Multidetector-row Computed Tomography in the Assessment of Coronary Artery Disease


for SPECT and MRI. Finally, not only is cardiac CT useful in the diagnostic work-up of patients with suspected CAD, it also permits a detailed assessment of the sequelae of CAD, allowing for the assessment of myocardial viability using delayed contrast enhancement.2


myocardial oedema in acute MI.37


Only recently, it was shown to be feasible to assess Its potential for assessing global


and regional left ventricular function has repeatedly been reported.38 With its ability to dynamically visualise cardiac structure at high spatial resolution, it permits a detailed assessment of the cardiac anatomy, including the heart valves. It can be used to plan cardiac surgery or resynchronisation therapy. Today, it is an


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appropriate technique for the non-invasive assessment of the coronary arteries in uninterpretable ECG and is the reference technique for assessing coronary anomalies.39


With the broad introduction of state-of-the-art CT scanners, many indications that nowadays are considered inappropriate or uncertain for cardiac CT will become appropriate for routine cardiac CT. While the diversity and sophistication of cardiac imaging techniques commonly results in the question of ‘which test for which patient?’, the answer will more often be ‘cardiac CT’ as a single test for a broad range of clinical questions. n


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22. Achenbach S, Marwan M, Ropers D, et al., Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram- triggered high-pitch spiral acquisition, Eur Heart J, 2010; 31:340–46.


23. Schuijf JD, Wijns W, Jukema JW, et al., Relationship between noninvasive coronary angiography with multi- slice computed tomography and myocardial perfusion imaging, J Am Coll Cardiol, 2006;48:2508–14.


24. Adams DF, Hessel SJ, Judy PF, et al., Computed tomography of the normal and infarcted myocardium, AJR Am J Roentgenol, 1976;126:786–91.


25. Mahnken AH, Lautenschläger S, Fritz D, et al., Perfusion weighted color maps for enhanced visualization of myocardial infarction by MSCT: preliminary experience, Int J Cardiovasc Imaging, 2008;24:883–90.


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computed tomographymyocardial perfusion imaging during adenosine stress, J Am Coll Cardiol, 2006;48:153–60.


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36. Mahnken AH, Klotz E, Pietsch H, et al., Quantitative whole heart stress perfusion CT imaging as non-invasive assessment of hemodynamics in coronary artery stenosis: preliminary animal experience, Invest Radiol, 2010;45.


37. Mahnken AH, Bruners P, Bornikoel CM, et al., Assessment of myocardial edema by computed tomography in myocardial infarction, JACC Cardiovasc Imaging, 2009;2: 1167–74.


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39. Hendel RC, Patel MR, Kramer CM, et al., ACCF/ACR/SCCT/SCMR/ASNC/NASCI/ SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging, J Am Coll Cardiol, 2006;48:1475–97.


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