cardiac computerized tomography (CT)
Last edited 05/2019
- Cardiac Computed Tomography (CT)
- cardiac CT uses x-rays to build up 3D images of the heart
- CT imaging of the heart can be performed either with or without intravenous contrast agents
- as with cardiac magnetic resonance (CMR), following acquisition, the CT datasets can be reformatted in any orientation and can be viewed as cine loops for functional analysis of ventricular function
- software allows semi-automated extraction of the coronary arteries and the production of 3D volumetric datasets
- total scan time for a cardiac CT is about 15 minutes
Notes:
- CT provides rapid, high quality imaging of the coronary arteries not matched
by any other non-invasive technique and is the only technique able to provide
a coronary artery calcium score (CACS)
- presence of coronary artery calcium is associated with plaque burden
- however, it is not a marker of plaque vulnerability
- despite this limitation the CACS gives an insight to the patient's
level of cardiovascular disease risk and is helpful for guiding interventions
or prevent coronary artery disease (2,3)
- ACC/AHA guidelines on assessment of cardiovascular risk state that
assessment of CACS may be considered based on a large number of observational
studies:
- with a CACS of >=300 Agatston units (or >=75th percentile
for age, sex and ethnicity) supporting an upward revision in risk
assessment (4)
- with a CACS of >=300 Agatston units (or >=75th percentile
for age, sex and ethnicity) supporting an upward revision in risk
assessment (4)
- despite this limitation the CACS gives an insight to the patient's
level of cardiovascular disease risk and is helpful for guiding interventions
or prevent coronary artery disease (2,3)
- presence of coronary artery calcium is associated with plaque burden
- however, it is not a marker of plaque vulnerability
- CT scanning is less claustrophobic than MRI and can be used in most patients who are precluded from having CMR
Reference:
- British Heart Foundation Factfile (January 2010). Cardiac imaging with MRI, CT and Nuclear techniques
- Reed GW et al. Angiographic predictors of adverse outcomes after percutaneous coronary intervention in patients with radiation associated coronary artery disease. Catheter Cardiovasc Interv. 2019 Jan 28;
- Chen Y et al. Comparison of Nongated Chest CT and Dedicated Calcium Scoring CT for Coronary Calcium Quantification Using a 256-Dector Row CT Scanner. Acad Radiol. 2019 Jan 23
- Goff DCet al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2935-2959