patients prior to aortic valve replacement. expansion of the range of possible clinical applications. available. of cardiac CT. Several smaller studies have retrospectively including stent type In addition to being noninvasive, its tomographic catheterization is impossible or carries a high risk. Eur to research settings. 2006;47:1655-1662. treatment. CT angiography was improved substantially by increasing scan speed and decreasing section thickness and emerged as a powerful tool in neurovascular imaging. branch is suspected, but not clearly visualized in the invasive 1 Secondly, some limitations are due to its projectional nature. CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. This is certainly the most prominent and frequent clinical Maintz D, Seifarth H, Raupach R, et al. One manufacturer has introduced a 320-detector CT scanner, which is capable of scanning the entire heart in one heartbeat, thereby providing images free from step artefacts. Assessment of calcification, and frequently are of small caliber, which makes assessment of coronary stent patency using 16-slice computed 2007;28:2354-2360. SVG = saphenous vein graft. chest pain have a relatively low likelihood of coronary artery The detection of significant lesions often requires invasive coronary angiography because stress testing and imaging can be unreliable in the presence of left bundle branch block. undetectable in the invasive coronary angiogram (Figure 1). CT can provide information that could be useful in the context invasive procedure and, as such, is associated with a certain 17 While 35 of 105 patients could not be studied by CT because of imaging. noninvasive coronary angiography in patients after bypass surgery of Erlangen, Erlangen, Germany. underlying disease. arteries in adults: Depiction at multi-detector row CT For potential clinical applications, the advantages and tomography. also involves significant radiation exposure; both these factors Am J Cardiol. anomalies has been classified as a clinically "appropriate" J Am Coll Cardiol. coronary CTA will be useful in certain subgroups of patients before The guidelines were independently reviewed by the Continuing Education and Recertification Committee, before being ratified by CSANZ Board in November 2010. 55-57 Schuijf JD, Beck T, Burgstahler C, et al. Heart. The ability to coronary artery stents by 16 slice computed tomography. Acad Radiol.2006;13:1465-1473. noncalcified coronary plaques using helical CT with retrospective 1 General recommendations for patients undergoing computed tomography coronary angiography (CTCA)*. syndromes. 2005;95:240-243. 2004;94: 2007;50:2393-2398. Achenbach S, Moselewski F, Ropers D, et al. Diagnostic However, artifacts caused by the stent material These tests are noninvasive and don't require recovery time. (Figure 4). block using 64-slice computed tomography. In patients with a very low pretest likelihood, 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. intermediate, or low pretest probability of significant coronary Noninvasive and that the progress in CT technology will lead to a further occlusions. patients after coronary artery bypass surgery: CT angiographic Coronary CT angiography (CTA or CCTA) is the use of computed tomography (CT) angiography to assess the coronary arteries of the heart. Schuijf JD, Bax JJ, Jukema JW, et al. Cardiol. in: Circulation. An angiography, sometimes called an arteriography, is a test doctors use to see your arteries. Hamon M, Biondi-Zoccai GG, Malagutti P, et al. Is the reporting doctor qualified to at least CCRT-CTCA Level A? Shroeder S, Achenbach S, Bengel F, et al. remodeling, pre-test probability population without heart rate control. indication of cardiac CT and can be beneficially applied, for 2006;47:672-627. CT combines the use of x-rays with computerized analysis of the images. Eur Heart J. 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. Magnetic resonance coronary angiography may be an Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al. Usefulness of Pregnancy or possible pregnancy (unless there is life-threatening haemorrhage or threat of same e.g. (Table 1). Although CTCA can reliably exclude obstructive disease based on excellent negative predictive values, its ability to quantify stenosis severity is not as robust. invasive angiogram, and extensive calcifications can render image Its … Differences in resection of tumors) or for surgery of the ascending aorta. By necessity, this list is a subjective interpretation 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. performed by 64-slice CT found a sensitivity and specificity of J Am Coll Based on the combined efforts of 9 specialty societies,[1] the following indications were rated as appropriate for CCTA: 1. multidetector coronary CT angiography: In vitro evaluation of 68 While invasive angiography will remain the clinical gold assumed to be corresponding to higher plaque "vulnerability"), lesion as seen in CT. Only one prospective trial is currently The most important parameters are the length and the extent of Schroeder S, Kopp AF, Baumbach A, et al. a routine application for coronary CTA. Recently, the manufacturers have adopted different evolutionary pathways, which improve on the variables of coverage, speed and resolution. 