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Applications of cardiac multidetector CT beyond coronary angiography

Nature Reviews Cardiology volume 6, pages 699–710 (2009)Cite this article

Abstract

Noninvasive imaging of the coronary arteries using multidetector CT (MDCT) represents one of the most promising diagnostic imaging advances in contemporary cardiology. This challenging application has driven a rapid and impressive advancement in CT technology over the past 10 years; leading to increased spatial and temporal resolution, decreased scan times and substantial reductions in radiation dose. Recent technological improvements have not only improved the status of CT coronary angiography but have also enabled new functional myocardial applications that are gaining a foothold in clinical practice as adjuncts or replacements for conventional coronary angiographic studies. Wide-detector CT designs along with prospective ECG-triggered protocols have opened the possibility of performing multiple complementary myocardial measurements during a coronary CT exam with acceptable radiation and contrast exposure. In this Review, we discuss recent technical developments in cardiac MDCT and outline newly enabled noncoronary cardiac applications including viability assessment, myocardial perfusion and molecular imaging.

Key Points

  • Advances in scanner technology and imaging protocols have enabled noncoronary applications of multidetector CT (MDCT)

  • MDCT can be used to evaluate myocardial viability

  • Assessment of myocardial blood flow by MDCT is feasible under conditions of rest and stress

  • Current MDCT technology has the potential to visualize cells and molecular targets

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Figure 1: Technical progression of scanner technology.
Figure 2: Dual energy acquisition of perfusion deficits (black arrows) are shown as short-axis multiplanar reformation.
Figure 3: Examples of CT coronary angiography ECG-gating protocols for the 320-slice detector system.
Figure 4: Time course of contrast enhancement in an acute myocardial infarction after intravenous iodine injection.
Figure 5: Examples of coronary-MDCT and DE-MDCT in three representative patients.
Figure 6: Comparison of prospective and retrospective ECG-gated MDCT images obtained 10 min after injection of contrast agent.
Figure 7: Helical and dynamic MDCT perfusion imaging of a canine model of LAD stenosis.
Figure 8: Wide-range detector MDCT perfusion imaging protocol.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Johns Hopkins University Baltimore, MD, USA

    Karl H. Schuleri, Richard T. George & Albert C. Lardo

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  1. Karl H. Schuleri
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Correspondence to Albert C. Lardo.

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Competing interests

A. C. Lardo has received research support and honoraria to lecture on cardiovascular CT from Toshiba Medical Systems Inc. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict-of-interest policies.

R. T. George has received research support from Astellas Pharma US, and Toshiba Medical Systems.

K. H. Schuleri declares no competing interests.

Supplementary information

Supplementary Figure 1

New molecular CT contrast agent. (a) Schematic representation of the iodinated compound of the contrast agent N1177 with the three iodine atoms in red. Optical microscopy in a phase-contrast mode of macrophages after a 1 h incubation in vitro (b) with N1177 or (c) with the conventional CT contrast agent. Numerous dark granules were visualized only in the cytoplasm of macrophages incubated with N1177. Scale bar, 100 µm. Permission obtained from Nature Publishing Group © Hyafil, F. et al. Nat. Med. 13, 636–641 (2007). (JPG 228 kb)

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Schuleri, K., George, R. & Lardo, A. Applications of cardiac multidetector CT beyond coronary angiography. Nat Rev Cardiol 6, 699–710 (2009). https://doi.org/10.1038/nrcardio.2009.172

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