multidetector ct vs spiral ct
An open-label, 12-center, 6-country observational registry of 27,125 consecutive patients undergoing CCTA and CACS was queried, and 7,590 individuals without CPS or history of CAD met the inclusion criteria. UHC Clinical Practice Advancement Center. Westwood M, Al M, Burgers L, et al. Douglas PS, Pontone G, Hlatky MA, et al. Multi-slice CT differs from ultrafast CT in that the latter has no moving parts, and ultrafast CT scans are faster than with multi-sclice CT. One study examined the accuracy of spiral CT in evaluating coronary calcification, using ultrafast CT as the gold standard for comparison, in 33 asymptomatic individuals who were referred for calcium scans. 2017;69(14):1761-1770. J Am Coll Cardiol. London, UK: NICE; July 2016. Circulation. Cho I, Chang HJ, Sung JM, et al; CONFIRM Investigators. Furthermore, an UpToDate review on “Screening for coronary heart disease in patients with diabetes mellitus” (Bax et al, 2018) states that “In the 2018 Standards of Medical Care in Diabetes, the American Diabetes Association does not recommend routine screening for CHD in asymptomatic patients with diabetes, as outcomes are not improved as long as cardiovascular risk factors are treated. Liew GY, Feneley MP, Worthley SG. Cologne, Germany; DIMDI; 2006. Guaricci and colleagues (2018) stated that the prognostic impact of diabetes mellitus (DM) on cardiovascular outcomes is well known. Curr Atheroscler Rep. 2004;6(1):20-26. List of Issues. Helsinki, Finland: Duodecim Medical Publications Ltd.; September 13, 2004. J Ultrasound. Thus, no two CT projections are acquired at the same slice (z-position) in the body. Finnish Medical Society Duodecim. In fact, there are other reconstruction techniques
These conclusions are consistent with those of the U.S. Preventive Services Task Force (2004), which stated that there is "insufficient evidence to recommend for or against routine screening with ... EBCT [electron beam CT] scanning for coronary calcium for either the presence of severe [coronary artery stenosis] or the prediction of [coronary heart disease] events in adults at increased risk for coronary heart disease.” The USPSTF reaffirmed their position in 2009, stating that the evidence is insufficient to assess the balance of benefits and harms of using coronary artery calcification (CAC) score on electron-beam computed tomography (EBCT) to screen asymptomatic men and women with no history of CHD to prevent CHD events. Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). Clinical and cost effectiveness of CT and MRI for selected clinical disorders: Results of two systematic reviews. The authors reviewed the PROMISE trial outcomes and noted that although the findings are insufficient to conclude the possibility of either harm or benefit from the use of CCTA, a particularly salient feature was that although catheterization was performed in more CCTA patients in the 90 days following noninvasive testing, the likelihood of nonsignificant CAD was significantly lower in the CCTA group (3.4% vs. 4.3%; p = 0.02). Available at: https://emedicine.medscape.com/article/1603072-overview#showall. A calcium score of 1000 is often used as the cutoff value above which a CCTA will not be diagnostic (Lin, 2017). As you may have noticed, backprojection smears or blurs the final image. BlueCross BlueShield Association (BCBSA), Technology Evaluation Center (TEC). 0.5
Criqui MH, Denenberg JO, Ix JH, et al. In such cases, the patient may need invasive angiography to adequately assess the coronary vessels. The authors concluded that diagnostic CCTA, with 3(rd) generation DSCT at 120 kV, can routinely be performed in persons with BMI greater than 40. Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviors? ; American College of Physicians. Muhlestein and Moreno (2016) noted that it is well-known that there is a very high risk of cardiovascular complications among diabetic patients. O'Malley PG. Cho and colleagues (2012) stated that the predictive value of CCTA in subjects without chest pain syndrome (CPS) has not been established. Additionally, ED discharge rates, ED length of stay, and incidence of undetected ACS were similar. A total of 501 individuals had CCTA, 499 individuals had a standard evaluation in the emergency room. Helsinki, Finland: Duodecim Medical Publications Ltd.; September 14, 2004. J Am Coll Cardiol. Coronary angiography and indications for CABG or angioplasty. 2017;24(5):1619-25. Wong ND, Detrano RC, Diamond G, et al. Noninvasive atherosclerosis imaging for predicting cardiovascular events and assessing therapeutic interventions. Evidence-Based Medicine [CD-ROM]. Finnish Medical Society Duodecim. 2002;3(2):77-84. Norgaard BL, Hjort J, Gaur S, et al. Sometimes people talk
Cardiac troponin I appears to be more specific than cardiac troponin T or creatine kinase MB subunits in the diagnosis of acute myocardial infarction. Recommendations of the U.S. Preventive Services Task Force.
