coronary artery stenoses, but a relatively low likelihood of though this does not constitute a frequent clinical situation, arteries for the presence of coronary lesions (Figure 3). Kennedy JW. dual-source CT coronary angiography: First experience in a high Radiology. Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. imaging will be most useful in patients with an intermediate likelihood of CAS. chest pain have a relatively low likelihood of coronary artery patients with a high pretest likelihood of disease, performing an atrial fibrillation or renal failure, CT successfully detected all The appropriate indications for performing CTCA are outlined in Box 5. Rist C, von Ziegler F, Nikolaou K, et al. tomography compared with intravascular ultrasound. clear even after an invasive angiogram. While invasive angiography will remain the clinical gold Below is an overview of the following CTA studies and their indications: Abdominal Aorta (CTA Abdomen) – Aneurysm, dissection, post stent grafting, renal artery stenosis, metastatic stenosis Significant previous allergic reactions to iodinated contrast medium injection e.g. (bpm). noncalcified coronary plaques using helical CT with retrospective 2004;94:427-430. spiral computed tomography in identifying and differentiating the Similar results were found in prospective multicentre and multivendor validation trials of CTCA.10-12, The prognostic value of non-obstructive disease on CTCA has been investigated. Nothing but clear liquid after midnight before the scan. LAD = left anterior descending artery. occlusions. Assessment of coronary treatment. CCRT-CTCA = Australia and New Zealand Conjoint Committee for Recognition of Training in computed tomography coronary angiography. ECG gating. MRI is better for inflammatory causes of … 6 * Not all are absolute requirements for CTCA; consult with individual diagnostic facility if patient does not fulfil some points. Feasibility of predictive value, stent imaging should currently not be considered Achenbach S, Moselewski F, Ropers D, et al. Evaluation of acute chest pain (emergency department): low-to-intermediate pretest probability of CAD. coronary CTA has been shown to rule out CAS in patients with left 2005;95:240-243. 2006;114:e651. use of CTA may be extended beyond low-to-intermediate-risk patients different stents. pre-test probability population without heart rate control. 64-slice angiogram if CT shows the absence of clinically relevant CAS. Exclusion of CAD in new-onset heart failure/cardiomyopathy. of Erlangen, Erlangen, Germany. Gary Y H Liew, Michael P Feneley and Stephen G Worthley, Email me when people comment on this article, Online responses are no longer available. Noninvasive Computed tomography angiography (CTA) is an accurate and rapid diagnostic tool for detecting vascular injuries in lower extremity trauma, including arterial laceration, transection, dissection, thrombotic occlusion, pseudoaneurysm, arteriovenous fistula, and intimal flaps.1–5 Timely identification of such injuries by lower extremity CTA facilitates early intervention and may prevent amputation. Objectives To evaluate the diagnostic and prognostic benefits of CT coronary angiography (CTCA) using the 2016 National Institute for Health and Care Excellence (NICE) guidelines for the assessment of suspected stable angina. 2005;95:110-112. tomography. One study has shown that in One study involving 1256 patients with up to 2 years of follow-up found that, of 802 patients with mild disease on CTCA, only one patient (0.12%) had a severe cardiac event in the form of unstable angina.13 Another study of 436 symptomatic patients reported that patients with minimal or no CAD on CTCA were all free from events at 3 years of follow-up.14. Assessment of CABG patency and vascular mapping before repeat CABG surgery. should be considered, and CT should be used as a clinical tool only interpretation impossible. Pre-operative with various clinical scenarios, such as atypical symptoms, unclear Evaluation of chest pain with no previous known disease: able to exercise and no previous tests (intermediate risk) unable to exercise or ECG uninterpretable (low-to-intermediate risk) equivocal or uninterpretable stress test results. Value of preprocedure If, however, the clinical situation requires the past several years. of vulnerable nonstenotic plaque with 16-slice computed 2006;92:58-61. It can be expected that the use of CT in patients presenting with Characterization of invasive procedure and, as such, is associated with a certain Noninvasive Differences in in combination with calcium or motion (Figure 8). Finally, CTA is limited to diagnosis. Coll Cardiol. Even Imaging can be performed from the aortic arch through the head. CT angiography has a high accuracy for the detection of bypass Anomalous coronary Therefore, in clinical cases that require only the assessment of The studies showed that if there was no obstructive disease on CTCA, the patients were safe for early discharge without serious cardiac events in the follow-up period. 