Computed tomographic cardiac angiography: Difference between revisions
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Computed tomographic cardiac angiography (CT cardiac angiography) uses multidetector [[spiral computed tomography]] for diagnosing [[coronary heart disease]].<ref name="pmid18691486">{{cite journal |author=Stein PD, Yaekoub AY, Matta F, Sostman HD |title=64-slice CT for diagnosis of coronary artery disease: a systematic review |journal=The American journal of medicine |volume=121 |issue=8 |pages=715–25 |year=2008 |month=August |pmid=18691486 |doi=10.1016/j.amjmed.2008.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(08)00298-2 |issn=}}</ref><ref name="pmid18669550">{{cite journal |author=Mowatt G, Cook JA, Hillis GS, ''et al'' |title=64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis |journal=Heart |volume= |issue= |pages= |year=2008 |month=July |pmid=18669550 |doi=10.1136/hrt.2008.145292 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=18669550 |issn=}}</ref><ref name="pmid18462576">{{cite journal |author=Mowatt G, Cummins E, Waugh N, ''et al'' |title=Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease |journal=Health Technol Assess |volume=12 |issue=17 |pages=iii–iv, ix–143 |year=2008 |month=May |pmid=18462576 |doi= |url=http://www.hta.ac.uk/execsumm/summ1217.htm |issn=}}</ref><ref name="pmid17996512">{{cite journal |author=Rubinshtein R, Halon DA, Gaspar T, ''et al'' |title=Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin |journal=Am. J. Cardiol. |volume=100 |issue=10 |pages=1522–6 |year=2007 |month=November |pmid=17996512 |doi=10.1016/j.amjcard.2007.06.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)01506-8 |issn=}}</ref> The physiologic significance of obstructions estimated to be 60% to 80% is difficult to predict.<ref name="pmid18344444">{{cite journal |author=Sato A, Hiroe M, Tamura M, ''et al'' |title=Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging |journal=J. Nucl. Med. |volume=49 |issue=4 |pages=564–72 |year=2008 |month=April |pmid=18344444 |doi=10.2967/jnumed.107.042481 |url=http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=18344444 |issn=}}</ref> | Computed tomographic cardiac angiography (CT cardiac angiography) uses multidetector [[spiral computed tomography]] for diagnosing [[coronary heart disease]].<ref name="pmid18691486">{{cite journal |author=Stein PD, Yaekoub AY, Matta F, Sostman HD |title=64-slice CT for diagnosis of coronary artery disease: a systematic review |journal=The American journal of medicine |volume=121 |issue=8 |pages=715–25 |year=2008 |month=August |pmid=18691486 |doi=10.1016/j.amjmed.2008.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(08)00298-2 |issn=}}</ref><ref name="pmid18669550">{{cite journal |author=Mowatt G, Cook JA, Hillis GS, ''et al'' |title=64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis |journal=Heart |volume= |issue= |pages= |year=2008 |month=July |pmid=18669550 |doi=10.1136/hrt.2008.145292 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=18669550 |issn=}}</ref><ref name="pmid18462576">{{cite journal |author=Mowatt G, Cummins E, Waugh N, ''et al'' |title=Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease |journal=Health Technol Assess |volume=12 |issue=17 |pages=iii–iv, ix–143 |year=2008 |month=May |pmid=18462576 |doi= |url=http://www.hta.ac.uk/execsumm/summ1217.htm |issn=}}</ref><ref name="pmid17996512">{{cite journal |author=Rubinshtein R, Halon DA, Gaspar T, ''et al'' |title=Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin |journal=Am. J. Cardiol. |volume=100 |issue=10 |pages=1522–6 |year=2007 |month=November |pmid=17996512 |doi=10.1016/j.amjcard.2007.06.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)01506-8 |issn=}}</ref> The physiologic significance of obstructions estimated to be 60% to 80% is difficult to predict.<ref name="pmid18344444">{{cite journal |author=Sato A, Hiroe M, Tamura M, ''et al'' |title=Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging |journal=J. Nucl. Med. |volume=49 |issue=4 |pages=564–72 |year=2008 |month=April |pmid=18344444 |doi=10.2967/jnumed.107.042481 |url=http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=18344444 |issn=}}</ref> | ||
{| class="wikitable" | |||
|+ Accuracy using 64-row CT for detecting stenoses of 50%<ref name="pmid19038879">{{Cite journal | |||
| doi = 10.1056/NEJMoa0806576 | volume = 359 | issue = 22 | pages = 2324-2336 | last = Miller | | doi = 10.1056/NEJMoa0806576 | volume = 359 | issue = 22 | pages = 2324-2336 | last = Miller | ||
| first = Julie M. | coauthors = Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, Melvin E. Clouse, Edward P. Shapiro, John Hoe, Albert C. Lardo, David E. Bush, Albert de Roos, Christopher Cox, Jeffery Brinker, Joao A.C. Lima | | first = Julie M. | coauthors = Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, Melvin E. Clouse, Edward P. Shapiro, John Hoe, Albert C. Lardo, David E. Bush, Albert de Roos, Christopher Cox, Jeffery Brinker, Joao A.C. Lima | title = Diagnostic Performance of Coronary Angiography by 64-Row CT | journal = N Engl J Med | ||
| title = Diagnostic Performance of Coronary Angiography by 64-Row CT | journal = N Engl J Med | | accessdate = 2008-11-27 | date = 2008-11-27 | url = http://content.nejm.org/cgi/content/abstract/359/22/2324 |pmid=19038879 | ||
| accessdate = 2008-11-27 | date = 2008-11-27 | url = http://content.nejm.org/cgi/content/abstract/359/22/2324 | }}</ref><ref name="pmid19095130">{{cite journal |author=Meijboom WB, Meijs MF, Schuijf JD, ''et al.'' |title=Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study |journal=J. Am. Coll. Cardiol. |volume=52 |issue=25 |pages=2135–44 |year=2008 |month=December |pmid=19095130 |doi=10.1016/j.jacc.2008.08.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03234-8 |issn=}}</ref><ref name="pmid19007693">{{cite journal |author=Budoff MJ, Dowe D, Jollis JG, ''et al.'' |title=Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial |journal=J. Am. Coll. Cardiol. |volume=52 |issue=21 |pages=1724–32 |year=2008 |month=November |pmid=19007693 |doi=10.1016/j.jacc.2008.07.031 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)02609-0 |issn=}}</ref> | ||
}}</ref> | ! rowspan="2"| !! rowspan="2"|Patients!!colspan="2"|Per patient!! colspan="2"|Per segment | ||
|- | |||
! Sensitivity!!Specificity!! Sensitivity!!Specificity | |||
|- | |||
| CORE 64 study.<ref name="pmid19038879"/><br/>2008||291 patients with suspected coronary heart disease and calcium scores ≤ 600||align="center"| 85%||align="center"|90%||align="center"|75%||align="center"|93% | |||
|- | |||
| Meijboom et al.<ref name="pmid19095130"/><br/>2008||360 symptomatic patients||align="center"|99%||align="center"|64%||align="center"|88%||align="center"|90% | |||
|- | |||
| ACCURACY study.<ref name="pmid19007693"/><br/>2008||230 symptomatic patients||align="center"|95%||align="center"|83%||align="center"|84%||align="center"|90% | |||
|} | |||
===Bacterial endocarditis=== | ===Bacterial endocarditis=== | ||
Revision as of 15:26, 26 May 2009
In diagnostic imaging, computed tomographic cardiac angiography, also called CT coronary angiography, is a form of x-ray computed tomography for examining the coronary arteries.
