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Published on: September 22, 2023
Advances in the noninvasive evaluation of coronary artery disease with multislice computed tomography
Gabija Pundziute1, Joanne D Schuijf, J Wouter Jukema
1Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands.
Insights
Multislice computed tomography (MSCT) offers direct anatomical imaging of coronary arteries, unlike indirect ischemia detection methods for coronary artery disease (CAD). Reduced radiation could make MSCT crucial for diagnosing and assessing prognosis in CAD patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Current noninvasive detection of coronary artery disease (CAD) relies on indirect ischemia demonstration.
- This indirect method visualizes hemodynamic consequences rather than direct obstructive coronary artery lesions.
Purpose of the Study:
- To evaluate multislice computed tomography (MSCT) as a noninvasive imaging modality for CAD.
- To explore MSCT's capability for direct anatomical imaging and plaque assessment.
Main Methods:
- Utilized multislice computed tomography (MSCT) for noninvasive coronary angiography.
- Assessed plaque burden, morphology, and constitution using MSCT.
- Evaluated resting left ventricular systolic function and potential resting perfusion with MSCT.
Main Results:
- MSCT enables direct anatomical imaging of coronary arteries, providing noninvasive coronary angiography.
- MSCT allows assessment of total plaque burden, morphology, and constitution.
- MSCT offers information on resting left ventricular function and potential resting perfusion.
Conclusions:
- MSCT provides direct visualization of coronary arteries and plaque characteristics.
- High radiation doses from sequential acquisitions limit routine stress function/perfusion evaluation.
- Reduced radiation is anticipated to enhance MSCT's role in CAD diagnosis and prognosis.
Abstract:
Current noninvasive detection of coronary artery disease (CAD) is based on the demonstration of ischemia using stress-rest imaging, which is an indirect way of identifying CAD by demonstration of the hemodynamic consequences, rather than direct visualization of the obstructive lesions in the coronary arteries. Multislice computed tomography (MSCT) has recently emerged as an extremely rapidly developing noninvasive imaging modality, which allows anatomical imaging of the coronary arteries or noninvasive coronary angiography. In addition, total plaque burden, plaque morphology and (to some extent) plaque constitution can be assessed by MSCT. The technique also provides information on resting left ventricular systolic function, and possibly resting perfusion. Ideally, stress function and perfusion should also be evaluated, since this would allow detection of ischemia and would complete the picture of CAD. However, this is not routinely performed, since sequential acquisitions are associated with high radiation doses and thus pose a limitation for cardiovascular applications of MSCT. It is anticipated that, with a reduction in radiation, MSCT may become an important player in the diagnostic and prognostic work-up of patients with known or suspected CAD.
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