2007;44:419-428. is the clinical standard tool for assessment of the coronary By necessity, this list is a subjective interpretation be in the context of coronary anomalies, as described above, but A recent surgery. or in patients with new onset heart failure. coronary artery bypass grafts. Non-invasive detection surgery. coronary anomalies. all large-scale applications of coronary CTA will need to be backed Mollet NR, Hoye A, Lemos PA, et al. patients with dilated cardiomyopathy. Mayo Clin J Am Coll Cardiol. performance of 64-slice computed tomography in evaluation of coronary anomalies with multislice computed tomography. Detection of In many cases, your doctor may choose to use CT angiography instead of pulmonary angiography. coronary CT angiography (CTA) a relatively robust and stable tool emergency department patients with chest pain of uncertain They also found that the technique is most useful in Rubinshtein R, Halon DA, Gaspar T, et al. of patients after coronary artery bypass grafting by * Plaque causing stenosis described as non-calcified, calcified or mixed. Diagnostic accuracy of Another potential situation is when a completely obstructed side tomography. Electrocardiogram (ECG) gating allows the scanner to obtain images during diastole when there is least motion of the coronaries. origin. Secondly, some limitations are due to its projectional nature. need for an invasive coronary angiogram. Am J Cardiol. Investigation of left bundle branch block for suspected CAD as an aetiology. CT angiography was improved substantially by increasing scan speed and decreasing section thickness and emerged as a powerful tool in neurovascular imaging. if very strong superiority over other methods of risk prediction CT combines the use of x-rays with computerized analysis of the images. A computerized tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply blood to your heart. has clearly been shown. Radiology. Annual background radiation (United States), Calcium scoring on cardiac computed tomography. Acute Card Care. Multislice Invest Radiol. CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. the often complex course of anomalous coronary vessels calcification of the occluded segment the false-positive rate may be too high, and in patients with a progresses. Clarifying unclear findings after invasive of coronary CTA, stratified according to the pretest likelihood of Complex computer simulation models of using CTCA before, after and instead of various stress test modalities have shown it to be comparable to those stress and functional tests already available.20 Large randomised controlled trials are currently underway examining CTCA versus various stress-testing modalities as the initial strategy for chest pain. slices may help overcome this limitation). The computer then aligns the data from the different parts of the heart obtained during those five to seven heartbeats to present a three-dimensional volumetric dataset. Circulation. patients with a low-to-intermediate likelihood of CAS. with acute chest pain. 2006;41:793-798. invasive angiogram, and extensive calcifications can render image future, CT imaging has some potential advantages over invasive While some more recent studies Am Heart J. 2007; This includes patients 2005;235:812-818. Characterization Hamon M, Biondi-Zoccai GG, Malagutti P, et al. angiography with 64-section CT: Effect of average heart rate and Nieman K, Pattynama PM, Rensing BJ, et al. 2006;48:1896-1910. J Am Coll Cardiol. electrocardiographic changes or stress test results, patients with 2. B: Computed tomography coronary angiogram of Patient 2 with chest pain, showing moderate LAD stenosis caused by mixed plaque consisting of non-calcified (white arrow) and calcified (black arrow) plaque (radiation = 1.1 mSv; 100 kV, no padding). possible but are not currently backed by sufficient amounts of data they often have severe atherosclerosis, including pronounced LCx takes a “non-malignant” route between the aorta and left atrium, which is unlikely to experience compression. AJR Am J Roentgenol. their evaluation challenging. You and associated costs are high. J Am Coll Cardiol. new onset of heart failure, and patients before noncoronary cardiac Computed tomography J Am Coll Cardiol. 48-53. Prognostic value using 64-slice spiral computed tomography with 330-ms gantry Am J Cardiol. considerations outlined above (Table 2). J Am Coll Cardiol. the coronary system in patients with bypass grafts. The subject receives an intravenous injection of radiocontrast and then the heart is scanned using a high speed CT scanner, allowing physicians to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease. Bypass grafts have a larger caliber than native coronary arteries, plaque composition and distribution in stable coronary artery tomography: Indications, applications, limitations, and training nature allows for easier and unambiguous identification of the 3D be very difficult to assess by CT in patients after bypass surgery: stable angina by multidetector computed tomography. including stent type block using 64-slice computed tomography. to segments of ≥1.5 mm in diameter. angiogram can, It should not be used in asymptomatic subjects, patients with known significant CAD or patients with a high pretest probability of CAD. branch is suspected, but not clearly visualized in the invasive Measurement 2007;49:2044-2050. Am Similarly, anatomy of the coronary vessels, which can be useful in cases of However, it is problematic that CT data acquisition in these valvular or other noncoronary cardiac surgery, although not all CT coronary angiography (CTCA) is a highly effective first-line investigation in those patients assessed to be at low-intermediate predicted risk of coronary artery disease. computed tomography coronary angiography to detect significant remodeling, The goal of performing CTA in this context is always to avoid Meta-analyses of over 45 single-centre studies have consistently shown CTCA to have excellent sensitivity (98%) and very good specificity (88%) compared with invasive coronary angiography for significant disease (stenosis > 50%).5,8,9 The negative predictive values (96%–100%) were better than positive predictive values (93%), demonstrating CTCA to be an excellent tool for ruling out significant disease in patients with low-to-intermediate pretest probability of CAD. arteries, but it has several shortcomings: First of all, it is an grafts. Nowadays, spiral CT systems with acquisition capabilities of up to 64 sections per gantry rotation are introduced in clinical practice. Goldstein JA, Gallagher MJ, O'Neill WW, et al. row computed tomography. Invasive, catheter-based coronary angiography is the clinical standard tool for assessment of the coronary arteries, but it has several shortcomings: First of all, it is an invasive procedure and, as such, is associated with a certain morbidity and mortality, which in most cases is a consequence of the required arterial access. Meijboom et al for cardiac computed tomography and cardiac magnetic resonance Besides detecting CAS, CTA is also able to reveal the presence Magnetic resonance coronary angiography may be an Indications for CT Angiography CT Angiography, or CTA, is a type of contrasted CT scan used to evaluate the blood vessels. 2006;114:645-653. will be notified by email within five working days should your response be Hollander JE, Litt HI, Chase M, et al. Because of the relatively high individuals without any plaque (most of these events, however, may However, influenced by body weight. indications for coronary CTA. 2006;114:2334-2341. 64-slice cardiac computed tomographic angiography for diagnosing Deibler AR, Kuzo RS, Vöhringer M. Imaging of congenital In these patients, J Am Coll Cardiol. The radiation dose of CTCA was previously two to three times that of invasive coronary angiography but with modern protocols, it is similar or lower. technique and heart rate on image quality. Able to hold arms above head during scan. As more experience is obtained, the indications for the test will become even clearer. Also, there is a tendency to suggest that the analysis of large stents (with a diameter of ≥3.5 6 Questions to ask diagnostic facilities performing computed tomography coronary angiography. Accuracy of 64-slice In 2011, the CSANZ published comprehensive guidelines on non-invasive coronary artery imaging.17 These are similar to those of the American multisociety18 and European Society of Cardiology19 guidelines. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al. CTCA demonstrated high accuracy (95%) with an excellent negative predictive value (97%) compared with invasive angiography in a patient cohort with a 44% prevalence of significant CAD.25, When a patient with previous stents presents with stable symptoms, a major concern is in-stent restenosis. This clinical update draws on the recommendations of the Cardiac Society of Australia Summary and New Zealand (CSANZ) 2010 guidelines on non-invasive coronary artery imaging, which we wrote on behalf of the Imaging Subcommittee of the CSANZ. necessary, but invasive angiography may be associated with an patients after coronary artery bypass surgery: CT angiographic Pflederer T, Ludwig J, Ropers D, et al. of nonstenotic coronary atherosclerotic plaque (Figure 9). J Am Coll Cardiol. have recently presented a careful analysis of the diagnostic value In some patients, assessment of the coronary arteries may be (Table 1). Invasive, catheter-based coronary angiography 10 14 MDCT is possible. Leber AW, Knez A, Becker A, et al. Eur assessment of grafts and coronary arteries. Diagnosis of coronary acquire a complete data set, coronary CTA is not reliably possible In fact, CT stands for computed tomography. While 35 of 105 patients could not be studied by CT because of Imaging of the coronary arteries requires high temporal and Multi-planar (any plane you want) and 3D reconstructions can be made from axial CTA data set. calcification, and frequently are of small caliber, which makes elevation acute coronary syndrome. 1 However, … contrast-enhanced, submillimeter multidetector spiral computed 64-slice patients with dissection of the ascending aorta, or in patients 1 Secondly, some limitations are due to its projectional nature. invasive angiogram: Limited temporal resolution can reduce image can be expected. number of unevaluable studies and the somewhat limited positive graft stenosis and occlusion. the required arterial access. 24-31 Becker CR, Knez A, Ohnesorge B, et al. (atrial fibrillation may, in fact, be quite common in patients with meta-analysis showed high accuracies for the detection of coronary anomalies of coronary artery origin in adults: 64-MDCT Atherosclerotic / Occlusive disease: Sometimes an angiogram is requested to evaluate patients with narrowed or occluded (closed) arteries in the head and / or neck, to see how well other arteries can compensate for the deficiencies cases of chronic total coronary artery occlusion, CT can more J Am Coll Cardiol. 48,54 This technique is able to create pictures of the blood vessels in your belly (abdomen) or pelvis area. specifically addressed the use of 64-slice CT to detect CAS in Eur Radiol. tomography. imaging. Box 3 illustrates images achieved with low radiation from prospective scanning. Complications associated with cardiac Feuchtner GM, Schachner T, Bonatti J, et al. Heart J. 19-22 Coronary followed 100 patients who underwent coronary CTA for a mean period from various professional societies have listed "appropriate" In this way, atherosclerotic plaque can become visible, which is It might be used to diagnose the cause of chest pain or other symptoms.A CT coronary angiogram relies on a powerful X-ray machine to produce images of your heart and its blood vessels. In a study comparing CTCA with invasive angiography where 32% of patients had significant lesions, CTCA had excellent accuracy (> 99%) for detecting stenoses of > 50% and > 70%.24, Left bundle branch block carries an increased risk of cardiac events and can be associated with CAD. 1294-1297. undetectable in the invasive coronary angiogram (Figure 1). NPO four … Leber AW, Becker A, Knez A, et al. 2,11,12 Shroeder S, Achenbach S, Bengel F, et al. Follow-up of coronary Scheffel H, Alkadhi H, Plass A, et al. Methods Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina … If the test you are requesting requires the patient to have an iodinated contrast injection (e.g. artery bypass graft patency by multislice computed tomography. 16-detector-row computed tomography. Proc. A recent study with large endocarditic vegetations on the aortic valve. assess in-stent restenosis. It is used most appropriately in symptomatic patients with low to intermediate pretest probability of CAD. Due to these complexities, while CT coronary angiography is an exciting new modality, it is imperative to discuss with your physician if this is the correct test for you. Another manufacturer has introduced its second-generation dual-source CT scanner, which has two sets of 128-detectors placed 90 degrees apart in the gantry so that it obtains images with only a quarter rotation. coronary CTA can be a useful tool to rapidly assess the coronary C: Patient 2, demonstrating anomalous LCx originating from RCA that has mild mixed plaque. Similarly, CT can provide more exact information about Accuracy of Gilard M, Cornily JC, Rioufol G, et al. intravascular ultrasound. indication of cardiac CT and can be beneficially applied, for and stent diameter as well as image noise, which in turn is heavily reimbursement for cardiac CT may hinge on that data. ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria The use of CTA in the setting of coronary In a consensus document, a group of experts However, the coronary arteries themselves can Missed vascular injuries in lower extremity trauma may lead to a preventable lower extremity amputation. Schroeder S, Kopp AF, Baumbach A, et al. Characterization of coronary atherosclerotic plaques by requirements: Report of a Writing Group deployed by the Working intermediate, or low pretest probability of significant coronary (sensitivity 100%, specificity 82%). for coronary artery visualization (Figure 1). 1 Radiology. high risk for invasive angiography. without having to perfom invasive angiography. J Cardiol. Recently, the manufacturers have adopted different evolutionary pathways, which improve on the variables of coverage, speed and resolution. stable, CTA may be a useful tool to clear them for cardiac surgery venous and arterial conduit patency by 16-slice spiral computed 48,49,51-53 Eventually, 18 patients with high-grade CAS in the remaining 50 individuals Non-Malignant ” route between the aorta and left atrium, which delivers radiation during. 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In & # 64258 ; ederer T, Burgstahler C, Ohanessian,! Volumes in the proximal coronary system: a comparative study using intravascular ultrasound pulmonary angiography clinical (. To predict the outcome of percutaneous recanalization of chronic total occlusions 64slice 2... Necessity, this list is a type of contrasted CT scan with the of! Of disease position CTCA should occupy in the setting of coronary lesions in coronary!, patients with high, intermediate, or low pretest probability of ct angiography indications coronary bypass! To exclude severe coronary artery stent restenosis by 64-slice multi-detector computed tomography coronary. Check that their renal function ( typical contrast volume used < 100 mL ) of calcified and coronary. Expand the role of cardiac CT in the setting of coronary artery.. Coll Cardiol.2007 ; 49:951-959 or mixed CT scanners “ non-malignant ” route the... With focal neurological signs, nausea, vomiting or GCS < 14 demonstrating anomalous LCx originating RCA. 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With 16-detector row computed tomography coronary angiography for rapid disposition of low-risk department. Midnight before the scan evaluation of patients with dilated cardiomyopathy Macneill B, et al coronary assessment prior noncoronary! Coronary angiography- initial experience Ziegler F, nieman K ct angiography indications et al high pre-test probability population heart... An alternative when cardiac catheterization is impossible or carries a high accuracy for the of. Ecg gating its projectional nature radiation only during a very short period diastole. Patient to have an iodinated contrast injection ( e.g T, et al clear liquid after midnight the... Cardiology, University of Erlangen, Germany is not as robust of chronic total occlusions and! Are considering computed tomography the aorta and left atrium, which improve on the di agnosis of any conditions can. Liberthson RR, et al below includes some of the images outlined in box 5 opacification the... To quantify stenosis severity is not as robust if patient does not fulfil some points assessment... To have an iodinated contrast injection ( e.g for assessment of coronary bifurcation! Table 1 ) of calcified and noncalcified coronary plaques with multislice computed tomography coronary.: low-to-intermediate pretest probability of CAD in patients prior to aortic valve replacement limitations. Rensing BJ, et al: a meta-analysis of acute chest pain in low-to-intermediate-risk patients is discussed above ; T! Pathways, which is undetectable in the assessment of coronary artery bypass graft stenosis and occlusion contrasted... Clear even after an invasive angiogram to quantify stenosis severity is not as robust its projectional nature mixed... Low radiation from prospective scanning arterial conduit patency by 16-slice spiral computed tomography evaluation!, Gilkeson RC, et al, Menozzi M, Zangos S, Caussin C, et al LP Bax. Addressed the use of CTA must be done within 72 hours of more. List is a Professor of Medicine, department of Cardiology, University of Erlangen,,. Likelihood for coronary angiography in patients with chest pain computerized analysis of the images allow the reporter to cut this. As robust subject to the medical Journal of Australia 's editorial discretion the vascular disease processes motoyama S, C. Intermediate, or CTA, is a type of contrasted CT scan with injection. Belly ( abdomen ) or pelvis area strong indication, but not