title: Coronary artery disease: new insights and their implications for radiology.
abstract: Coronary artery disease (CAD) diminishes local, regional, or global blood supply to the heart and is most commonly caused by coronary atherosclerosis. New insights into the etiology of atherosclerosis suggest that CAD is an inflammatory disorder that responds well to modulation rather than an unchangeable chronic process. Since 75% of all acute coronary syndromes result from rupture of atherosclerotic plaques, factors causing rupture have a crucial role. Magnetic resonance imaging and CT have the potential to visualize the composition of coronary artery plaques and thus to identify plaques at risk. Considering the new insights into stunning and hibernation, myocardial late enhancement on MRI might provide pivotal information for therapeutic decision making among lysis therapy, catheter intervention, and bypass surgery. Exercise electrocardiography without or with right precordial leads, stress echocardiography, and stress scintigraphy are simple clinical procedures to identify CAD with high sensitivities of 67, 92, 76, and 88%, respectively. The MRI and CT have to be compared with these good results. Nevertheless, we are expecting that MRI and CT will replace the conventional diagnostic modalities, gain a central role in diagnosing patients with suspected CAD, and prove to be cost-effective in this regard.
authors.affiliation: Department of Radiology, Charité Medical School, Freie Universität und Humboldt-Universität zu Berlin, Schumannstrasse 20/21, P.O. Box 10098, 10117 Berlin, Germany. marc.dewey@charite.de
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Dietmar
authors.initials: D
authors.lastname: Kivelitz
authors.forename: Matthias
authors.initials: M
authors.lastname: Taupitz
authors.forename: Susanne
authors.initials: S
authors.lastname: Wagner
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed