Computed tomographic cardiac angiography: Difference between revisions

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In [[diagnostic imaging]], '''computed tomographic cardiac angiography''', also called '''CT coronary angiography''', is a form of [[x-ray computed tomography]] for examining the [[coronary artery|coronary arteries]].
In [[diagnostic imaging]], '''computed tomographic cardiac angiography''', also called '''CT coronary angiography''', is a form of [[x-ray computed tomography]] for examining the [[coronary artery|coronary arteries]].


==Role in diagnosis of coronary heart disease==
Interpreters may need one year of experience to gain proficiency.<ref name="pmid19401570">{{cite journal |author=Pugliese F, Hunink MG, Gruszczynska K, ''et al.'' |title=Learning curve for coronary CT angiography: what constitutes sufficient training? |journal=Radiology |volume=251 |issue=2 |pages=359–68 |year=2009 |month=May |pmid=19401570 |doi=10.1148/radiol.2512080384 |url=http://radiology.rsnajnls.org/cgi/pmidlookup?view=long&pmid=19401570 |issn=}}</ref>
A [[systematic review]] has examined this role.<ref name="pmid18691486">{{cite journal |author=Stein PD, Yaekoub AY, Matta F, Sostman HD |title=64-slice CT for diagnosis of coronary artery disease: a systematic review |journal=The American journal of medicine |volume=121 |issue=8 |pages=715–25 |year=2008 |month=August |pmid=18691486 |doi=10.1016/j.amjmed.2008.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(08)00298-2 |issn=}}</ref>


