J Cardiovasc Ultrasound.  2016 Mar;24(1):7-17. 10.4250/jcu.2016.24.1.7.

Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography

• Lee JH
• Han D
• Danad I
• Hartaigh B
• Lin FY
• Min JK

• KMID: 2160989
• DOI: http://doi.org/10.4250/jcu.2016.24.1.7

Abstract

Coronary artery disease (CAD) is the leading cause of mortality worldwide, and various cardiovascular imaging modalities have been introduced for the purpose of diagnosing and determining the severity of CAD. More recently, advances in computed tomography (CT) technology have contributed to the widespread clinical application of cardiac CT for accurate and noninvasive evaluation of CAD. In this review, we focus on imaging assessment of CAD based upon CT, which includes coronary artery calcium screening, coronary CT angiography, myocardial CT perfusion, and fractional flow reserve CT. Further, we provide a discussion regarding the potential implications, benefits and limitations, as well as the possible future directions according to each modality.

Keyword

Coronary artery disease; Computed tomography; Multimodality imaging

MeSH Terms

Angiography
Calcium
Coronary Artery Disease*
Coronary Vessels*
Mass Screening
Mortality
Perfusion
Calcium

Figure

• 

  Fig. 1 A 62-year-old Caucasian man visited due to exertional chest pain. A: Multiplanar reformat of a CT angiogram demonstrated a severe stenosis lesion in proximal LAD, a moderate to severe stenosis in middle LCX, severe stenosis in proximal RCA and suspected total occlusion in middle RCA. B: The FFRCT value of LAD, LCX, and RCA is < 0.50, 0.79, and 0.68, both of LAD and RCA indicated significant ischemia. The FFRCT value of LCX is borderline. All stenosis lesions in (A) was indicated by asterisks (*). LAD: left anterior descending coronary artery, LCX: left circumflex artery, RCA: right coronary artery, FFRCT: fraction flow reserve derived from CT.

• 

  Fig. 2 Schematic illustration of 4 different approaches for obtaining dual-energy information. A: Dual source-detector pairs with each source operating at a different tube voltage. Each X-ray source covers a different scan field. B: Single source-detector pair with the source capable of rapid voltage switching in a single gantry rotation. C: Single source-detector pair with a dual-layer detector made of 2 different materials capable of differentiating between low-energy (upper layer) and high-energy (bottom layer) photons, with the source operating at constant tube voltage. D: Single source-detector pair with tube voltage switching between sequential gantry rotations. Fig. 2A, B, and C are courtesy of Philips Healthcare. Reprinted from Danad I et al. JACC Cardiovasc Imaging 2015;8:710-23, with permission of Elsevier.40)

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