Coronary CT Angiography started to become possible approximately 15 years ago, when multi-detector CT systems were developed which for the first time were sufficiently fast to permit coronary visualization without motion artefact. Since then, technology has matured substantially. Faster gantry rotation times, wider detectors arrays with up to 320 rows, the development of dual source CT, improvements in tube technology and better image reconstruction techniques lead to higher spatial and temporal resolution as well a lower image noise. With current CT systems and after some preselection according to patient characteristics (avoiding severe obesity as well as high and irregular heart rates) it is possible to robustly image the coronary coronary arteries after intravenous injection of contrast agent and with reasonably low radiation exposure which is typically between 1.5 and 5.0 mSv, but can be substantially lower in selected cases.
The main clinical application is the use of CT to rule out coronary artery stenoses in patients with a relatively low pre-test likelihood of disease, an application that is supported by the most recent cardiology guidelines. Detection and characterization of non-obstructive atherosclerotic plaque is possible by contrast-enhanced CT, but not yet a clinical application. It should be noted that CT imaging, owing to its isotropic spatial resolution, is gaining increasing importance as non-invasive anatomic guidance to coronary and cardiac interventions. Most prominently this includes percutaneous interventions for the recanalization of chronic total coronary artery occlusions (“CTO”) as well as the workup of candidates for transcatheter aortic valve implantation (TAVI). Most likely, the indications for coronary CTA and cardiac CT in general will expand in the future.
Educational aims/learning objectives:
• Understand the main clinical applications of coronary CTA
• Interpret coronary CTA in the context of suspected CAD and for planned coronary / cardiac interventions
1 CPD credit.
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Stephan Achenbach, MD graduated from the University of Erlangen Medical School in 1993. Following positions in Erlangen, Germany, Boston, MA, USA and Giessen, Germany he was appointed Chairman of the Department of Cardiology and a Professor of Medicine at the University of Erlangen, Germany in 2012.
His clinical interests are general cardiology, interventional cardiology as well as cardiac imaging. His research focuses on cardiac imaging, mainly computed tomography, for early detection and characterization of coronary atherosclerosis and for the support of coronary and cardiac interventional procedures.
Stephan Achenbach has authored approximately 550 publications and is listed among the 1% most cited researchers in the field of Clinical
Medicine. He serves as the Editor in Chief of the Journal of Cardiovascular Computed Tomography, is a Board member of the Society of Cardiovascular Computed Tomography (SCCT) and European Society of Cardiology (ESC) and was elected ESC Vice President for the 2014-2016 period.