As a consequence of improved technology, there is growing clinical interest in the use of multi-detector row computed tomography (MDCT) for non-invasive coronary angiography. Indeed, the accuracy of MDCT to detect or exclude coronary artery stenoses has been high in many published studies. This report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT (WG 5) of the European Society of Cardiology and the European Council of Nuclear Cardiology summarizes the present state of cardiac CT technology, as well as the currently available data concerning its accuracy and applicability in certain clinical situations. Besides coronary CT angiography, the use of CT for the assessment of cardiac morphology and function, evaluation of perfusion and viability, and analysis of heart valves is discussed. In addition, recommendations for clinical applications of cardiac CT imaging are given and limitations of the technique are described.

https://www.zora.uzh.ch/id/eprint/14228/4/Schroeder_EuropHeartJourn_2008V.pdf

Cardiac computed tomography: Indications, applications, limitations, and training requirements - Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology

OBJECTIVE. The purpose of this study was to compare the accuracy of 64-MDCT with that of intravascular ultrasound (IVUS) for the identification and quantitative analysis of coronary atherosclerotic plaques.MATERIALS AND METHODS. Twenty-six patients (17 men, nine women; mean age, 56 years) with suspected coronary atherosclerotic disease were studied using contrast-enhanced 64-MDCT and IVUS. The coronary arteries were divided into 10-mm segments and vascular cross-sectional area (CSA), luminal CSA, and plaque burden were measured in each segment. Plaque analysis software was used to automatically detect both plaques and vessel walls on CT images. Two investigators who were blinded to IVUS results independently determined the presence, classification, and quantitative measurement of atherosclerotic plaques on the CT images, which were then compared with the IVUS images.RESULTS. Of 40 coronary arteries, 247 of 263 segments were imaged and analyzed by both contrast-enhanced 64-MDCT and IVUS. Sixteen segments w...

https://www.ajronline.org/doi/pdf/10.2214/AJR.07.2763

Identification and quantification of coronary atherosclerotic plaques: a comparison of 64-MDCT and intravascular ultrasound.

Atherosclerotic plaque characterization by multidetector row computed tomography angiography.

Objectives: The aim of this study was to quantify image quality gains of a moving coronary plaque phantom using dual-source computed tomography (DSCT) providing 83 milliseconds temporal resolution in direct comparison to 64 slice single-source multidetector CT (MDCT) with a temporal resolution of 165 milliseconds. Materials and Methods: Three cardiac vessel phantoms with fixed 50% stenosis and changing plaque configurations were mounted on a moving device simulating cardiac motion. Scans were performed at a simulated heart frequency of 60 to 120 bpm. Image quality assessment was performed in different anatomic orientations inside a thoracic phantom. Results: A significant improvement of image quality using the DSCT could be found (P = 0.0002). Relevant factors influencing image quality aside from frequency (P = 0.0002) are plaque composition (P < 0.0001), as well as orientation (P < 0.0001). Conclusion: Scanning with 83 milliseconds temporal resolution improved image quality of coronary plaque at higher heart frequencies.

Dual-source computed tomography: advances of improved temporal resolution in coronary plaque imaging.

The purpose of this study was to assess the blooming artifacts in ex vivo coronary arteries at multidetector computed tomography (CT) and flat-panel-volume CT by comparing measured areas of calcified plaque with respect to the reference standard of histopathologic findings. Three ex vivo hearts were scanned with multidetector CT and flat-panel-volume CT after institutional review board approval. The area of calcified plaque was measured at histopathologic examination, multidetector CT, and flat-panel-volume CT. The plaque area was overestimated at multidetector CT by 400% (4.61/1.15) on average, and the predicted difference between the measurements was significant (3.46 mm(2), P = .018). The average overestimation of plaque area at flat-panel-volume CT was twofold (214% [2.18/1.02]), and the predicted difference was smaller (1.16 mm(2), P = .08). The extent of the blooming artifact in visualizing calcified coronary plaque is reduced by using flat-panel-volume CT.

Calcified plaque: measurement of area at thin-section flat-panel CT and 64-section multidetector CT and comparison with histopathologic findings.

Objective: To evaluate the diagnostic accuracy of 16 slice computed tomography (CT) in determining plaque morphology and composition in an experimental setting. The results were compared with histopathological analysis as the reference standard. Methods: Nine human popliteal arteries derived from amputations because of atherosclerotic disease were investigated with multislice spiral CT (MSCT). Atherosclerotic lesions were morphologically classified (completely or partially occlusive, concentric, eccentric), and tissue densities were determined within these plaques. In addition, vessel dimensions were quantitatively measured. Results: The results were compared with histological analysis. The concordance index κ for morphological classification was 0.88. Plaque density (n  =  51 lesions) was significantly different (p r  =  0.98). Conclusions: 16 slice CT was found to be a reliable non-invasive imaging technique for assessing atherosclerotic plaque morphology and composition. Although calcified lesions can be differentiated from non-calcified lesions, the diagnostic accuracy in further subclassifying non-calcified plaques as lipid rich and fibrotic is low, even under experimental conditions.

https://heart.bmj.com/content/heartjnl/90/12/1471.full.pdf

Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations

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Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations