Multidetector Coronary Angiography Research Articles

Comparison of Diagnostic Performance of Multi Detector CT Angiography with Conventional Coronary Angiography for Assessment of Coronary Artery Disease

Aim: The point of this study was to reflectively assess the analytic exactness of multi detector angiography as a different option for conventional coronary angiography in evaluating coronary artery disease. Materials and Methods: This review study selected 57 patients, who experienced both conventional coronary angiography (CCA), and additionally multi-detector computed coronary angiography (MDCT). Aggregate of 931 open segments were studied. Of which 95 portions indicated shifted level of stenosis, with 34 segments <50% stenosis, 43 segments 50-70% stenosis and 18 segments >70% stenosis. Results: The affectability and specificity of 64 slice MDCT for identifying stenosis in <50%, 50-70% and >70% are 78.57% and 99.34%; 81.08% and 99.33%; 87.5% and 99.78%. The positive predictive value (PPV) and negative predictive value (NPV) are 78.57% and 99.34%; 83.33% and 99.22%; 87.5% and 99.78% individually. Over all exact nesses are 88.95%, 90.2% and 93.64% separately. There was no critical contrast in analytic exactness between conventional coronary angiography and 64 slice computed tomography in moderate (50-70%) and additionally severe (>70%) stenosis (p>0.05). Be that as it may, critical contrast was found in gentle (<50%) stenosis (p<0.05). Conclusion: Indicative exactness of multi detector coronary angiography (MDCT) was found to be higher in moderate and extreme stenosis and can be utilized as a substitute to conventional coronary angiography (CCA).

Do we need three coronary arteries?

Normal myocardium is usually perfused by three coronary arteries- a left main system bifurcating into left anterior descending artery (LAD), and left circumflex artery (LCx), and right coronary artery (RCA). Coronary artery anomalies are congenital changes in their origin, course, and/or structure, which are usually discovered as incidental findings during coronary angiographic studies. Here, we report a case of 56-year-old hypertensive, and diabetic male who was being evaluated for exertional angina and dyspnoea whose coronary angiogram revealed a rare coronary anomaly: normal LAD, absent LCx, and superdominant RCA which was better delineated on Multidetector coronary angiography (MDCT). Multislice CT is the non-invasive modality of choice for imaging anomalies of coronary arteries and provides high speed with excellent spatial resolution.

Management of Medical Radiation: Perspectives from Cardiology

Cardiac imaging with ionizing radiation provides immense diagnostic and therapeutic benefits, and also determines a corresponding increase in long-term cancer risk that should be included in the tailored, individualized benefit-risk balance. Cardiologists have a particular responsibility to avoid inappropriate and non-optimized use of radiation, since they are responsible for about 40 % of overall exposure from medical radiation, but they sometimes show suboptimal radiological awareness. The radiological dose of common radiological examinations can range from the equivalent of 1–60 milliSievert (mSv), with a reference dose average of 15 mSv (corresponding to 750 chest x-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. The tendency of the previous generation of cardiologists to ignore radiological doses, neglect risks and forget long-term consequences is no longer conscionable considering medical and ethical reasons, but also medicolegal. Institutions, scientific societies and political governance of health care should implement policies to reduce the unacceptablly high rate of inappropriate examinations, not infrequently performed on the wrong patient, with the wrong dose, at the wrong moment. Appropriateness and optimization are a difficult, moving, and elusive target, and there are so many clinical nuances in patient presentation and factors of variability regarding dose determination that it is not easy to have a sharp cut-off between appropriate and optimized vs inappropriate and nonoptimized examinations, but the wrong indication and dose is certainly one that is not audited and remains undisclosed. The 2014 European Society of Cardiology position paper on the use of medical radiation in cardiology provides a simple roadmap for clinical cardiologists to achieve the challenging yet fundamental goal of making our cardiology wards, imaging laboratories, and catheterization suites a safer place for doctors and patients.

The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology

The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1-60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: 'each patient should get the right imaging exam, at the right time, with the right radiation dose'.

The radiation issue in cardiology: the time for action is now.

The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.

An incidental nonfunctioning mediastinal paragaglioma (2009: 11b)

A rare case of an incidental nonfunctioning mediastinal paraganglioma is presented. The diagnosis of aorticosympathetic paraganglioma was established by histological examination after surgical removal of the tumor. The appearance of this rare tumor on multidetector coronary angiography is demonstrated and the differential diagnosis is discussed.