[Combined approach of contrast and non contrast CT for the assessment of coronary atherosclerosis].
BACKGROUND
The newest generation multi-detector-row CT scanner is allowed for investigation of the entire heart within a breathhold period of approximately 20 s. Within this time 250 slices with a thickness of 1 mm each are acquired. In conjunction with the ECG signal the images are acquired with a temporal resolution of 210 ms in the mid diastolic phase of the heart.
In patients with a heart rate < 60 beats per minute images free of motion artefacts can be reconstructed, that allow for assessment of the coronary artery lumen as well as calcified and non-calcified lesions in the coronary artery wall. Such lesions may be differentiated into thrombus, atheroma and fibrocalcified plaques on the base of characteristic morphologic criteria.
The absence of coronary artery lesions in symptomatic patients with atypical chest pain allows for reliable exclusion for coronary heart disease. In asymptomatic patients with cardiovascular risk factors we first perform an investigation without contrast media to detect coronary calcifications as a marker of atherosclerosis. To assess the complete extent of coronary atherosclerosis in high risk patients, we then consider a contrast enhanced CT study.
Becker
Christoph R
CR
Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Munich. christoph.becker@ikra.med.uni-muenchen.de
D000787:Angina Pectoris / Q000000981:diagnostic imaging; D000789:Angina, Unstable / Q000000981:diagnostic imaging; D016477:Artifacts; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D003971:Diastole / Q000502:physiology; D004562:Electrocardiography; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed