J Korean Med Assoc.  2003 Nov;46(11):1009-1015. 10.5124/jkma.2003.46.11.1009.

Coronary CT Angiography

• Choi BW

• KMID: 2183134
• DOI: http://doi.org/10.5124/jkma.2003.46.11.1009

Abstract

With the advent of multislice computed tomography (MSCT), noninvasive coronary angiography by using CT has become practical for clinical purposes. The accuracy of MSCT in evaluation of coronary artery stenosis challenges that of conventional X-ray coronary arteriography. The essential component of the CT technique in evaluation of coronary arteries on a beating heart consists of a multidetector row system, which enables thin-sliced volume scan during one breath-hold, and the fast rotation speed of gantry, which is most important to increase the time resolution. However, the technical development so far achieved just allows CT to acquire diagnostic-quality images only with lowering the heart rate less than 65 beats per minute using a beta-blocker. Motion artifacts caused by physiologic or diseased complex movement of the heart and blooming artifacts from dense calcification are the major limitations compromising accurate interpretation of coronary CT angiograms. Although many problems related to coronary CT angiography has not been solved at present, we should remember that the present CT technique is just at its infancy, and CT has many benefits as a noninvasive diagnostic modality. In addition, measurement of a cross-sectional area at stenosis of coronary artery will improve diagnostic accuracy, which is also a major advantage over the projection image of X-ray angiography. Characterization of a vulnerable plaque by density measurement of an atherosclerotic plaque of the coronary vessel wall and evaluation of in-stent restenosis should be other possibilities of CT.

Keyword

Computed tomography (CT); Coronary disease; Stenosis; Angiography

MeSH Terms

Angiography*
Artifacts
Constriction, Pathologic
Coronary Angiography
Coronary Disease
Coronary Stenosis
Coronary Vessels
Heart
Heart Rate
Multidetector Computed Tomography
Plaque, Atherosclerotic

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Reference

1. Kachelriess M, Kalender WA. EKG-correlated image reconstruction from subsecond spiral computed tomography scans of the heart. Med Phys. 1998. 25:2417–2431.

2. Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns RJ. Coronary angiography with multi-slice computed tomography. Lancet. 2001. 357:599–603.

3. Schroeder S, Kopp AF, Ohnesorge B, Flohr T, Baumbach A, Claussen CD, et al. Accuracy and reliability of quantitative measurements in coronary arteries by multi-slice computed tomography. Experimental and initial clinical results. Clin Raiol. 2001. 56:466–474.

4. Kopp AF, Schroeder S, Kuettner A, Baumbach A, Georg C, Claussen CD, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J. 2002. 23:1714–1725.

5. Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Reyter PJ. Reliable noninvasive coronary angiography with fast submilimeter multislice spiral computed tomography. Circulation. 2002. 106:2051–2054.

6. Leber AW, Knez A, Becker C, Becker A, White C, Steinbeck G, et al. Noninvasive intravenous coronary angiography using electron beam tomography and multislice computed tomography. Heart. 2003. 89:633–639.

7. Schroeder S, Kopp AF, Kuettner A, Burgstahler C, Herdeg C, Seipel L, et al. Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography : Experience in 94 patients. Clin Imaging. 2002. 26:106–111.

8. Nieman K, Rensing BJ, van Geuns RJ, Vos J, Pattynama PM, de Feyter PJ, et al. Non-invasive coronary angiography with multislice spiral computed tomography : impact of heart rate. Heart. 2002. 88:470–474.

9. Giesler T, Baum U, Ropers D, Ulzheimer S, Wenkel E, Achenbach S, et al. Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT : influence of heart rate on image quality and stenosis detection. AJR. 2002. 179:911–916.

10. Lembcke A, Rogalla P, Mews J, Blobel J, Enzweiler CN, Hamm B, et al. Imaging of the coronary arteries by means of multislice helical CT : optimization of image quality with multisegmental reconstruction and variable gantry rotation time. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2003. 175:780–785.

11. Stierstorfer K, Flohr T, Bruder H. Segmented multiple plane reconstruction:a novel approximate reconstruction scheme for multi-slice spiral CT. Phys Med Biol. 2002. 47:2571–2581.

12. Vembar M, Garcia MJ, Heuscher DJ, Matthews D, Bohme GE, Greenberg NL, et al. A dynamic approach to identifying desired physiological phases for cardiac imaging using multislice spiral CT. Med Phys. 2003. 30:1683–1693.

13. Achenbach S, Ropers D, Holle J, Muschiol G, Daniel WG, Moshage W. In-plane coronary arterial motion velocity : measurement with electron-beam CT. Radiology. 2000. 216:457–463.

14. Kopp AF, Schroeder S, Kuettner A, Heuschmid M, Georg C, Claussen CD, et al. Coronary arteries : retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the image reconstruction window. Radiology. 2001. 221:683–688.

15. Hong C, Becker CR, Huber A, Schoepf UJ, Ohnesorge B, Reiser MF, et al. ECG-gated reconstructed multi-detector row CT coronary angiography. Effect of varying trigger delay on image quality. Radiology. 2001. 220:712–717.

16. Funabashi N, Kobayashi Y, Perlroth M, Rubin GD. Coronary artery : quantitative evaluation of normal diameter determined with electron-beam CT compared with cine coronary angiography-initial experience. Radiology. 2003. 226:263–271.

17. Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Achenbach S, et al. Detection of coronary artery stenosis with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation. 2003. 107:664–666.

18. Maintz D, Juergens KU, Wichter T, Grude M, Heindel W, Fischbach . Imaging of coronary artery stents using multislice computed tomography : in vitro evaluation. Eur Raiol. 2003. 13:830–835.

19. Kruger S, Mahnken AH, Sinha AM, Borghans A, Dedden K, Hanrath P, et al. Multislice spiral computed tomography for the detection of coronary stent restenosis and patency. Int J Cardiol. 2003. 89:167–172.

20. Leber AW, Knez A, White CW, Becker A, von Ziegler F, Boekstegers P, et al. Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol. 2003. 91:714–718.

21. Ning R, Tang X, Conover D, Yu R. Flat panel detector-based cone beam computed tomography with a circle-plus-two-arcs data acquisition orbit:preliminary phantom study. Med Phys. 2003. 30:1694–1705.

22. Mahesh M. Next-generation x-ray CT units will provide <500 msec images with 3D resolution comparable to today's projection radiography. Med Phys. 2003. 30:1543–1544.