Technical principles of computed tomography in patients with congenital heart disease

Cardiac magnetic resonance imaging and echocardiography are often the primary imaging techniques for many patients with congenital heart disease (CHD). However, with modern generations of CT systems and recent advances in temporal and spatial resolution, cardiac CT has been gaining an increasing reputation in the field of cardiac imaging and in the evaluation of patients with congenital heart disease. The CT imaging protocol depends on the suspected cardiac defect, the type of previous surgical repair, and the patient’s age and level of cooperation. Various strategies are available for reducing radiation exposure, which is of utmost importance particularly in paediatric patients. A sequential segmental analysis is a commonly used approach to analysing congenital heart defects. Familiarity of the performing radiologist with dedicated CT protocols, the complex anatomy, morphology and terminology of CHD, as well as with the surgical procedures used to correct congenital abnormalities is a prerequisite for correct diagnosis

Application of Dual-Energy Computed Tomography to the Evalution of Coronary Atherosclerotic Plaque

Atherosclerotic coronary artery disease is responsible for around 50 of cardiovascular deaths in USA. Early detection and characterization of coronary artery atherosclerotic plaque could help prevent cardiac events. Computed tomography (CT) is an excellent modality for imaging calcifications and has higher spatial resolution than other common non-invasive modalities (e.g MRI), making it more suitable for coronary plaque detection. However, attenuation-based classification of non-calcified plaques as fibrous or lipid is difficult with conventional CT, which relies on a single x-ray energy. Dual-energy CT (DECT) may provide additional attenuation data for the identification and discrimination of plaque components. The purpose of this research was to evaluate the feasibility of DECT imaging for coronary plaque characterization and further, to explore the limits of CT for non-invasive plaque analysis. DECT techniques were applied to plaque classification using a clinical CT system. Saline perfused coronary arteries from autopsies were scanned at 80 and 140 kVp, prior to and during injection of iodinated contrast. Plaque attenuation was measured from CT images and matched to histology. Measurements were compared to assess differences among plaque types. Although calcified and non-calcified plaques could be identified and differentiated with DECT, further characterization of non-calcified plaques was not possible. The results also demonstrated that calcified plaque and iodine could be discriminated. The limits of x-ray based non-calcified plaque discrimination were assessed using microCT, a pre-clinical x-ray based high spatial resolution modality. Phantoms and tissues of different composition were scanned using different tube voltages (i.e., different energies) and resulting attenuation values were compared. Better vessel wall visualization and increase in tissue contrast resolution was observed with decrease in x-ray energy. Feasibility of calcium quantification from contrast-enhanced scans by creating virtual n

Multimodality Imaging of Anatomy and Function in Coronary Artery Disease

Various modalities are available in the diagnostic and prognostic evaluation of patients presenting with known or suspected coronary artery disease (CAD). A rapidly expanding technique is noninvasive coronary angiography with Multi-Slice Computed Tomography (MSCT), which allows accurate detection of significant stenoses. The main value of the technique lies in the noninvasive exclusion of CAD in patients with intermediate pre-test likelihood. Although imaging in populations such as patients with previous stent placement appears to be more challenging, promising results have been obtained in these populations as well. However, it remains important to realize that the presence of coronary atherosclerosis with luminal obstruction does not invariably imply the presence of ischemia. Accordingly, a noninvasive angiographic imaging technique as MSCT cannot be used to predict the hemodynamical importance of lesions. In patients with borderline stenosis, therefore, functional testing (which can be performed by nuclear imaging, stress echocardiography or MRI) will remain necessary to determine management. Nonetheless, detection of CAD at a far earlier stage than functional imaging is an important advantage of MSCT. Initial investigations suggest that MSCT may distinguish different plaque characteristics between various presentations. Potentially, this information could be useful for risk stratification. Finally, additional non-coronary information can be derived as well. LV function can be evaluated with high accuracy while also information on the cardiac venous system can be obtained.LEI Universiteit LeidenNederlandse Hartstichting, ICIN Toshiba Medical Systems BV, Vital Images BV, Biotronik BV, Stichting EMEX, Foundation Imago, J.E. Jurriaanse Stichting, Medtronic BV, Astellas Pharma BV, St Jude Medical BV, Tyco Healthcare BV, Amgen BV (Breda), Boehringer Ingelheim BV, GE Healthcare Medical Diagnostics (Eindhoven), Pfizer BV, Siemens BV, Bristol-Myers Squibb, Boston Scientific Benelux BV, Merck Sharp & Dohme BV.Vasculaire biologie en interventi

Computed tomography and other imaging modalities in pediatric congenital heart disease

Congenital heart defects (CHD) are the most common congenital disabilities. Early and accurate diagnosis of coronary heart disease is very important for patients to get timely and effective treatment. In recent years, the accuracy of coronary heart disease diagnosis has been greatly improved with the development of medical imaging equipment and technology. At present, the clinical application of echocardiogram (echo), cardiovascular magnetic resonance (CMR) and computed tomography angiography (CTA) in coronary heart disease anatomy and function has increased significantly, which plays an important role in preoperative diagnosis, intraoperative monitoring, and postoperative recovery evaluation. However, each imaging technique has its indications. Providing the best examination plan for patients requires clinicians and radiologists’ close cooperation. Therefore, this study reviewed the imaging techniques for diagnosing coronary heart disease

Multislice computed tomography coronary angiography

__Abstract__ Computed Tomography (CT) imaging is also known as "CAT scanning" (Computed Axia

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

Objectives: To assess the clinical effectiveness and cost-effectiveness, in different patient groups, of the use of 64-slice or higher computed tomography (CT) angiography, instead of invasive coronary angiography (CA), for diagnosing people with suspected coronary artery disease (CAD) and assessing people with known CAD. Data sources: Electronic databases were searched from 2002 to December 2006. Review methods: Included studies were tabulated and sensitivity, specificity, positive and negative predictive values calculated. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic curves. Summary sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios for each model were reported as a median and 95% credible interval (CrI). Searches were also carried out for studies on the cost-effectiveness of 64-slice CT in the assessment of CAD. Results: The diagnostic accuracy and prognostic studies enrolled over 2500 and 1700 people, respectively. The overall quality of the studies was reasonably good. In the pooled estimates, 64-slice CT angiography was highly sensitive (99%, 95% CrI 97 to 99%) for patientbased detection of significant CAD (defined as 50% or more stenosis), while across studies the negative predictive value (NPV) was very high (median 100%, range 86 to 100%). In segment-level analysis compared with patient-based detection, sensitivity was lower (90%, 95% CrI 85 to 94%, versus 99%, 95% CrI 97 to 99%) and specificity higher (97%, 95% CrI 95 to 98%, versus 89%, 95% CrI 83 to 94%), while across studies the median NPV was similar (99%, range 95 to 100%, versus 100%, range 86 to 100%). At individual coronary artery level the pooled estimates for sensitivity ranged from 85% for the left circumflex (LCX) artery to 95% for the left main artery, specificity ranged from 96% for both the left anterior descending (LAD) artery and LCX to 100% for the left main artery, while across studies the positive predictive value (PPV) ranged from 81% for the LCX to 100% for the left main artery and NPV was very high, ranging from 98% for the LAD (range 95 to 100%), LCX (range 93 to 100%) and right coronary artery (RCA) (range 94 to 100%) to 100% for the left main artery. The pooled estimates for bypass graft analysis were 99% (95% CrI 95 to 100%) sensitivity, 96% (95% CrI 86 to 99%) specificity, with median PPV and NPV values across studies of 93% (range 90 to 95%) and 99% (range 98 to 100%), respectively. This compares with, for stent analysis, a pooled sensitivity of 89% (95% CrI 68 to 97%), specificity 94% (95% CrI 83 to 98%), and median PPV and NPV values across studies of 77% (range 33 to 100%) and 96% (range 71 to 100%), respectively. Sixty-four-slice CT is almost as good as invasive CA in terms of detecting true positives. However, it is somewhat poorer in its rate of false positives. It seems likely that diagnostic strategies involving 64-slice CT will still require invasive CA for CT test positives, partly to identify CT false positives, but also because CA provides other information that CT currently does not, notably details of insertion site and distal run-off for possible coronary artery bypass graft (CABG). The high sensitivity of 64-slice CT avoids the costs of unnecessary CA in those referred for investigation but who do not have CAD. Given the possible, although small, associated death rate, avoiding these unnecessary CAs through the use of 64-slice CT may also confer a small immediate survival advantage. This in itself may be sufficient to outweigh the very marginally inferior rates of detection of true positives by strategies involving 64-slice CT. The avoidance of unnecessary CA through the use of 64-slice CT also appears likely to result in overall cost savings in the diagnostic pathway. Only if both the cost of CA is relatively low and the prevalence of CAD in the presenting population is relatively high (so that most patients will go on to CA) will the use of 64-slice CT be likely to result in a higher overall diagnostic cost per patient. Conclusions: The main value of 64-slice CT may at present be to rule out significant CAD. It is unlikely to replace CA in assessment for revascularisation of patients, particularly as angiography and angioplasty are often done on the same occasion. Further research is needed into the marginal advantages and costs of 256-slice machines compared with 64-sliceCT, the usefulness of 64-slice CT in people with suspected acute coronary syndrome, the potential of multislice computed tomography to examine plaque morphology, the role of CT in identifying patients suitable for CABG, and the concerns raised about repetitive use, or use of 64-slice or higher CT angiography in younger individuals or women of childbearing age.The Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, is core-funded by the Chief Scientist Office of the Scottish Government Health Directorates

Imaging of coronary atherosclerosis with multi-slice computed tomography

Current non-invasive detection of coronary artery disease (CAD) is based on demonstration of ischemia using stress-rest imaging: this is an indirect way of identifying CAD by demonstration of the hemodynamic consequences rather than direct visualization of the obstructive lesions in the coronary arteries. Multi-slice computed tomography (MSCT) has recently emerged as an extremely rapidly developing non-invasive imaging modality, which allows anatomical imaging of the coronary arteries, or non-invasive coronary angiography. In addition, total plaque burden, plaque morphology and (to some extent) plaque constitution can be assessed by MSCT. The technique also provides information on resting left ventricular systolic function, and possibly resting perfusion. Ideally, stress function and perfusion should also be evaluated, since this would allow detection of ischemia and would complete the picture on CAD. However, this is not routinely performed, since sequential acquisitions are associated with high radiation doses and thus pose a limitation for cardiovascular applications of MSCT. It is anticipated that, with reduction in radiation, MSCT may become an important player in the diagnostic and prognostic workup of patients with known or suspected CAD.UBL - phd migration 201