Cardiac multidetector CT: method, indications and applications

Abstract

•. Cardiac CT is a rapidly developing field offering a viable non-invasive alternative to conventional coronary angiography. •. The development of CT technology often outpaces evaluation of its benefit; however 64 slice multidetector CT is now considered as a reference standard for cardiac CT examination. •. Careful selection of patients and optimisation of CT technique is essential to obtain high-quality images and minimise the radiation dose to the patients. •. Although cardiac CT is primarily used for the assessment of coronary artery disease in low- and intermediate-risk patients, it can be used in a range of other indications, including assessment of coronary artery bypass grafts (CABGs), cardiac valves, congenital cardiac anomalies, the left atrium prior to electrophysiology treatment and assessment of suitability for trans-catheter aortic valve implantation. •. The scope of cardiac CT continues to expand and future developments where cardiac CT is likely to be useful include coronary plaque assessment and perfusion imaging. The potential to non-invasively image the heart has led to the rapid development and dissemination of cardiac CT. With the advent of 64 slice systems, cardiac multidetector CT continues to evolve as an essential tool in the investigation of many cardiac conditions. It is now routinely used to provide accurate information about coronary artery disease, cardiac anatomy and congenital anomalies, coronary artery bypass grafts, cardiac valves and pulmonary vein/left atrial anatomy. However, its value in the assessment of coronary stents, ventricular function and coronary plaque morphology remains limited and requires further research. Although cardiac CT is a robust technique, it requires careful patient selection and close interaction between radiologists and cardiologists. It is also considered a radiation-intensive examination and requires careful planning to consistently achieve low levels of radiation exposure to patients. In this review we describe the optimal technique of performing cardiac CT. We also summarise the current indications of cardiac CT and discuss the evidence for various applications.