Since the advent of multislice computed tomography (MSCT), remarkable technical advances have occurred. Arguably, 4-slice scanners have become obsolete, and 16-slice systems may soon be considered antiquated with the arrival of faster 64-slice technology. Improvements in spatial and temporal resolution have accompanied this rapid progress in technology, thus allowing for better visualization of coronary anatomy. This systematic review evaluates state-of-the-art cardiac MSCT in the diagnosis of coronary artery disease and discusses its performance relative to competing modalities.
The early detection and treatment of coronary artery disease (CAD) remains paramount, given its morbidity, mortality, and economic consequences.1 Conventional invasive angiography is the gold standard for the definitive delineation of coronary anatomy. However, new imaging modalities are now available for the evaluation of CAD, and they are increasingly being used for the diagnostic and therapeutic management of patients. These modalities include cardiac magnetic resonance imaging (MRI), intravascular ultrasonography (IVUS), and cardiac computed tomography (CT), all of which continue to evolve technologically. The invasive nature of conventional angiography and IVUS make cardiac MRI and CT particularly attractive as noninvasive options for CAD evaluation. In the past few years, we have also witnessed the rapid evolution of cardiac positron emission tomography (PET) instrumentation, which now offers hybrid scanners that integrate PET with CT (PET/CT), resulting in higher sensitivity2 for CAD detection. Catalyzed by the emergence of portable rubidium-82 generators,36 the proliferation of PET/CT instruments has been rapid, accounting for approximately 80% of the new PET units installed in 2003.7
Since the advent of multislice computed tomography (MSCT) in 1998, we have witnessed remarkable technologic advancement. Thus, 4-slice scanners have arguably become obsolete, and 16-slice systems may soon be considered antiquated with the arrival of faster, newer-generation 64-slice technology; interestingly, 128- and 256-slice scanners beckon from the horizon. This rapid progress in technology with associated improvement in spatial and temporal resolution now allows for better visualization of native and non-native coronary anatomy. Thus, numerous studies have assessed the diagnostic accuracy of MSCT in the detection of CAD. However, in the arena of CAD evaluation and treatment where competing diagnostic modalities exist, the exact role of cardiac of CT in the evaluation of patients with known or unknown CAD awaits clear definition. In the context of a systematic review of the diagnostic accuracy of cardiac MSCT for CAD evaluation, this article provides a succinct discussion of its performance relative to other diagnostic tests for CAD.