Coronary computed tomographic angiography: current role in the diagnosis and management of coronary artery disease.
Advances in computed tomography (CT) technology allow images to be obtained with high spatial and temporal resolution. These features now permit noninvasive coronary CT angiography (CCTA). Many studies addressing proof of concept, feasibility, and clinical robustness have been published since CCTA was first described. More recently, the scientific evaluation of CCTA has rightly focused less on technical aspects and more on multicenter trials of the diagnostic value of CCTA and on head-to-head comparisons with other noninvasive modalities for the detection of coronary artery disease (CAD), such as stress myocardial perfusion imaging (MPI) with radionuclides. Recent peer-reviewed publications that compare CCTA to invasive, selective coronary angiography (SCA) or MPI, or that address radiation protection issues related to CCTA, were reviewed and summarized. Overall, there is high agreement between CCTA and both SCA and MPI for the presence of CAD. However, CCTA can over- or underestimate the severity of CAD compared to SCA as a reference standard. Initial studies that compared CCTA to MPI found their accuracies for determining the presence of high-grade luminal obstructions comparable. Limitations of CCTA include inability to reliably assess the coronary artery lumen dimensions in patients with large amounts of coronary artery calcium, artifacts caused by coronary and respiratory motion, and the need for ionizing radiation and intravenous administration of iodinated contrast material. Various dose reduction methods for CCTA now exist that may substantially lower patient dose to levels less than those of SCA or MPI. Although current expert consensus does not call for CCTA to be a first-line test for CAD, particularly for screening in asymptomatic individuals, current data suggest a promising role in the evaluation of symptomatic patients for possible CAD.
Bowman
Andrew W
AW
Department of Radiology, Mayo Clinic, Jacksonville, FL, United States.
Kantor
Birgit
B
Gerber
Thomas C
TC
D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
Mayo Clin Proc. 2002 Jan;77(1):55-71
11794459
J Am Coll Cardiol. 2008 Dec 16;52(25):2135-44
19095130
Am Heart J. 2007 Sep;154(3):415-23
17719283
Circulation. 2000 Mar 21;101(11):1344-51
10725297
J Nucl Cardiol. 2002 Jan-Feb;9(1):133-4
11883393
Circulation. 2006 Jan 3;113(1):156-75
16391169
Circulation. 2009 Feb 24;119(7):1056-65
19188512
J Am Coll Cardiol. 2008 Dec 16;52(25):2145-7
19095131
Circulation. 2004 Aug 31;110(9):1168-76
15339866
Radiology. 2000 Nov;217(2):564-71
11058661
Circulation. 2002 Oct 1;106(14):1883-92
12356646
Ann Emerg Med. 2007 Feb;49(2):125-36
16978738
J Am Coll Cardiol. 2005 Jul 5;46(1):92-100
15992641
Eur J Nucl Med Mol Imaging. 2007 Aug;34(8):1162-71
17219136
Heart. 2002 Mar;87(3):205-9
11847152
J Am Coll Cardiol. 2006 Nov 21;48(10):1929-34
17112979
Am J Med. 2008 Aug;121(8):715-25
18691486
Ann Intern Med. 1999 May 4;130(9):709-18
10357689
Eur Radiol. 2009 Apr;19(4):816-28
18998142
J Am Coll Cardiol. 2006 Oct 17;48(8):1658-65
17045904
Catheter Cardiovasc Interv. 2003 May;59(1):13-8
12720234
JAMA. 2009 Feb 4;301(5):500-7
19190314
Eur Heart J. 2008 Sep;29(17):2070-2
18641045
Radiology. 1995 Sep;196(3):707-14
7644633
J Am Coll Cardiol. 2001 Apr;37(5):1430-5
11300457
Ann Intern Med. 1979 Sep;91(3):350-6
475165
J Am Coll Cardiol. 2007 Mar 13;49(10):1059-67
17349885
J Am Coll Cardiol. 2006 Nov 7;48(9):1896-910
17084268
Radiology. 2008 Jul;248(1):254-63
18566177
N Engl J Med. 2008 Nov 27;359(22):2324-36
19038879
Atherosclerosis. 2008 Apr;197(2):700-9
17720167
Circulation. 1988 Nov;78(5 Pt 1):1157-66
3180375
Circulation. 2008 Jul 29;118(5):586-606
18586979
Circulation. 2000 Jan 4;101(1):E16-22
10618318
Mayo Clin Proc. 2009 Mar;84(3):218-20
19252107
Health Aff (Millwood). 2007 Jan-Feb;26(1):86-95
17211017
Angiology. 2005 Jan-Feb;56(1):75-80
15678259
Circulation. 2009 Jan 27;119(3):480-6
19171871
J Am Coll Cardiol. 2006 Aug 15;48(4):772-8
16904548
J Am Coll Cardiol. 2006 Dec 19;48(12):2508-14
17174190
Circulation. 1994 May;89(5):2015-25
8181125
Am Heart J. 2007 Feb;153(2):159-60
17239672
J Nucl Med. 2008 Apr;49(4):564-72
18344444
J Am Coll Cardiol. 1988 Apr;11(4):882-5
3280642
Eur Heart J. 2008 Sep;29(17):2133-40
18385120
JAMA. 2007 Jul 18;298(3):317-23
17635892
Radiology. 2008 Aug;248(2):414-23
18552310
Ann Intern Med. 1987 Jun;106(6):793-800
3579066
Catheter Cardiovasc Interv. 2001 Mar;52(3):289-95
11246238
Mayo Clin Proc. 2004 Aug;79(8):1017-23
15301329