Roles in diagnostic imaging
Coronary heart disease
Computed tomographic cardiac angiography (CT cardiac angiography) uses multidetector spiral computed tomography for diagnosing coronary heart disease.[1][2][3][4] The physiologic significance of obstructions estimated to be 60% to 80% is difficult to predict.[5]
| Patients | Per patient | Per segment | |||
|---|---|---|---|---|---|
| Sensitivity | Specificity | Sensitivity | Specificity | ||
| CORE 64 study.[6] 2008 |
291 patients with suspected coronary heart disease and calcium scores ≤ 600 | 85% | 90% | 75% | 93% |
| Meijboom et al.[7] 2008 |
360 symptomatic patients | 99% | 64% | 88% | 90% |
| ACCURACY study.[8] 2008 |
230 symptomatic patients | 95% | 83% | 84% | 90% |
Bacterial endocarditis
Computed tomographic cardiac angiography can detect vegetations and abscesses/pseudoaneurysms of bacterial endocarditis, but not leaflet perforations, almost as well as transesophageal echocardiography.[9]
Adverse effects
Radiation
The radiation dose is estimated to be "1.2 x the dose of an abdominal CT study or 600 chest x-rays."[10]
References
- ↑ Stein PD, Yaekoub AY, Matta F, Sostman HD (August 2008). "64-slice CT for diagnosis of coronary artery disease: a systematic review". The American journal of medicine 121 (8): 715–25. DOI:10.1016/j.amjmed.2008.02.039. PMID 18691486. Research Blogging.
- ↑ Mowatt G, Cook JA, Hillis GS, et al (July 2008). "64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis". Heart. DOI:10.1136/hrt.2008.145292. PMID 18669550. Research Blogging.
- ↑ Mowatt G, Cummins E, Waugh N, et al (May 2008). "Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease". Health Technol Assess 12 (17): iii–iv, ix–143. PMID 18462576. [e]
- ↑ Rubinshtein R, Halon DA, Gaspar T, et al (November 2007). "Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin". Am. J. Cardiol. 100 (10): 1522–6. DOI:10.1016/j.amjcard.2007.06.052. PMID 17996512. Research Blogging.
- ↑ Sato A, Hiroe M, Tamura M, et al (April 2008). "Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging". J. Nucl. Med. 49 (4): 564–72. DOI:10.2967/jnumed.107.042481. PMID 18344444. Research Blogging.
- ↑ 6.0 6.1 Miller, Julie M.; Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, Melvin E. Clouse, Edward P. Shapiro, John Hoe, Albert C. Lardo, David E. Bush, Albert de Roos, Christopher Cox, Jeffery Brinker, Joao A.C. Lima (2008-11-27). "Diagnostic Performance of Coronary Angiography by 64-Row CT". N Engl J Med 359 (22): 2324-2336. DOI:10.1056/NEJMoa0806576. PMID 19038879. Retrieved on 2008-11-27. Research Blogging.
- ↑ 7.0 7.1 Meijboom WB, Meijs MF, Schuijf JD, et al. (December 2008). "Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study". J. Am. Coll. Cardiol. 52 (25): 2135–44. DOI:10.1016/j.jacc.2008.08.058. PMID 19095130. Research Blogging.
- ↑ 8.0 8.1 Budoff MJ, Dowe D, Jollis JG, et al. (November 2008). "Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial". J. Am. Coll. Cardiol. 52 (21): 1724–32. DOI:10.1016/j.jacc.2008.07.031. PMID 19007693. Research Blogging.
- ↑ Feuchtner GM, Stolzmann P, Dichtl W, et al (February 2009). "Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings". J. Am. Coll. Cardiol. 53 (5): 436–44. DOI:10.1016/j.jacc.2008.01.077. PMID 19179202. Research Blogging.
- ↑ Hausleiter J, Meyer T, Hermann F, et al (February 2009). "Estimated radiation dose associated with cardiac CT angiography". JAMA 301 (5): 500–7. DOI:10.1001/jama.2009.54. PMID 19190314. Research Blogging.