[43]  Konstantin Nikolaou,et al.  Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. , 2006, AJR. American journal of roentgenology.

[44]  Werner Moshage,et al.  Noninvasive Coronary Angiography by Retrospectively ECG-Gated Multislice Spiral CT , 2000, Circulation.

[45]  R Erbel,et al.  Coronary arterial stent patency: assessment with electron-beam CT. , 2000, Radiology.

[46]  J. Debatin,et al.  Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT. , 2003, Radiology.

[47]  Manesh R. Patel,et al.  ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group. , 2006, Journal of the American College of Radiology : JACR.

[48]  Michael Jerosch-Herold,et al.  Quantification of Myocardial Perfusion Using Dynamic 64-Detector Computed Tomography , 2007, Investigative radiology.

[49]  Bénédicte Belge,et al.  Characterization of Acute and Chronic Myocardial Infarcts by Multidetector Computed Tomography: Comparison With Contrast-Enhanced Magnetic Resonance , 2006, Circulation.

[50]  R Ruthazer,et al.  Missed diagnoses of acute cardiac ischemia in the emergency department. , 2000, The New England journal of medicine.

[51]  M. Reiser,et al.  Einsatz der Dual-source-Computertomographie in der prä- und postoperativen kardiochirurgischen Diagnostik , 2007, Der Radiologe.

[52]  C. Herzog,et al.  Coronary CT angiography. , 2007, Radiology.

[53]  Matthijs Oudkerk,et al.  Evaluation of global left ventricular function assessment by dual-source computed tomography compared with MRI , 2009, European Radiology.

[54]  Rainer Raupach,et al.  64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents , 2006, European Radiology.

[55]  Philipp Bruners,et al.  Late-phase MSCT in the different stages of myocardial infarction: animal experiments , 2007, European Radiology.

[56]  H. Alkadhi,et al.  Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT , 2007, European Journal of Nuclear Medicine and Molecular Imaging.

[57]  Heshui Shi,et al.  Noninvasive coronary angiography with multislice computed tomography. , 2005, JAMA.

[58]  E F Cook,et al.  A computer protocol to predict myocardial infarction in emergency department patients with chest pain. , 1988, The New England journal of medicine.

[59]  Gabriel P Krestin,et al.  Multislice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. , 2006, Journal of the American College of Cardiology.

[60]  William W O'Neill,et al.  A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. , 2007, Journal of the American College of Cardiology.

[61]  L. Shaw,et al.  Journal of Cardiovascular Magnetic Resonance Clinical Indications for Cardiovascular Magnetic Resonance (cmr): Consensus Panel Report , 2022 .

[62]  Jörg Hausleiter,et al.  Estimated radiation dose associated with cardiac CT angiography. , 2009, JAMA.

[63]  Mathias Prokop,et al.  Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. , 2008, Journal of the American College of Cardiology.

[64]  V. Fuster,et al.  Detection of healed myocardial infarction with multidetector-row computed tomography and comparison with cardiac magnetic resonance delayed hyperenhancement. , 2006, The American journal of cardiology.

[65]  Rolf Fimmers,et al.  Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study , 2003, The Lancet.

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

[67]  Rémy Morello,et al.  Diagnostic performance of 16- and 64-section spiral CT for coronary artery bypass graft assessment: meta-analysis. , 2008, Radiology.

[68]  H Reichenspurner,et al.  Preoperative 3D-reconstructions of ultrafast-CT images for the planning of minimally invasive direct coronary artery bypass operation (MIDCAB). , 1998, The heart surgery forum.

[69]  Victor Mor-Avi,et al.  Quantitative Assessment of Left Ventricular Size and Function: Side-by-Side Comparison of Real-Time Three-Dimensional Echocardiography and Computed Tomography With Magnetic Resonance Reference , 2006, Circulation.

[70]  R. Günther,et al.  Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction , 2005, European Radiology.

[71]  B. Lewis,et al.  Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[72]  Henry R. Halperin,et al.  Contrast-Enhanced Multidetector Computed Tomography Viability Imaging After Myocardial Infarction: Characterization of Myocyte Death, Microvascular Obstruction, and Chronic Scar , 2006, Circulation.

[73]  B. Brundage,et al.  Measurement of myocardial blood flow by ultrafast computed tomography. , 1987, Circulation.

