Cardiac CT: why, when, and how

Busse, Anke; Cantré, Daniel; Beller, Ebba; Streckenbach, Felix; İnce, Hüseyin; Weber, Marc‐André; Meinel, Felix G.

doi:10.1007/s00117-019-0530-9

Cited by 18 publications

(9 citation statements)

References 37 publications

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“…Calcium is detected as an area of hyperattenuation, defined as an area of at least 1 mm 2 with >130 Hounsfield units or ≥3 adjacent pixels using the Agatston method. [22] The calcium score is the sum of all coronary calcified lesions (excluding calcium in the valve or aorta) and is a strong prognostic factor for clinical events in the mid to long term in asymptomatic individuals. [11,14,15] CCTA is able to characterise coronary plaques; in particular, CCTA can detect spotty calcification, which is one of the four signs of vulnerable plaques (i.e.…”

Section: Calcium and Imaging Techniquesmentioning

confidence: 99%

Contemporary Approach to Heavily Calcified Coronary Lesions

et al. 2019

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Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.

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Section: Calcium and Imaging Techniquesmentioning

confidence: 99%

Contemporary Approach to Heavily Calcified Coronary Lesions

et al. 2019

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“…Cardiac CT imaging requires competence on many levels [ 12 ]. Image reconstruction and post-processing need knowledge in CT physics, radiology, and cardiac physiology [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

et al. 2021

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Purpose To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. Methods Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. Results Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. Conclusions Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.

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“…The use of cCTA to diagnose in-stent restenosis is not recommended in the current guidelines [1,6] because the diagnostic accuracy even of modern CT scanners depends greatly on the width of the stent and the type of stent (material) [7,8]. For stents with a diameter greater than 3 mm, cCTA had a high diagnostic accuracy regarding restenosis particularly in the left main coronary artery [8].…”

Section: Current Guidelines For Using Cctamentioning

confidence: 99%

“…Calcium scoring is of prognostic value here and can help when making decisions regarding medication for atherosclerosis prophylaxis. Therefore, multiple studies, e. g., the Multi-Ethnic Study of Atherosclerosis (MESA), were able to show that the Agatston score is highly correlated with the amount of coronary plaque and is an independent risk predictor for the occurrence of a future coronary event (heart attack, coronary cardiac death) and for overall mortality [26,27]. A study with over 13 000 patients was able to show that the total Agatston score could identify with high accuracy patients who would benefit from statin therapy [28].…”

Section: Scout View Calcium Scoringmentioning

confidence: 99%

Update for the Performance of CT Coronary Angiography – Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine

Soschynski

Hagar

Taron

et al. 2022

Rofo

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Background Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure. Method The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience. Results and Conclusion According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI). Key Points: Citation Format

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Cardiac CT: why, when, and how

Cited by 18 publications

References 37 publications

Contemporary Approach to Heavily Calcified Coronary Lesions

Contemporary Approach to Heavily Calcified Coronary Lesions

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Update for the Performance of CT Coronary Angiography – Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine

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