Computed tomographic assessment of coronary artery disease: state-of-the-art imaging techniques.

While coronary computed tomography (CT) angiography and more refined imaging of the coronary anatomy have driven technical innovation in cardiac CT for the last 10 years, there is now an increasing focus on functional applications of cardiac CT, such as evaluation of the myocardial blood supply or assessment of dynamic myocardial perfusion. Novel techniques show promising results. This article focuses on state-of-the-art CT imaging techniques to visualize the coronary anatomy, describes aspects of radiation dose reduction, and briefly touches on recent approaches to obtain functional information from a CT scan of the heart, in particular dual-energy CT.

[1]  Stefan Ulzheimer,et al.  Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. , 2014, European heart journal cardiovascular Imaging.

[2]  U Joseph Schoepf,et al.  CT of coronary artery disease. , 2004, Journal of thoracic imaging.

[3]  Thomas Henzler,et al.  Comparison of the effect of iterative reconstruction versus filtered back projection on cardiac CT postprocessing. , 2014, Academic radiology.

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

[5]  I. Meredith,et al.  Diagnostic accuracy of noninvasive coronary angiography with 320-detector row computed tomography. , 2010, The American journal of cardiology.

[6]  T. Flohr,et al.  Image quality and radiation dose of low tube voltage 3rd generation dual-source coronary CT angiography in obese patients: a phantom study , 2014, European Radiology.

[7]  Peter Boesiger,et al.  Low-dose CT coronary angiography for the prediction of myocardial ischaemia , 2009, European Radiology.

[8]  Cynthia H McCollough,et al.  Measurement of temporal resolution in dual source CT. , 2008, Medical physics.

[9]  Bernhard Schmidt,et al.  Radiation dose and image quality in pediatric CT: effect of technical factors and phantom size and shape. , 2004, Radiology.

[10]  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.

[11]  M. Reiser,et al.  Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques , 2009, European Radiology.

[12]  H. Alkadhi,et al.  Image Quality and Reconstruction Intervals of Dual-Source CT Coronary Angiography: Recommendations for ECG-Pulsing Windowing , 2007, Investigative radiology.

[13]  Joel G Fletcher,et al.  Dual-source dual-energy CT with additional tin filtration: Dose and image quality evaluation in phantoms and in vivo. , 2010, AJR. American journal of roentgenology.

[14]  K. Stierstorfer,et al.  First performance evaluation of a dual-source CT (DSCT) system , 2006, European Radiology.

[15]  Marcel van Straten,et al.  Impact of heart rate frequency and variability on radiation exposure, image quality, and diagnostic performance in dual-source spiral CT coronary angiography. , 2009, Radiology.

[16]  G. Feuchtner,et al.  Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience , 2009, European Radiology.

[17]  S. Kim,et al.  Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT in patients with normal body mass indices: effect of tube voltage, tube current, and iodine concentration on image quality and radiation dose , 2014, The International Journal of Cardiovascular Imaging.

[18]  M Li,et al.  Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. , 2014, Clinical radiology.

[19]  Mouaz Al-Mallah,et al.  CT dose reduction using prospectively triggered or fast-pitch spiral technique employed in cardiothoracic imaging (the CT dose study). , 2014, Journal of cardiovascular computed tomography.

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

[21]  Peng Wang,et al.  Radiation and contrast agent doses reductions by using 80-kV tube voltage in coronary computed tomographic angiography: a comparative study. , 2014, European journal of radiology.

[22]  T. Flohr,et al.  Chasing the heart: new developments for cardiac CT. , 2007, Journal of thoracic imaging.

[23]  Borut Marincek,et al.  Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control , 2006, European Radiology.

[24]  W. Kalender,et al.  High-Pitch Electrocardiogram-Triggered Computed Tomography of the Chest: Initial Results , 2009, Investigative radiology.

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

[26]  Julia Stehli,et al.  Accuracy of coronary CT angiography using a submillisievert fraction of radiation exposure: comparison with invasive coronary angiography. , 2014, Journal of the American College of Cardiology.

[27]  C Georg,et al.  Coronary arteries: retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the image reconstruction window. , 2001, Radiology.

[28]  U. Schoepf,et al.  Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction , 2013, European Radiology.

[29]  Walter Heindel,et al.  Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT , 2008, European Radiology.

[30]  S. Schoenberg,et al.  Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. , 2014, Radiology.

[31]  Maria Iatrou,et al.  Nonrigid registration-based coronary artery motion correction for cardiac computed tomography. , 2012, Medical physics.

[32]  C. Unterberg-Buchwald,et al.  Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image quality, and radiation dose. , 2013, American heart journal.

[33]  H. Kauczor,et al.  Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology , 2014, European Radiology.

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

[35]  C. Fink,et al.  Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results. , 2012, European journal of radiology.

[36]  K. Chinnaiyan,et al.  Development and Validation of a Predictive Screening Tool for Uninterpretable Coronary CT Angiography Results , 2011, Circulation. Cardiovascular imaging.

[37]  U. Hoffmann,et al.  Advanced adaptive axial-sequential prospectively electrocardiogram-triggered dual-source coronary computed tomographic angiography in a patient with atrial fibrillation. , 2011, Journal of computer assisted tomography.

[38]  Jean-Baptiste Thibault,et al.  A three-dimensional statistical approach to improved image quality for multislice helical CT. , 2007, Medical physics.

[39]  Andrew E. Arai,et al.  Influence of image acquisition settings on radiation dose and image quality in coronary angiography by 320-detector volume computed tomography: the CORE320 pilot experience , 2012, Heart international.

[40]  Marcel van Straten,et al.  Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: randomized study. , 2011, Radiology.

[41]  Michael Fiechter,et al.  First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography , 2013, The International Journal of Cardiovascular Imaging.

[42]  Simon Wildermuth,et al.  Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. , 2006, Radiology.

[43]  Jiang Hsieh,et al.  Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. , 2008, Radiology.

[44]  W. Kalender,et al.  Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction , 2013, European Radiology.

[45]  Natalie N. Braun,et al.  Strategies for reducing radiation dose in CT. , 2009, Radiologic clinics of North America.

[46]  Heshui Shi,et al.  Noninvasive Coronary Angiography With Multislice Computed Tomography , 2005 .

[47]  U. Schoepf,et al.  Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. , 2014, The British journal of radiology.

[48]  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.

[49]  A. Arai,et al.  Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients. , 2013, Radiology.

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

[51]  H. Otero,et al.  Initial evaluation of coronary images from 320-detector row computed tomography , 2008, The International Journal of Cardiovascular Imaging.

[52]  Simon Wildermuth,et al.  Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience , 2014, European Radiology.

[53]  J. Lima,et al.  Computed Tomography Myocardial Perfusion Imaging With 320-Row Detector Computed Tomography Accurately Detects Myocardial Ischemia in Patients With Obstructive Coronary Artery Disease , 2012, Circulation. Cardiovascular imaging.

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

[55]  Michael Fiechter,et al.  Impact of a new motion-correction algorithm on image quality of low-dose coronary CT angiography in patients with insufficient heart rate control. , 2014, Academic radiology.

[56]  J. Leipsic,et al.  Effect of padding duration on radiation dose and image interpretation in prospectively ECG-triggered coronary CT angiography. , 2010, AJR. American journal of roentgenology.

[57]  R. Cury,et al.  Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. , 2006, The American journal of cardiology.

[58]  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.

[59]  Ernst J Rummeny,et al.  Coronary CT angiography in step-and-shoot technique with 256-slice CT: impact of the field of view on image quality, craniocaudal coverage, and radiation exposure. , 2012, European journal of radiology.

[60]  Borut Marincek,et al.  Dual-source CT coronary angiography: image quality, mean heart rate, and heart rate variability. , 2007, AJR. American journal of roentgenology.

[61]  Shuai Leng,et al.  Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution: Image reconstruction and assessment of image quality. , 2009, Medical physics.

[62]  Ashley M. Lee,et al.  Coronary computed tomography angiography during arrhythmia: Radiation dose reduction with prospectively ECG-triggered axial and retrospectively ECG-gated helical 128-slice dual-source CT. , 2012, Journal of cardiovascular computed tomography.

[63]  Hatem Alkadhi,et al.  Image quality and radiation exposure with prospectively ECG-triggered axial scanning for coronary CT angiography: the multicenter, multivendor, randomized PROTECTION-III study. , 2012, JACC. Cardiovascular imaging.

[64]  M. Oudkerk,et al.  Dual-energy CT of the heart. , 2012, AJR. American journal of roentgenology.

[65]  Thomas Frauenfelder,et al.  High-pitch coronary CT angiography with third generation dual-source CT: limits of heart rate , 2014, The International Journal of Cardiovascular Imaging.

[66]  Ashley M. Lee,et al.  Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study , 2013, The International Journal of Cardiovascular Imaging.

[67]  K. Ohtomo,et al.  Coronary CT angiography using the second-generation 320-detector row CT: assessment of image quality and radiation dose in various heart rates compared with the first-generation scanner , 2013, The International Journal of Cardiovascular Imaging.

[68]  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.

[69]  W. Kalender,et al.  Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience , 2009, European Radiology.

[70]  W. Brenner,et al.  Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study. , 2014, Radiology.

[71]  M. Walker,et al.  Prospectively gated axial CT coronary angiography: comparison of image quality and effective radiation dose between 64- and 256-slice CT , 2010, European Radiology.

[72]  F. Rybicki,et al.  Prospective ECG-gated coronary 320-MDCT angiography with absolute acquisition delay strategy for patients with persistent atrial fibrillation. , 2013, AJR. American journal of roentgenology.

[73]  Werner Bautz,et al.  Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. , 2007, Journal of the American College of Cardiology.

[74]  S. Ko,et al.  Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography , 2010, European Radiology.

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

[76]  C. Herrmann,et al.  X-ray scattering in single- and dual-source CT. , 2007, Medical physics.

[77]  S. Ko,et al.  Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis. , 2012, AJR. American journal of roentgenology.

[78]  J. Babb,et al.  Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. , 2013, Journal of cardiovascular computed tomography.

[79]  Thomas Flohr,et al.  Next generation coronary CT angiography: in vitro evaluation of 27 coronary stents , 2014, European Radiology.

[80]  S. Petersen,et al.  Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions? , 2014, European heart journal cardiovascular Imaging.

[81]  S. Wildermuth,et al.  Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. , 2008, Radiology.

[82]  Zhao-qi Zhang,et al.  Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography , 2011, The International Journal of Cardiovascular Imaging.

[83]  Bernhard Bischoff,et al.  Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II Trial. , 2010, JACC. Cardiovascular imaging.

[84]  Karl Stierstorfer,et al.  Enhanced temporal resolution at cardiac CT with a novel CT image reconstruction algorithm: initial patient experience. , 2013, European journal of radiology.

[85]  Christopher Rohkohl,et al.  Improving best-phase image quality in cardiac CT by motion correction with MAM optimization. , 2013, Medical physics.