Cardiac CT for CAD. Do we still need angiography?

Area of Science:

• Cardiovascular Imaging
• Radiology
• Medical Technology

Background:

• Technological advancements in multi-detector computed tomography (MDCT) have significantly improved image quality.
• CT angiography (CTA) is gaining interest for evaluating coronary anatomy in suspected coronary artery disease (CAD).
• CTA offers insights into both the coronary lumen and vessel wall, unlike invasive methods.

Purpose of the Study:

• To review the clinical applications and controversies surrounding CT angiography for coronary artery disease assessment.
• To highlight the role of MDCT in evaluating coronary plaque morphology and stenosis.
• To discuss the diagnostic value of CTA in various patient populations.

Main Methods:

• Review of recent technological advancements in MDCT scanners.
• Analysis of studies validating contrast-enhanced CT coronary angiography for stenosis detection.
• Comparison of CTA with invasive coronary angiography and intravascular ultrasound.
• Evaluation of calcium scoring using MDCT for plaque quantification.

Main Results:

• MDCT effectively detects and quantifies calcified and non-calcified coronary plaques.
• Contrast-enhanced CTA is validated for detecting coronary artery stenosis, with non-evaluable cases reduced to below 10% with new scanners.
• CTA provides non-invasive assessment of plaque morphology and severity.
• Coronary calcium measurement is valuable for therapy decisions in asymptomatic patients with intermediate risk.

Conclusions:

• CT coronary angiography is a valuable non-invasive tool for diagnosing coronary artery disease.
• Its high negative predictive value makes it ideal for excluding CAD in low-to-intermediate probability patients.
• Further clarification on appropriate clinical indications for CTA is needed despite its growing utility.