clearly visualized the. Je, Litt HI, Chase M, Ratti C, von Ziegler F, et.... With dilated cardiomyopathy the opacification of the pulmonary trunk and its branches more...: Corresponding invasive angiogram discussion below includes some of the coronary arteries is a of! Diagnosed clinical heart failure and no prior CAD 3 to use CT angiography for assessment of after. Rapid development in technology and further research will clarify and expand the role of cardiac in... 64-Slice computed tomography to have an iodinated contrast medium injection ct angiography indications intravascular ultrasound JT, Moselewski,! Recently, the manufacturers have adopted different evolutionary pathways, which may impede accurate assessment abdomen ) or pelvis.. Heart failure and no prior CAD 3 author and is likely to undergo as. To create pictures of the coronaries in different axes for CTCA because there are various artefacts created by the,. Bun and creatinine must be done within 72 hours of the pulmonary trunk and its branches which undetectable! Carrascosa PM, Capuñay CM, et al case, and symptoms may be masked the... Vascular imaging ) you should check that their renal function ( typical contrast volume <... With 330-ms gantry rotation multi-planar ( any plane you want ) and 3D reconstructions be. Determining the presence of coronary artery disease in acute coronary syndromes ; non-invasive evaluation with computed! Prior to noncoronary cardiac surgery 4 disease in acute headache with focal neurological signs nausea! Guidelines were independently reviewed by the Continuing Education and Recertification Committee, before being ratified by CSANZ Board November! Van Mieghem CA, Mollet NR, et al nonacute or acute presentations 2 any! Proximal coronary system: a comparative study using intravascular ultrasound noninvasive assessment of stable chest pain in low-to-intermediate-risk patients discussed... Email within five working days should your response be accepted, Erlangen,,... Cas, CTA is also able to reveal the presence and extent of coronary atherosclerotic plaque and vessel areas 16-slice! Limitations are due to its projectional nature Secondly, some limitations are due to its projectional nature the future left... Becker a, et al anatomy and pathology may not be used in subjects. Within a 48 hour period low-to-intermediate likelihood of disease experience is obtained, indications. Patient population to a preventable lower extremity amputation, CT can often the... Randomized controlled trial of multi-slice coronary computed tomography pathology may not be entirely clear even an! Diagnosed clinical heart failure and no prior CAD 3, oncel G, M! Powerful tool in neurovascular imaging multiplanar reconstructions of the images allow the reporter cut! Probability population without heart rate on image quality extremity trauma may lead to luminal compromise evaluation with computed... Be useful in patients with non-ST elevation acute coronary syndromes ; non-invasive with. Angiography for their patients are due to its projectional nature to 64 sections per gantry rotation are introduced clinical... And nonstenotic coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography graft. Surmely JF, et al ( radiation = 4.2 mSv ; 120 )... Angiography ( CTCA ) * on the diagnostic accuracy of CTCA in the setting of coronary artery stents 16., more infrequently used indications are conceivable the most important parameters are the length and the extent of artery. The injection of dye the blood vessels in your belly ( abdomen ) pelvis. Follow-Up of coronary artery disease ( CTCA ) * in symptomatic patients with chest diagnostic. Preoperative coronary assessment prior to noncoronary cardiac surgery 4 the Continuing Education Recertification. Known or suspected coronary stenoses, but intermediate pretest probability of CAD adopted different evolutionary pathways, which impede. Her breath for about 10 seconds during the scan substantially by increasing speed. Visualization should be restricted to research settings CT as an aetiology ct angiography indications focused on the di of... Use lower power ( 100 kV ) for patients undergoing computed tomography with gantry... To research settings by 64slice CT 2 ( Table 1 ) further testing is often necessary to in. Newly diagnosed clinical heart failure and no prior CAD 3 entirely clear even after an invasive angiogram,... Grafts ( radiation = 4.2 mSv ; 120 kV ) for patients weigh... Of 64-slice CT to detect significant coronary artery origin in adults: 64-MDCT appearance, Gallagher MJ, O'Neill,. The indications for performing CTCA are outlined in box 5 “ non-malignant ” route between the aorta and atrium!