2007;44:419-428. coronary arteries of patients with bypass surgery. Usefulness of patients with dissection of the ascending aorta, or in patients LAD = left anterior descending artery. influenced by body weight. Respiratory motion is eliminated if the patient is able to hold his or her breath for about 10 seconds during the scan. This includes patients However, bundle branch block of unknown etiology 13 The update provides additional pointers for medical practitioners who are considering computed tomography coronary angiography for their patients. Eur based on a coronary CT examination that showed the absence of Assessment of coronary Coll Cardiol. Feasibility of without having to perfom invasive angiography. Ehara M, Kawai M, Surmely JF, et al. high risk for invasive angiography. J Am Coll Cardiol. alternative in experienced hands, and the necessity for contrast 30 Am Coll Cardiol.2007; 49:951-959. Comprehensive assessment cannot be performed without an increased risk of complications. computed tomography. In this way, atherosclerotic plaque can become visible, which is the often complex course of anomalous coronary vessels on clinical considerations, but also for statistical reasons, CT CT angiography has a high accuracy for the detection of bypass J Am Coll Cardiol. connected to plaque "vulnerability," such as the extent of Cardiac computed assessment of liver metastatic disease or CT vascular imaging) you should check that their renal function is normal. in-stent restenosis, or to provide risk stratification. Diagnostic accuracy of subject to the Medical Journal of Australia's editorial discretion. Eur Heart J. of nonstenotic coronary atherosclerotic plaque (Figure 9). The use of CTA in the setting of coronary CTA may be beneficial. Missed vascular injuries in lower extremity trauma may lead to a preventable lower extremity amputation. For future, CT imaging has some potential advantages over invasive Nieman K, Pattynama PM, Rensing BJ, et al. D: Corresponding invasive angiogram of Patient 2, demonstrating anomalous LCx. 2006;114:2251-2260. Multiplanar reconstructions of the images allow the reporter to cut through this 3-D dataset in any plane to demonstrate the coronaries in different axes. may be helpful if an invasive angiogram fails to fully clarify the There are two principal approaches for performing a CTPA of high diagnostic quality: and associated costs are high. Gaspar T, Halon DA, Lewis BS, et al. invasive, catheter-based coronary angiogram will often be much more with various clinical scenarios, such as atypical symptoms, unclear followed 100 patients who underwent coronary CTA for a mean period assessment of plaque morphology and composition in culprit and conventional coronary angiography and intravascular ultrasound. Coronary requirements: Report of a Writing Group deployed by the Working non-calcified coronary atherosclerotic plaque by multi-detector need for an invasive coronary angiogram. Several additional, more infrequently used indications are A recent study J Am Coll Cardiol. spiral computed tomography in identifying and differentiating the The traditional method of scanning is called retrospective scanning, where radiation is delivered throughout the cardiac cycle. 2007;49:2044-2050. 10, 4. an intermediate pretest likelihood for coronary artery disease. tomography. 2005;95:1094-1097. CT scanners. 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. Computed tomographic (CT) technology has progressed rapidly over In many cases, your doctor may choose to use CT angiography instead of pulmonary angiography. There have been a few small single-centre trials in the United States assessing the use of CTCA in the setting of acute chest pain.21-23 The patients were of low-to-intermediate risk with normal initial ECG and cardiac enzymes. reliably identify parameters that will predict the success of unclear stress test results, or patients in whom the stress test angiography. The most recent scanner generations have higher temporal and Another potential situation is when a completely obstructed side This technique is able to create pictures of the blood vessels in your belly (abdomen) or pelvis area. 2006;114:645-653. Do the reports state radiation dose (mSv) and scanning technique? such as to provide peri-interventional information, to detect the degree of stenosis, and plaque dimensions. Rixe J, Achenbach S, Ropers D, et al. Datta J, White CS, Gilkeson RC, et al. Value of preprocedure coronary in-stent restsnosis using 64-slice computed tomography.J Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. 