Coronary Computed Tomography Angiography in Coronary Artery Disease: A Systematic Review of Image Quality, Diagnostic Accuracy and Radiation Dose

202 Pages·2013·5.82 MB·English

by  Zhonghua Sun

CARDIOLOGY RESEARCH AND CLINICAL DEVELOPMENTS

C C
ORONARY OMPUTED
T A
OMOGRAPHY NGIOGRAPHY
C A D
IN ORONARY RTERY ISEASE

A S R I
YSTEMATIC EVIEW OF MAGE
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UALITY IAGNOSTIC CCURACY
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AND ADIATION OSE

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CARDIOLOGY RESEARCH AND CLINICAL DEVELOPMENTS

C C
ORONARY OMPUTED
T A
OMOGRAPHY NGIOGRAPHY
C A D
IN ORONARY RTERY ISEASE

A S R I
YSTEMATIC EVIEW OF MAGE
Q , D A
UALITY IAGNOSTIC CCURACY
R D
AND ADIATION OSE

ZHONGHUA SUN

New York
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ISBN: (cid:28)(cid:26)(cid:27)(cid:16)(cid:20)(cid:16)(cid:25)(cid:21)(cid:23)(cid:20)(cid:26)(cid:16)(cid:25)(cid:20)(cid:22)(cid:16)(cid:24) (eBook)

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Contents

Preface vii
Chapter 1 Introduction 1
Chapter 2 Coronary CT Angiography: Imaging Principles
and Technical Developments 5
Chapter 3 Coronary CT Angiography: Radiation Dose Measurements
and Dose Reduction Strategies 27
Chapter 4 64-Slice Coronary CT Angiography in Coronary
Artery Disease: A Systematic Review of Diagnostic Value,
Image Quality and Radiation Dose 39
Chapter 5 Dual-Source Coronary CT Angiography in Coronary
Artery Disease: A Systematic Review of
Diagnostic Value, Image Quality and Radiation Dose 55
Chapter 6 320-Slice Coronary CT Angiography in Coronary
Artery Disease: A Systematic Review of Diagnostic Value,
Image Quality and Radiation Dose 75
Chapter 7 Coronary CT Angiography in Coronary Artery Disease:
A Systematic Review of Research Directions 89
Chapter 8 Coronary CT Angiography in Coronary Artery Disease:
Prospective ECG-Triggering versus Retrospective ECG-Gating 105
Chapter 9 Coronary CT Angiography Using Prospective ECG-Triggering:
An Effective Alternative to Invasive Coronary Angiography 117
Chapter 10 Coronary CT Angiography with Prospective ECG-Triggering
in Coronary Artery Disease: A Systematic Review
and Meta-Analysis of Diagnostic Value, Image Quality
and Radiation Dose 133
Chapter 11 Coronary CT Angiography in Coronary Artery Disease:
How to Use It Wisely and When to Request It Appropriately? 151
vi Contents
Chapter 12 Coronary CT Angiography: Current Status
and Continuing Challenges 165
Chapter 13 Coronary CT Angiography in Coronary Artery Disease:
Summary and Conclusion 185
Index 187
Preface

Coronary artery disease is the leading cause of death in the developed countries and it is
becoming increasingly common in the developing world. Conventional invasive coronary
angiography currently remains the gold standard for the evaluation of patients with known or
suspected coronary artery disease. Limitations of the modality include its invasiveness,
expense, and time consumption, with small but substantial procedure-related complications.
This indicates the necessity and importance of identifying a reliable non-invasive imaging
modality for detection and diagnosis of coronary artery disease.
Computed tomography (CT) has become a widely used non-invasive imaging modality
for the diagnosis of cardiovascular disease since the advent of spiral CT in early 1990s.
However, diagnostic applications of CT in cardiac imaging with single-slice CT scanners
were limited due to restrictions in spatial and temporal resolution. The introduction of
multislice CT scanners in 1998 represented another significant advancement in CT
technology, and for the first time CT angiography with ECG-gating is able to acquire cardiac
images at considerably faster volume coverage with improved spatial and temporal resolution.
Since then, multislice CT angiography in cardiac imaging (which is nowadays called
coronary CT angiography) has become increasingly used for the diagnosis of coronary artery
disease. With the wide availability of dual-source CT and the recent introduction of 320-slice
CT the diagnostic accuracy of coronary CT angiography has been significantly enhanced,
thus, the spectrum of coronary CT angiography in cardiac imaging will be expanded in the
near future.
Over the last decade studies on coronary CT angiography have been increasingly
published in the literature with a focus on the diagnostic performance of coronary CT
angiography in the diagnosis of coronary artery disease. This is mainly due to the high spatial
and temporal resolution which is available with the latest multislice CT scanners. However, it
is important for researchers and clinicians to be aware of the variable results reported in these
studies with regard to the diagnostic value and study limitations due to heterogeneity of study
design and patient selection. Judicious use of coronary CT angiography in routine clinical
practice is an evidence-based practice, which can be addressed by a systematic review of the
literature. This book fulfills this goal.
This book is intended to fill the gap by providing a systematic review and meta-analysis
of the diagnostic value, image quality and radiation dose of coronary CT angiography. It
serves as a comprehensive piece of literature that encompasses all aspects from the technical
principles of coronary CT angiography image acquisition to clinical diagnostic value and
viii Preface
potential pitfalls of cardiac CT imaging. The primary motion to write this book is to provide
an overview of the current status of coronary CT angiography in coronary artery disease with
a focus on the diagnostic value, image quality and radiation dose, as well as the current
research directions of this fast evolving technique. Effects of various scanning parameters on
radiation dose and image quality are also addressed in detail.
The book consists of 13 chapters covering various topics related to the coronary CT
angiography with inclusion of comprehensive recently published literature. Chapter 1 is an
introduction of the coronary artery disease with a focus on the increased application of
coronary CT angiography in clinical diagnosis. Chapter 2 describes the imaging principles of
cardiac imaging and technical developments of coronary CT angiography including a variety
of reconstructed visualizations. Chapter 3 discusses the radiation dose measurements in
cardiac CT and strategies for dose reduction. Commonly used or recommended approaches
for coronary CT angiography dose reduction are discussed in detail. Chapters 4, 5, 6 and 10
focus entirely on the systematic review and meta-analysis of diagnostic value of coronary CT
angiography performed with 64-slice CT, dual-source CT, 320-slice CT, and coronary CT
angiography with use of prospective ECG-triggering, respectively. Chapter 7 presents a
systematic review of the research directions in coronary CT angiography based on analysis of
the articles published in five top radiology journals over the last 6 years. Chapter 8 compares
retrospectively ECG-gated with prospectively ECG-triggered coronary CT angiography in
terms of diagnostic value and radiation dose, while chapter 9 elucidates the effectiveness of
prospectively ECG-triggered coronary CT angiography in terms of diagnostic accuracy when
compared to invasive coronary angiography. Chapter 11 discusses how coronary CT
angiography can be used wisely by clinicians and when it should be requested and how its
benefits can be maximized from a clinical perspective. Chapter 12 describes the current status
of coronary CT angiography and challenges with regard to the utilization of this fast growing
technique. Finally, chapter 13 is a brief summary and conclusion of coronary CT
angiography.
This book is intended primarily for radiologists, cardiologists and medical imaging
technologists who are actively involved in performing coronary CT angiography
examinations. However, other physicians, residents, postgraduate students and other
healthcare professions who are dealing with cardiac imaging could also benefit from it. This
book can also be used as guidance for radiology residents or postgraduate students to conduct
systematic review or meta-analysis as part of the research training program or research
degree. I hope this book will improve understanding of the diagnostic performance of
coronary CT angiography and it will contribute considerably to the judicious use of coronary
CT angiography in the diagnosis of coronary artery disease.

Zhonghua Sun, MB, PhD