==Roles in diagnostic imaging==
===Coronary heart disease===
Computed tomographic cardiac angiography (CT cardiac angiography) uses multidetector [[spiral computed tomography]] for diagnosing [[coronary heart disease]].<ref name="pmid18691486">{{cite journal |author=Stein PD, Yaekoub AY, Matta F, Sostman HD |title=64-slice CT for diagnosis of coronary artery disease: a systematic review |journal=The American journal of medicine |volume=121 |issue=8 |pages=715–25 |year=2008 |month=August |pmid=18691486 |doi=10.1016/j.amjmed.2008.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(08)00298-2 |issn=}}</ref><ref name="pmid18669550">{{cite journal |author=Mowatt G, Cook JA, Hillis GS, ''et al'' |title=64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis |journal=Heart |volume= |issue= |pages= |year=2008 |month=July |pmid=18669550 |doi=10.1136/hrt.2008.145292 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=18669550 |issn=}}</ref><ref name="pmid18462576">{{cite journal |author=Mowatt G, Cummins E, Waugh N, ''et al'' |title=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 |journal=Health Technol Assess |volume=12 |issue=17 |pages=iii–iv, ix–143 |year=2008 |month=May |pmid=18462576 |doi= |url=http://www.hta.ac.uk/execsumm/summ1217.htm |issn=}}</ref><ref name="pmid17996512">{{cite journal |author=Rubinshtein R, Halon DA, Gaspar T, ''et al'' |title=Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin |journal=Am. J. Cardiol. |volume=100 |issue=10 |pages=1522–6 |year=2007 |month=November |pmid=17996512 |doi=10.1016/j.amjcard.2007.06.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)01506-8 |issn=}}</ref> The physiologic significance of obstructions estimated to be 60% to 80% is difficult to predict.<ref name="pmid18344444">{{cite journal |author=Sato A, Hiroe M, Tamura M, ''et al'' |title=Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging |journal=J. Nucl. Med. |volume=49 |issue=4 |pages=564–72 |year=2008 |month=April |pmid=18344444 |doi=10.2967/jnumed.107.042481 |url=http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=18344444 |issn=}}</ref>
Computed tomographic cardiac angiography has accuracy of:<ref name="pmid20124233">{{cite journal| author=Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M| title=Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. | journal=Ann Intern Med | year= 2010 | volume= 152 | issue= 3 | pages= 167-77 | pmid=20124233
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20124233 | doi=10.1059/0003-4819-152-3-201002020-00008 }} </ref>
* [[Sensitivity and specificity|Sensitivity]] 97.2% (95% [[Confidence interval|CI]], 96.2% to 98.0%)
* [[Sensitivity and specificity|Specificity]]  87.4% ([[Confidence interval|CI]], 84.5% to 89.8%)
{| class="wikitable"
|+ Studies with at least 100 patients to measure the accuracy using 64-row CT for detecting stenoses of 50%<ref name="pmid19406338">{{cite journal |author=Hoffmann U, Bamberg F, Chae CU, ''et al.'' |title=Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial |journal=J. Am. Coll. Cardiol. |volume=53 |issue=18 |pages=1642–50 |year=2009 |month=May |pmid=19406338 |doi=10.1016/j.jacc.2009.01.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)00541-5 |issn=}}</ref><ref name="pmid19038879">{{Cite journal
| doi = 10.1056/NEJMoa0806576 | volume = 359 | issue = 22 | pages = 2324-2336 | last = Miller
| first = Julie M. | coauthors = Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, Melvin E. Clouse, Edward P. Shapiro, John Hoe, Albert C. Lardo, David E. Bush, Albert de Roos, Christopher Cox, Jeffery Brinker, Joao A.C. Lima | title = Diagnostic Performance of Coronary Angiography by 64-Row CT | journal = N Engl J Med
| accessdate = 2008-11-27 | date = 2008-11-27 | url = http://content.nejm.org/cgi/content/abstract/359/22/2324 |pmid=19038879
}}</ref><ref name="pmid19095130">{{cite journal |author=Meijboom WB, Meijs MF, Schuijf JD, ''et al.'' |title=Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study |journal=J. Am. Coll. Cardiol. |volume=52 |issue=25 |pages=2135–44 |year=2008 |month=December |pmid=19095130 |doi=10.1016/j.jacc.2008.08.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03234-8 |issn=}}</ref><ref name="pmid19007693">{{cite journal |author=Budoff MJ, Dowe D, Jollis JG, ''et al.'' |title=Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial |journal=J. Am. Coll. Cardiol. |volume=52 |issue=21 |pages=1724–32 |year=2008 |month=November |pmid=19007693 |doi=10.1016/j.jacc.2008.07.031 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)02609-0 |issn=}}</ref>
! rowspan="2"|&nbsp;!! rowspan="2"|Patients!! rowspan="2"|Scanner!!colspan="2"|Per patient!! colspan="2"|Per segment!! colspan="2"|Negative predictive value<br/>(per patient)
|-
! Sensitivity!!Specificity!! Sensitivity!!Specificity!!at prevalence = 25%!!at prevalence = 50%
|-
| ROMICAT.<ref name="pmid19406338"/><br/>2008||368 patients admitted for possible [[acute coronary syndrome]]||Sensation ||align="center"| 77%||align="center"|87%||align="center"|&nbsp;||align="center"|&nbsp;||align="center"|91.9||align="center"|79.1%
|-
| CORE 64 study.<ref name="pmid19038879"/><br/>2008||291 patients with suspected [[coronary heart disease]] and calcium scores &le; 600||Aquilion||align="center"| 85%||align="center"|90%||align="center"|75%||align="center"|93%||align="center"|95%||align="center"|89.5%
|-
| Meijboom et al.<ref name="pmid19095130"/><br/>2008||360 symptomatic patients||Multipple vendors||align="center"|99%||align="center"|64%||align="center"|88%||align="center"|90%||align="center"|99.5%||align="center"|98.5%
|-
| ACCURACY study.<ref name="pmid19007693"/><br/>2008||230 symptomatic patients||Lightspeed||align="center"|95%||align="center"|83%||align="center"|84%||align="center"|90%||align="center"|98%||align="center"|94.3%
|}
===Bacterial endocarditis===
Computed tomographic cardiac angiography can detect vegetations and abscesses/pseudoaneurysms of [[bacterial endocarditis]], but not leaflet perforations, almost as well as transesophageal echocardiography.<ref name="pmid19179202">{{cite journal |author=Feuchtner GM, Stolzmann P, Dichtl W, ''et al'' |title=Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings |journal=J. Am. Coll. Cardiol. |volume=53 |issue=5 |pages=436–44 |year=2009 |month=February |pmid=19179202 |doi=10.1016/j.jacc.2008.01.077 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03666-8 |issn=}}</ref>
==Adverse effects==
===Radiation===
The radiation dose is estimated to be "1.2 x the dose of an abdominal CT study or 600 chest x-rays."<ref name="pmid19190314">{{cite journal |author=Hausleiter J, Meyer T, Hermann F, ''et al'' |title=Estimated radiation dose associated with cardiac CT angiography |journal=JAMA |volume=301 |issue=5 |pages=500–7 |year=2009 |month=February |pmid=19190314 |doi=10.1001/jama.2009.54 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19190314 |issn=}}</ref>


==References==
==References==
<references/>
<references/>[[Category:Suggestion Bot Tag]]

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In diagnostic imaging, computed tomographic cardiac angiography, also called CT coronary angiography, is a form of x-ray computed tomography for examining the coronary arteries.

Interpreters may need one year of experience to gain proficiency.[1]

Roles in diagnostic imaging

Coronary heart disease

Computed tomographic cardiac angiography (CT cardiac angiography) uses multidetector spiral computed tomography for diagnosing coronary heart disease.[2][3][4][5] The physiologic significance of obstructions estimated to be 60% to 80% is difficult to predict.[6]

Computed tomographic cardiac angiography has accuracy of:[7]

Studies with at least 100 patients to measure the accuracy using 64-row CT for detecting stenoses of 50%[8][9][10][11]
  Patients Scanner Per patient Per segment Negative predictive value
(per patient)
Sensitivity Specificity Sensitivity Specificity at prevalence = 25% at prevalence = 50%
ROMICAT.[8]
2008		 368 patients admitted for possible acute coronary syndrome Sensation 77% 87%     91.9 79.1%
CORE 64 study.[9]
2008		 291 patients with suspected coronary heart disease and calcium scores ≤ 600 Aquilion 85% 90% 75% 93% 95% 89.5%
Meijboom et al.[10]
2008		 360 symptomatic patients Multipple vendors 99% 64% 88% 90% 99.5% 98.5%
ACCURACY study.[11]
2008		 230 symptomatic patients Lightspeed 95% 83% 84% 90% 98% 94.3%

Bacterial endocarditis

Computed tomographic cardiac angiography can detect vegetations and abscesses/pseudoaneurysms of bacterial endocarditis, but not leaflet perforations, almost as well as transesophageal echocardiography.[12]

Adverse effects

Radiation

The radiation dose is estimated to be "1.2 x the dose of an abdominal CT study or 600 chest x-rays."[13]

References

  1. ↑ Pugliese F, Hunink MG, Gruszczynska K, et al. (May 2009). "Learning curve for coronary CT angiography: what constitutes sufficient training?". Radiology 251 (2): 359–68. DOI:10.1148/radiol.2512080384. PMID 19401570. Research Blogging.
  2. ↑ Stein PD, Yaekoub AY, Matta F, Sostman HD (August 2008). "64-slice CT for diagnosis of coronary artery disease: a systematic review". The American journal of medicine 121 (8): 715–25. DOI:10.1016/j.amjmed.2008.02.039. PMID 18691486. Research Blogging.
  3. ↑ Mowatt G, Cook JA, Hillis GS, et al (July 2008). "64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis". Heart. DOI:10.1136/hrt.2008.145292. PMID 18669550. Research Blogging.
  4. ↑ Mowatt G, Cummins E, Waugh N, et al (May 2008). "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". Health Technol Assess 12 (17): iii–iv, ix–143. PMID 18462576. [e]
  5. ↑ Rubinshtein R, Halon DA, Gaspar T, et al (November 2007). "Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin". Am. J. Cardiol. 100 (10): 1522–6. DOI:10.1016/j.amjcard.2007.06.052. PMID 17996512. Research Blogging.
  6. ↑ Sato A, Hiroe M, Tamura M, et al (April 2008). "Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging". J. Nucl. Med. 49 (4): 564–72. DOI:10.2967/jnumed.107.042481. PMID 18344444. Research Blogging.
  7. ↑ Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M (2010). "Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging.". Ann Intern Med 152 (3): 167-77. DOI:10.1059/0003-4819-152-3-201002020-00008. PMID 20124233. Research Blogging.
  8. ↑ 8.0 8.1 Hoffmann U, Bamberg F, Chae CU, et al. (May 2009). "Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial". J. Am. Coll. Cardiol. 53 (18): 1642–50. DOI:10.1016/j.jacc.2009.01.052. PMID 19406338. Research Blogging.
  9. ↑ 9.0 9.1 Miller, Julie M.; Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, Melvin E. Clouse, Edward P. Shapiro, John Hoe, Albert C. Lardo, David E. Bush, Albert de Roos, Christopher Cox, Jeffery Brinker, Joao A.C. Lima (2008-11-27). "Diagnostic Performance of Coronary Angiography by 64-Row CT". N Engl J Med 359 (22): 2324-2336. DOI:10.1056/NEJMoa0806576. PMID 19038879. Retrieved on 2008-11-27. Research Blogging.
  10. ↑ 10.0 10.1 Meijboom WB, Meijs MF, Schuijf JD, et al. (December 2008). "Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study". J. Am. Coll. Cardiol. 52 (25): 2135–44. DOI:10.1016/j.jacc.2008.08.058. PMID 19095130. Research Blogging.
  11. ↑ 11.0 11.1 Budoff MJ, Dowe D, Jollis JG, et al. (November 2008). "Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial". J. Am. Coll. Cardiol. 52 (21): 1724–32. DOI:10.1016/j.jacc.2008.07.031. PMID 19007693. Research Blogging.
  12. ↑ Feuchtner GM, Stolzmann P, Dichtl W, et al (February 2009). "Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings". J. Am. Coll. Cardiol. 53 (5): 436–44. DOI:10.1016/j.jacc.2008.01.077. PMID 19179202. Research Blogging.
  13. ↑ Hausleiter J, Meyer T, Hermann F, et al (February 2009). "Estimated radiation dose associated with cardiac CT angiography". JAMA 301 (5): 500–7. DOI:10.1001/jama.2009.54. PMID 19190314. Research Blogging.
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