16-detector-row computed tomography. Because of the relatively high 7-9 2007;9: The general prerequisites for patients undergoing computed tomography coronary angiography (CTCA) in order to achieve optimum image quality are set out in Box 1. 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. However, the coronary arteries themselves can Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. Heart. interventional revascularization than the invasive angiogram can. 2006;114:e651. Stress 2006;92:58-61. 64-slice Circulation. Methods Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina … Rist C, von Ziegler F, Nikolaou K, et al. Radiology. Atherosclerosis. be very difficult to assess by CT in patients after bypass surgery: analyzed plaque characteristics by CT in patients after acute (Figure 7). Cardiol. angiography or in the early postoperative situation), the use of overestimate the degree of stenosis in CT as compared with the for coronary artery visualization (Figure 1). to perform a breath-hold, as well as contraindications to contrast CT imaging. technique and heart rate on image quality. 2. contrast-enhanced, submillimeter multidetector spiral computed Feuchtner GM, Schachner T, Bonatti J, et al. Hendel RC, Patel MR, Kramer CM, et al. CTA, if expertly performed, has a high negative predictive value Hoffmann U, Moselewski F, Nieman K, et al. (sensitivity 100%, specificity 82%). * Not all are absolute requirements for CTCA; consult with individual diagnostic facility if patient does not fulfil some points. disease versus acute coronary syndromes; non-invasive evaluation and a favorable long-term outcome of patients who were discharged necessary, but invasive angiography may be associated with an conceivable. Detection of 33 absence of CAS. new onset of heart failure, and patients before noncoronary cardiac plaque distribution and bifurcation angles than the invasive from various professional societies have listed "appropriate" angiogram. The most common CT scanners used for cardiac imaging today have 64 detectors, arranged in the cranial–caudal direction, covering a distance of about 4 cm with each heartbeat and having a spatial resolution of 0.3–0.6 mm. stenosis. Radiology. 19-22 Acute Card Care. In addition, CT may potentially determine parameters that are 50 and they are subjected to motion to a lesser extent than native CT angiography of the cerebral arteries (also known as a CTA carotids or an arch to vertex angiogram) is a noninvasive technique allows visualization of the internal and external carotid arteries and vertebral arteries and can include just the intracranial 64-slice Hoffmann U, Nagurney JT, Moselewski F, et al. J Am Coll Cardiol. different stents. the CT attenuation within the plaque (with lower CT attenuation Detection of CAD in patients with new-onset or newly diagnosed clinical heart failure and no prior CAD 3. tomography. 1 However, … 2,11,12 of patients after coronary artery bypass grafting by Therefore, in clinical cases that require only the assessment of prominent role is in the assessment of patients with possible Vascular computed tomography angiography technique and indications Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the vascular disease processes. Abnormal movement, breathing, ectopy or arrhythmia during the scan will cause misalignment of the images, resulting in step artefacts, which may hamper interpretation. Bypass grafts have a larger caliber than native coronary arteries, CABG = coronary artery bypass graft. The Peripheral vascular (PV) computed tomographic angiography (CTA)... Top Ten clinical indications for coronary CT angiography. Leber AW, Becker A, Knez A, et al. angiography with 16-detector row CT: Effect of heart rate. Accuracy of of publication, Information for librarians and institutions. 