Multidetector computed tomography (MDCT) allows for evaluation of native coronary arteries, coronary artery anomalies, bypass graft patency and quantification of atherosclerosis. Multidetector CT provides a safe, accurate, noninvasive alternative to invasive coronary angiograms in a select patient population. Successful CTA acquisition involves various components that this article will focus on, including adequate patient preparation, utilization of beta-blockers for heart rate control, understanding the principles of scan acquisition, and optimization of radiation dose. The current limitations of CTA and the potential role of dual-source CT (DSCT) to resolve many of the current limitations are also discussed.
Noninvasive echocardiographic-gated multidetector computed tomography (MDCT) allows for visualization and characterization of native coronary arteries, coronary artery anomalies, quantification of atherosclerosis and luminal vessel diameter as well as the evaluation of bypass graft patency. The growing acceptance of MDCT as an alternative or adjunct to conventional cardiac evaluations has fostered the rapidly emerging technical advances in the field.
Proper patient selection and adequate patient preparation are vital to the success of the procedure. Radiation exposure is a significant concern with CT angiography (CTA), and new scanning protocols are being evaluated for radiation reduction while maintaining diagnostic image quality. Conventional invasive coronary angiography remains the gold standard for the detection of coronary artery stenosis, in-stent restenosis, and the evaluation of bypass graft patency. The risks of adverse events, cost, and potential complications of the procedure have led to an intensive search for a noninvasive alternative. The growing acceptance of MDCT as an alternative or adjunct to conventional cardiac evaluation has fostered the rapidly emerging technical advances in this field.
The objectives of this article are to provide current information from the literature on some of the fundamental aspects of CTA, including the following: adequate patient preparation, utilization of beta-blockers for heart rate control, principles of scan acquisition, optimization of radiation dose, current limitations of CTA, and potential of dual-source CT (DSCT) to resolve many of the current limitations of CTA.
The technology is rapidly advancing, and with increasing experience the clinical acceptance of MDCT is growing. Multidetector CT will provide a safe, accurate, noninvasive imaging alternative to invasive coronary angiograms.