Abstract
Invasive coronary angiography (ICA) was the only method to image coronary arteries for a long time and is still the gold-standard. Technology of noninvasive imaging by coronary computed-tomography angiography (CCTA) has experienced remarkable progress during the last two decades. It is possible to visualize atherosclerotic lesions in the vessel wall in contrast to “lumenography” performed by ICA. Coronary artery disease can be ruled out by CCTA with excellent accuracy. The degree of stenoses is, however, often overestimated which impairs specificity. Atherosclerotic lesions can be characterized as calcified, non-calcified and partially calcified. Calcified plaques are usually quantified using the Agatston-Score. Higher scores are correlated with worse cardiovascular outcome and increased risk of cardiac events. For non-calcified or partially calcified plaques different angiographic findings like positive remodelling, a large necrotic core or spotty calcification more frequently lead to myocardial infarctions. CCTA is an important tool with increasing clinical value for ruling out coronary artery disease or relevant stenoses as well as for advanced risk stratification.
Highlights
Recent developments of CT scanners have improved accuracy especially regarding the visualization of the coronary arteries
Single calcium scores are recommended in asymptomatic persons with intermediate risk (Framingham risk score 10%–20%) as support for clinical decisions whether to start aggressive medical therapy
There was a weak correlation between significant coronary lesions on coronary computed-tomography angiography (CCTA) and Invasive coronary angiography (ICA) combined with Fractional Flow Reserve (FFR) < 0.75; diagnostic accuracy was only 49%
Summary
Recent developments of CT scanners have improved accuracy especially regarding the visualization of the coronary arteries. A better spatial and temporal resolution makes it possible to scan the heart and the coronary arteries free of motion and to detect vascular plaques and stenoses. 60–65/min are preferable to achieve high quality images with a low radiation exposure using prospective ECG (electrocardiographic)-gating. Common nomenclature distinguishes between different types of plaque: calcified, noncalcified and predominant calcified or predominant noncalcified [1]. Calcified plaques are visualized and quantified by CT scans without injection of contrast agent (calcium scanning). For detecting different types of plaque as well as determining possible coronary stenoses, intravenous contrast agent must be injected prior to the scan (CT-angiography, CTA)
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