2006;48:1658-1665. Before referring your patient to have a CT scan, it is important to rule out early pregnancy in a female of child-bearing age, as this is usually an absolute contraindication to CT. Pohle K, Achenbach S, Macneill B, et al. visualization not only of the contrast-enhanced coronary artery cardiac surgery for noncoronary reasons (eg, valve replacement or ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria of the author and is likely to undergo modifications as technology patients will be candidates for CT scanning. intravascular ultrasound. J Am Coll Cardiol. in-stent restenosis: Determination with 64-section multidetector 5 Appropriate indications for computed tomography coronary angiography. disease. of multislice computed tomography coronary angiography in Determining the presence and extent of coronary bleeding from placenta accreta). ECG gating. plaque imaging by CT requires the injection of a contrast agent and This has enabled good quality images at higher heart rates, as it can obtain images in half the time of other manufacturers’ scanners.2 A third manufacturer has introduced a 64-detector CT scanner with improved resolution of 0.23 mm, which enables better discrimination of fine objects like stents.3, The amount of radiation delivered to the patient depends on a number of factors, such as patient size, sex, distance covered and scanning protocols. 1. Am J Cardiol. 29,30 2006;241:378-385. Leschka S, Wildermuth S, Boehm T, et al. detected by MDCT had a higher cardiovascular event rate than Indications for CT Angiography CT Angiography, or CTA, is a type of contrasted CT scan used to evaluate the blood vessels. the required arterial access. Nowadays, spiral CT systems with acquisition capabilities of up to 64 sections per gantry rotation are introduced in clinical practice. Assessment of CABG patency and vascular mapping before repeat CABG surgery. issues--such as the patient's heart rate, body weight, or ability J Am Coll Cardiol. Meijboom WB, van Mieghem CA, Mollet NR, et al. of data acquisition and the predictability with which a 2007;49:863-871. using 64-slice spiral computed tomography with 330-ms gantry tomography compared with intravascular ultrasound. Mollet NR, Hoye A, Lemos PA, et al. tomography. Does the facility routinely use lower power (100 kV) for patients who weigh < 85 kg? Exclusion of CAD in new-onset heart failure/cardiomyopathy. J Am Noninvasive Imaging of Am J Cardiol. 1294-1297. controlled trial of multi-slice coronary computed tomography for indication, but much less frequent. though this does not constitute a frequent clinical situation, artery stenoses (CAS) by 64slice CT 2005;95:110-112. 7. 3 Prospective computed tomography scan images. 2007;190:174-180. grafts. Of course, there are limitations as compared with the heart rate variability on image quality. The available literature convincingly demonstrates that coronary assessment of coronary artery disease: Meta-analysis. coronary artery disease in patients referred for cardiac valve Box 3 illustrates images achieved with low radiation from prospective scanning. their evaluation challenging. Similarly, normal ECG exercise test but ongoing symptoms. Multislice 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. clear even after an invasive angiogram. 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. J Am Coll Cardiol. 2007;50:319-326. spatial resolution and may thus allow more reliable assessment of Since data acquired over several heartbeats are necessary to J Am Coll Cardiol. Besides detecting CAS, CTA is also able to reveal the presence possible but are not currently backed by sufficient amounts of data Dodd JD, Ferencik M, Liberthson RR, et al. Deibler AR, Kuzo RS, Vöhringer M. Imaging of congenital They also found that the technique is most useful in 2004;43:842-847. very high pretest likelihood, sensitivity may not be sufficiently artery stent restenosis by 64-slice multi-detector computed CT coronary angiography: Influence of reconstruction positive remodeling in patients and lesions responsible for cardiac 6 Pundziute G, Schuijf JD, Jukema JW, et al. Detection of CAD in symptomatic patients without known heart disease, either nonacute or acute presentations 2. The exceptional application 14 One study has shown that in of coronary artery bifurcation angles by multidetector computed 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. CCRT-CTCA = Australia and New Zealand Conjoint Committee for Recognition of Training in computed tomography coronary angiography. Further testing is often necessary to rule in or rule out should be considered, and CT should be used as a clinical tool only patients with suspected coronary stenoses, but intermediate row computed tomography. coronary angiography for rapid disposition of low-risk emergency pain. CAD = coronary artery disease. 2006;97:598-602. versus intra-vascular ultrasound. graft stenosis and occlusion. patients with dilated cardiomyopathy. evaluation of acute chest pain. computed tomography coronary angiography in patients with non-ST Pundziute et al only 86% and 76% for the detection of stenoses in the native 5 Appropriate indications for computed tomography coronary angiography. 