Update for the Performance of CT Coronary Angiography – Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine

Abstract

Background Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure.

Method The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience.

Results and Conclusion According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI).

Key Points: 

• CCTA is a valid method to exclude coronary artery disease in patients with a low to intermediate clinical likelihood.

• Even with the latest generation CT scanners, premedication with beta blockers and nitrates can improve image quality at low radiation exposure.

• Current CT scanners usually provide retrospective ECG gating and prospective ECG triggering. Dual-source scanners additionally provide a “high pitch” scan mode to scan the whole heart during one heartbeat, which may also be achieved using single-source scanners with broad detectors in some cases.

• Besides the available scanner technology, the choice of scan mode primarily depends on heart rate and heart rate variability (e. g., arrhythmia).

Citation Format

• Soschynski M, Hagar MT, Taron J et al. Update for the Performance of CT Coronary Angiography. Fortschr Röntgenstr 2022; 194: 613 – 624

Key words

coronary CT angiography - acquisition - technique - guidelines - cardiac CT - performance

Publikationsverlauf

Eingereicht: 31. Mai 2021

Angenommen: 20. Dezember 2021

Artikel online veröffentlicht:
01. März 2022

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