Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective “CORE-64” trial (“Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors”). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.

/pdf/coronary-ct-angiography-using-64-detector-rows-methods-and-2iw43suuv5.pdf

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Introduction: Basic principles of CT. Established imaging modalities for cardiac imaging. Clinical goals for CT in the diagnosis of cardiac and thoracic diseases. History and evolution of CT in cardiac imaging.- Cardiac and cardio-thoracic anatomy in CT: Topography. Standard views. Coronary arteries and veins. Pericardium. Cardiac chambers. Cardiac valves. Great vessels.- Multi-slice CT technology basics: Evolution of spiral CT from 1 to 64 slices. Principles of multi-slice CT system design. Multi-slice CT acquisition and reconstruction for whole-body imaging.- Technical principles of multi-slice cardiac imaging: Basic performance requirements for CT imaging of the heart. CT imaging with optimized temporal resolution: The principle of half-scan reconstruction. Prospectively ECG-triggered multi-slice CT. Retrospectively ECG-gated multi-slice CT. Synchronization to the ECG and cardiac motion. Radiation exposure considerations.- Clinical examination protocols with 4- to 64-slice CT: Quantification of coronary artery calcification. CT angiography of the cardiac anatomy and the coronary arteries. Cardiac function imaging. Cardio-thoracic examination protocols.- Image visualization and postprocessing techniques: Trans-axial image slices. Multi-planar reformation (MPR). Maximum intensity projection (MIP). Volume rendering technique (VRT). Vessel segmentation and vessel analysis. 4D visualization and functional parameter assessment. Dynamic evaluation of myocardial perfusion. Quantification of coronary calcification.- Clinical Indications: Current and future clinical potentials. Risk assessment with coronary artery calcium screening. Detection and exclusion of coronary artery stenosis. Assessment and interpretation of atherosclerotic coronary plaque. Usefulness in patients with chest pain. Evaluation of coronary artery bypass grafts. Patency control of coronary stents. Evaluation of non-atherosclerotic coronary disease. Diagnosis of congenital heart disease in adults and children. Evaluation of ventricular function parameters. Imaging and diagnosis of cardiac valves. Visualization of cardiac tumors and masses. Imaging of the pulmonary veins. Potential of myocardial perfusion and viability studies. Cardio-thoracic multi-slice CT in the emergency department.- Future technical developments in cardiac CT: Limitations and pitfalls with today's multi-slice CT. A future for electron beam CT? Future possibilities with area detector CT. New frontiers with dual-source CT.-

Multi-slice and dual-source CT in cardiac imaging : principles - protocols - indications - outlook ; with 26 tables ; [CD-ROM included]

PURPOSE: To test the hypothesis that computed tomographic (CT) scanning during optimal electrocardiographic (EKG) triggering can minimize image motion artifact and reduce interexamination variation of coronary arterial calcification (CAC) score at electron-beam CT. MATERIALS AND METHODS: Two hundred patients underwent electron-beam CT once and again 5 minutes later to evaluate interexamination variability of CAC score. Group 1 (104 patients) underwent scanning with use of an optimal EKG-triggering protocol (EKG triggering performed individually at the time of least coronary arterial motion during the cardiac cycle); group 2 (96 patients) underwent scanning with use of conventional 80% R-R interval triggering (the most common protocol with the electron-beam CT scanner). Interexamination, intraobserver, and interobserver variations of CAC measurements were compared between groups by using unpaired t tests for both Agatston and volumetric scores (in square millimeters). RESULTS: Coronary arterial motion artifacts were found in 26% (27 of 104) versus 80% (77 of 96) of patients in groups 1 and 2, respectively (P .05). CONCLUSION: Optimal EKG triggering improves the reproducibility of CAC measurement by reducing coronary arterial motion artifacts.

EKG-triggered CT data acquisition to reduce variability in coronary arterial calcium score.

Objectives:Multidetector-row computed tomography coronary images are usually analyzed in mid-diastole (MD). Because of slow coronary motion also in end-systole (ES), we evaluated the impact on image quality of including ES images and defined an efficient reconstruction protocol.Material and Methods:

The importance of end-systole for optimal reconstruction protocol of coronary angiography with 16-slice multidetector computed tomography.

The lower the heart rate the better image quality in multislice computed tomography (MSCT) coronary angiography. We prospectively assessed the influence of heart rate on per-patient diagnostic accuracy and image quality of MSCT coronary angiography and compared adaptive multisegment and standard halfscan reconstruction. A consecutive cohort of 126 patients scheduled to undergo conventional coronary angiography was examined with 16-slice CT. For all heart rate groups, per-patient diagnostic accuracy was significantly higher for multisegment than halfscan reconstruction with values of 95 vs. 79% (p 74 bpm, 41 patients). Differences in diagnostic accuracy between adjacent heart rate groups were only significant for halfscan reconstruction for the comparison between the 65–74 and >74 bpm group (p < 0.05). The vessel lengths free of motion artifacts were significantly longer with multisegment reconstruction in all heart rate groups and for all coronary arteries (p < 0.005). For noninvasive MSCT coronary angiography, both per-patient diagnostic accuracy and image quality decline with increasing heart rate, and multisegment reconstruction at high heart rates yields similar results as standard halfscan reconstruction at low heart rates.

Influence of heart rate on diagnostic accuracy and image quality of 16-slice CT coronary angiography: comparison of multisegment and halfscan reconstruction approaches

Optimal electrocardiographically triggered phase for reducing motion artifact at electron-beam CT in the coronary artery.

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Optimal electrocardiographically triggered phase for reducing motion artifact at electron-beam CT in the coronary artery.