Dual-Energy Heart CT: Beyond Better Angiography—Review

Tarkowski, Piotr; Czekajska−Chehab, Elżbieta

doi:10.3390/jcm10215193

Cited by 10 publications

(10 citation statements)

References 81 publications

(156 reference statements)

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“…DECT enhances plaque visualization and enables an accurate assessment of high-risk plaque features by combining information on vulnerable features on CT and effective atomic number. 83,84 This approach also permits subtraction of calcified plaques from the image, improving intracavity visualization of patients with severely calcified coronary arteries, a limitation of conventional CCTA. 85 Moreover, the use of multiple virtual monoenergetic images can reduce blooming artifacts caused by highly dense calcification.…”

Section: Pcct and Dectmentioning

confidence: 99%

Coronary Artery Calcification: Current Concepts and Clinical Implications

Onnis,

Virmani,

Kawai

et al. 2024

Circulation

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Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.

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Section: Pcct and Dectmentioning

confidence: 99%

Coronary Artery Calcification: Current Concepts and Clinical Implications

Onnis,

Virmani,

Kawai

et al. 2024

Circulation

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“…DECT is an innovation in computed tomography technology that provides several benefits to the investigation of CAD when compared to single-energy computed tomography [ 55 , 56 ]. DECT uses two X-ray photon energy spectra to acquire datasets for each energy level in a single image acquisition, which allows for improved imaging quality and material interrogation.…”

Section: Dual-energy Computed Tomography (Dect)mentioning

confidence: 99%

“…DECT imaging datasets are then used to generate multiple image types that aid in coronary imaging by reducing bloom artifact, increasing luminal visualization in stents and calcified plaques, enhancing coronary plaque characterization, improving assessment of myocardial perfusion defects, and decreasing radiation dose [ 55 ]. In addition, static and dynamic myocardial perfusion imaging acquired with DECT can be used to directly assess the hemodynamic significance of coronary stenoses by calculating myocardial iodine concentrations distal to stenotic lesions [ 56 , 57 ]. Accordingly, myocardial perfusion imaging acquired with DECT, as opposed to single-energy computed tomography, is superior with regard to sensitivity and specificity, as well as positive and negative predictive value for detecting significant stenoses [ 58 , 59 ].…”

Section: Dual-energy Computed Tomography (Dect)mentioning

confidence: 99%

The Cost Effectiveness of Coronary CT Angiography and the Effective Utilization of CT-Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease

Burch

Siddiqui

Tou

et al. 2023

JCDD

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Given the high global disease burden of coronary artery disease (CAD), a major problem facing healthcare economic policy is identifying the most cost-effective diagnostic strategy for patients with suspected CAD. The aim of this review is to assess the long-term cost-effectiveness of coronary computed tomography angiography (CCTA) when compared with other diagnostic modalities and to define the cost and effective diagnostic utilization of computed tomography-fractional flow reserve (CT-FFR). A search was conducted through the MEDLINE database using PubMed with 16 of 119 manuscripts fitting the inclusion and exclusion criteria for review. An analysis of the data included in this review suggests that CCTA is a cost-effective strategy for both low risk acute chest pain patients presenting to the emergency department (ED) and low-to-intermediate risk stable chest pain outpatients. For patients with intermediate-to-high risk, CT-FFR is superior to CCTA in identifying clinically significant stenosis. In low-to-intermediate risk patients, CCTA provides a cost-effective diagnostic strategy with the potential to reduce economic burden and improve long-term health outcomes. CT-FFR should be utilized in intermediate-to-high risk patients with stenosis of uncertain clinical significance. Long-term analysis of cost-effectiveness and diagnostic utility is needed to determine the optimal balance between the cost-effectiveness and diagnostic utility of CT-FFR.

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“…DECT improves the characterization of plaque compared to conventional single-energy CT (SECT) by providing more detailed information on plaque composition. In fact, DECT can assess both the density and the atomic number of plaque constituents, thus representing a promising useful tool to detect vulnerable plaques in emergency scenarios, too [148]. If, on the one hand, DECT can be used to evaluate the morphology of a plaque, on the other hand, it can be used to assess the stenosis percentage [149].…”

Section: Future Perspectivesmentioning

confidence: 99%

Advanced Cardiac Imaging and Women’s Chest Pain: A Question of Gender

Dell’Aversana,

Tedeschi,

Comune

et al. 2023

Diagnostics

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Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.

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Dual-Energy Heart CT: Beyond Better Angiography—Review

Cited by 10 publications

References 81 publications

Coronary Artery Calcification: Current Concepts and Clinical Implications

Coronary Artery Calcification: Current Concepts and Clinical Implications

The Cost Effectiveness of Coronary CT Angiography and the Effective Utilization of CT-Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease

Advanced Cardiac Imaging and Women’s Chest Pain: A Question of Gender

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