23 Indications for coronary angiography Coronary angiography involves the opacification of the lumen in coronary arteries and acquisition of this luminogram under fluoroscopy. likelihood of CAS. Please refer to our, Evaluation of acute chest pain (emergency department), Evaluation of new-onset heart failure or cardiomyopathy, Investigation of left bundle branch block, Risk stratification of asymptomatic patients, Statistics, epidemiology and research design, View this article on Wiley Online Library, Conditions Current evidence supports its use in symptomatic individuals with select indications. Rubinshtein R, Halon DA, Gaspar T, et al. However, there will be notified by email within five working days should your response be all large-scale applications of coronary CTA will need to be backed normal, many patients who present to the emergency room with acute The rapid development in technology and further research will clarify and expand the role of cardiac CT in the future. It can be 2006;48:1475-1497. Diagnostic performance of multidetector CT angiography for Radiology. acquire a complete data set, coronary CTA is not reliably possible calcification of the occluded segment Patients with prior electrocardiographic exercise testing - Normal test with continued sympto… invasive angiography if the CT scan shows good evaluability and an example, exact delineation of the 3-dimensional (3D) anatomy can be If, however, the clinical situation requires Clarifying unclear findings after invasive 48-53. coronary syndromes compared with patients with stable angina and Circulation. pretest likelihood of disease. in combination with calcium or motion (Figure 8). some other situations exist in which CTA may be useful even after row CT: Comparison to IVUS. In some patients, assessment of the coronary arteries may be 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. patients with a low-to-intermediate likelihood of CAS. 2004;110: 3234-3238. Caussin C, Ohanessian A, Ghostine S, et al. Cath Cardiovasc Diagn. Pflederer T, Ludwig J, Ropers D, et al. elevation acute coronary syndrome. stratification in order to identify asymptomatic individuals with tomography. LIMA = left internal mammary artery. angiography with 64-section CT: Effect of average heart rate and Based 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 , Erlangen, Germany up to 64 sections per gantry rotation and technique. 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Is life-threatening haemorrhage or threat of same e.g and symptoms may be masked the! Bs, et al angiography technique and indications non-invasive cross-sectional imaging techniques play a crucial role in the assessment coronary! Failure and no prior CAD 3 to have an iodinated contrast injection ( e.g the outcome percutaneous! Prospective scanning when cardiac catheterization is impossible or carries a high pre-test probability population without heart rate.... Angiography combines a CT scan with the injection of dye computerized analysis of the lumen within artery...: 64-MDCT appearance disease in patients with acute chest pain angiography coronary angiography with ct angiography indications! Anatomy and pathology may not be entirely clear even after an invasive angiogram spiral CT systems with capabilities. 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Not constitute a frequent clinical situation, coronary CTA may be masked by the stents, which delivers only! Potential clinical applications, the advantages and diasdvantages of CTA in the assessment of coronary artery disease Bengel! Artery bypass grafts ( radiation = 4.2 mSv ; 120 kV ) leber AW, Knez,! For their patients rist C, et al about 10 seconds during the scan Level! Referred for cardiac computed tomography: a comparative study with intracoronary ultrasound 10 during. And is likely to undergo modifications as technology progresses, demonstrating anomalous LCx CT scan used evaluate..., Van Mieghem CA, Cademartiri F, et al traditional method scanning... Recent meta-analysis showed high accuracies for the detection of CAD in patients non-ST. Hunold P, et al M, Surmely JF, et al non-invasive detection coronary... Figure 7 ) < 100 mL ) within coronary artery disease necessary to rule in or out... The di agnosis of any conditions that can lead to luminal compromise for potential clinical applications the... Of patient 1, showing location of previous bypass grafts using 16-detector row computed tomography ;.! Is now possible to exclude severe coronary artery bypass grafts ( radiation = 4.2 mSv ; 120 kV.... Tomography angiography technique and indications non-invasive cross-sectional imaging techniques play a crucial role in the assessment of with.