Coronary CT angiography in coronary artery disease: Opportunities and challenges

Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease

Multislice CT angiography in coronary artery disease: Technical developments, radiation dose and diagnostic value

Multislice computed tomography (CT) angiography has been increasingly used in the detection and diagnosis of coronary artery disease because of its rapid technical evolution from the early generation of 4-slice CT scanners to the latest models such as 64-slice, 256-slice and 320-slice CT scanners. Technical developments of multislice CT imaging enable improved diagnostic value in the detection of coronary artery disease, and this indicates that multislice CT can be used as a reliable less-invasive alternative to invasive coronary angiography in selected patients. In addition, multislice CT angiography has played a significant role in the prediction of disease progression and cardiac events. Despite promising results reported in the literature, multislice CT has the disadvantage of having a high radiation dose which could contribute to the radiation-induced malignancy. A variety of strategies have been currently undertaken to reduce the radiation dose associated with multislice CT coronary angiography while in the meantime acquiring diagnostic images. In this article, the author will review the technical developments, radiation dose associated with multislice CT coronary angiography, and strategies to reduce radiation dose. The diagnostic and prognostic value of multislice CT angiography in coronary artery disease is briefly discussed, and future directions of multislice CT angiography in the diagnosis of coronary artery disease will also be highlighted

Cardiac CT imaging in coronary artery disease: Current status and future directions

Computed tomography has undergone rapid developments over the last decades, in particular, the emergence and technological improvements of multislice CT scanners enable satisfactory performance of cardiac CT imaging. Cardiac CT has been widely used in the diagnosis of coronary artery disease, which is the leading cause of death in industrialized countries. Cardiac CT also provides valuable information to predict the extent and prognosis of coronary artery disease. The main disadvantage of cardiac CT imaging is radiation dose, which raises concern in recent years, as there is potential risk of radiation-induced malignancy. This article will provide an overview of the current research status of cardiac CT imaging in the diagnosis of coronary artery disease, highlight the key applications of cardiac CT imaging and briefly discuss future directions of this fast advancing technique

Effects of Iterative Reconstruction on the Diagnostic Assesment of Coronary Calcium Scores

Coronary Artery Calcium (CAC) score is a widely used indicator to determine disease severity and predict the risk of severe cardiac events. However, radiation dose associated with coronary CT scanning for CAC scoring raises concerns, especially for asymptomatic patients. Iterative Reconstruction (IR) technique represents a recently developed image processing approach for reduction of image noise and radiation dose, while improving diagnostic image quality. Despite these advantages over conventional filtered back projection technique, effects of IR techniques on CAC scores remain unclear. This review article aims to provide an overview of clinical applications of IR techniques in coronary CT angiography with a focus on the effects of different IR techniques on CAC score assessment

The promise of synchrotron radiation in medical science

A synchrotron is capable of providing information about structures down to nano, molecular and atomic level. Essentially it accelerates electrons to almost the speed of light, where they have a very high energy level. The electrons are passed through a series of magnets and deflected around a "storage ring" where they emit beams of extremely intense radiation (light) that can be channeled out of the device. These beams consist of high intensity light across multiple wavelengths and have many useful applications that yield results far superior than conventional medical imaging modalities. For example, synchrotron x-rays are hundreds of thousands of times brighter (more intense) than the x-rays obtained from conventional x-ray machines that are available in labs and hospitals. Synchrotron measurements enable characterization across scales, ranging from life-size images down to nano, molecular and atomic structures due to its high resolution and high signal-to-noise ratio. The applications of synchrotron radiation in medicine are many and varied. Diagnostic imaging, the major medical application of x-rays, represents just one application of synchrotron radiation. In this editorial, I briefly summarise the applications of synchrotron radiation in medical research and provide a few examples of their impact in medicine

Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease

Coronary artery disease is the leading cause of death in advanced countries. Early detection and diagnosis of coronary artery disease plays an important role in the identification of disease severity and prediction of disease outcome, consequently improving patient management. Diagnosis and management of coronary artery disease is increasingly dependent on less-invasive imaging modalities, including coronary CT angiography, cardiac magnetic resonance imaging, cardiac radionuclide imaging such as SPECT and PET modalities. Rapid developments of these imaging modalities have significantly improved the diagnostic performance of each imaging technique with high diagnostic accuracy achieved in both diagnostic and prognostic value in coronary artery disease. This editorial provides an overview of the diagnostic applications of a variety of less-invasive imaging modalities in the diagnosis of coronary artery disease. This special issue of “Arteriosclerotic Vascular Disease: Part II” in the journal of Clinical and Experimental Cardiology will give particular attention to contributions focusing on the clinical applications of these imaging modalities in the arteriosclerotic vascular disease, in particular, coronary artery disease