[74]  Filippo Cademartiri,et al.  Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography , 2005, European Radiology.

[75]  P J de Feyter,et al.  Dual source coronary computed tomography angiography for detecting in-stent restenosis , 2007, Heart.

[76]  C D Claussen,et al.  Accuracy of dual-source CT in the characterisation of non-calcified plaque: use of a colour-coded analysis compared with virtual histology intravascular ultrasound. , 2009, The British journal of radiology.

[77]  I. Komuro,et al.  Patency of coronary artery lumen surrounded by metallic stent evaluated by three dimensional volume rendering images using ECG gated multislice computed tomography , 2003, Heart.

[78]  H. Litt,et al.  Evaluation of the patient with acute chest pain. , 2010, Radiologic clinics of North America.

[79]  K. Hergan,et al.  Forty-slice spiral computed tomography of the coronary arteries: assessment of image quality and diagnostic accuracy in a non-selected patient population , 2007, Acta radiologica.

[80]  Gabriel P. Krestin,et al.  High-Resolution Spiral Computed Tomography Coronary Angiography in Patients Referred for Diagnostic Conventional Coronary Angiography , 2005, Circulation.

[81]  E. Kotter,et al.  Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts. , 2006, European heart journal.

[82]  S. Achenbach,et al.  Assessment of regional left ventricular function by dual source computed tomography: interobserver variability and validation to laevocardiography. , 2009, European journal of radiology.

[83]  C. McCollough,et al.  CT dose reduction and dose management tools: overview of available options. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[84]  R B D'Agostino,et al.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial. , 1984, The New England journal of medicine.

[85]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[86]  N. Sinha,et al.  Primary congenital anomalies of the coronary arteries: a coronary: arteriographic study. , 2000, International journal of cardiology.

[87]  A. Mahnken,et al.  Multislice spiral computed tomography for the detection of coronary stent restenosis and patency. , 2003, International journal of cardiology.

[88]  Nancy A Obuchowski,et al.  Potential of dual-energy computed tomography to characterize atherosclerotic plaque: ex vivo assessment of human coronary arteries in comparison to histology. , 2008, Journal of cardiovascular computed tomography.

[89]  G. Bastarrika,et al.  Quantification of left ventricular function and mass in heart transplant recipients using dual-source CT and MRI: initial clinical experience , 2008, European Radiology.

[90]  C Georg,et al.  Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. , 2001, Journal of the American College of Cardiology.

[91]  M F Reiser,et al.  Imaging of noncalcified coronary plaques using helical CT with retrospective ECG gating. , 2000, AJR. American journal of roentgenology.

[92]  R. Hobbs,et al.  Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. , 1990, Catheterization and cardiovascular diagnosis.

[93]  B. Lee,et al.  Anomalous Right Coronary Artery Originated From Left Coronary Sinus With Interarterial Course: Evaluation of the Proximal Segment on Multidetector Row Computed Tomography With Clinical Correlation , 2009, Journal of computer assisted tomography.

[94]  B. Schnackenburg,et al.  Assessment of Myocardial Viability With Contrast-Enhanced Magnetic Resonance Imaging: Comparison With Positron Emission Tomography , 2002, Circulation.

[95]  S. Achenbach,et al.  Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. , 2010, European heart journal.

[96]  K. Tanabe,et al.  Evaluation of coronary artery bypass grafts and native coronary arteries using 64-slice multidetector computed tomography. , 2007, American heart journal.

[97]  J. Coll,et al.  Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population , 2012 .

[98]  Gordon H. Guyatt,et al.  Is This Patient Having a Myocardial Infarction , 1998 .

[99]  Thomas Flohr,et al.  High-pitch spiral acquisition: a new scan mode for coronary CT angiography. , 2009, Journal of cardiovascular computed tomography.

[100]  G. Raff,et al.  Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology , 2007, European Radiology.

[101]  R. Jabara,et al.  Comparison of Multidetector 64-Slice Computed Tomographic Angiography to Coronary Angiography to Assess the Patency of Coronary Artery Bypass Grafts , 2007 .

[102]  Dieter Ropers,et al.  Assessment of changes in non-calcified atherosclerotic plaque volume in the left main and left anterior descending coronary arteries over time by 64-slice computed tomography. , 2008, The American journal of cardiology.