Helical CT. ; Society of Cardiovascular Computed Tomography. Mann JM, Davies MJ. The results showed that 8 of 1102 (0.7%) segments demonstrated poor image quality. Pharmaceutical Executive. Accessed March 23, 2004. van den Hoogen IJ, de Graaf MA, Roos CJ, et al. Opolski MP, Staruch AD, Jakubczyk M, et al. lung vs air or bone vs soft tissue. TEC Assessment Program. Tomographic (plaque) imaging: State of the art. The iterative nature of the algorithm means that it takes an initial guess and refines it over several tries. Technology Report No. 2001;88(2-A):66E-69E. acquired. Eur Radiol. 1990;15:827-832. Both tube voltage and tube current should be optimized to deliver the least necessary radiation for adequate image quality. Lessons learned from the analysis of prognostic studies over the past decade have challenged this dogma and now support the idea that diabetic population is not uniformly distributed in the highest risk box. Antman EM, Anbe DT, Armstrong PW, et al. Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? Evidence Note 9. Vulnerable plaque: Relation of characteristics to degree of stenosis in human coronary arteries. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Recently, several studies reported that the prevalence of subclinical coronary atherosclerosis (SCA) is higher than expected, and this could impact on CAD progression in asymptomatic diabetic patients. 2016;72(4):377-383. The assessment concluded that "The evidence is consistent with prior physiologic data and long-held beliefs that identifying stenoses is insufficient to determine when revascularization is likely to have benefit. All patients underwent conventional coronary angiography (CAG). 2016;23(2):185-197. Helsinki, Finland: Duodecim Medical Publications Ltd.; September 14, 2004. 2017. J Am Coll Cardiol. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years. Image quality and radiation exposure comparison of a double high-pitch acquisition for coronary computed tomography angiography versus standard retrospective spiral acquisition in patients with atrial fibrillation. 1995;25:626-632. By smearing back all of the projections, you reconstruct an image. Moreover, in the event of irregular heart rates or atrial fibrillation it is essential that other determinants of image quality such as coronary calcification, body weight and patient cooperation are taken into consideration before deciding whether to proceed with the scan. Computed tomography coronary angiography has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results. degrees. New Zealand Health Technology Assessment (NZHTA). images of the body part at multiple angles (or projections) around the body. ACC/AHA guideline update for exercise testing. Biomed Res Int. of any given slice is determined by which projection is used to start the slice. The addition of CCTA early in the evaluation of patients presenting acutely to the emergency department with chest pain has been extensively studied in prospective, multicenter trials. The critical issue that defines the utility (or lack thereof) of ultrafast CT is its prognostic value. 2016;67(15):1759-1768. Canberra, ACT: MSAC; November 2007. Health Technol Assess. This can be performed with fusion imaging or with hybrid imaging using PET-CT or SPECT-CT. First trial results with PET-CCTA and SPECT-CCTA carried out as cardiac hybrid imaging on a 64-slice CT showed a major effect to be a decrease in the number of false-positive results, significantly increasing the specificity of CCTA and SPECT. Lee CH, Lee SW, Park SW. Diabetes and subclinical coronary atherosclerosis. Image quality evaluation agreement was high between observers (κ = 0.8). 1996;78:1220-1223. Computed tomography coronary angiography. Last reviewed November 2018. Screening for coronary artery disease. Agatston AS, Janowitz WR, Hildner FJ, et al. American College of Cardiology/American Heart Association guidelines (Greenland et al, 2010) have two Class IIa recommendations for screening with calcium scoring, where Class IIa recommendations are defined as those for which “[t]he weight of evidence or opinion is in favor of the procedure or treatment.” Class IIa recommendations for calcium scoring are for asymptomatic patients with an intermediate (10% to 20%) 10-year risk of cardiac events based on the Framingham risk score (FRS) or other global risk algorithm, and for asymptomatic patients 40 years and older with diabetes mellitus. Each patient served as their own control. The presence of cardiac symptoms, disease activity, and other co-morbidities was not associated with differences in coronary artery involvement. Detection of coronary calcification with electron beam computed tomography: Evaluation of interexamination reproducibility and comparison of 3 image acquisition protocols. Koshy AN, Ha FJ, Gow PJ, et al. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); October 2009. member’s most recent coronary artery calcium (CAC) scan result was zero, member's most recent CAC scan was at least 5 years ago, and. CCTA is generally contraindicated for decompensated heart failure; however, may be considered on a case-by-case basis (Abbara et al, 2016). Noninvasive fractional flow reserve derived from coronary computed tomography angiography for identification of ischemic lesions: A systematic review and meta-analysis. Fihn SD, Blankenship JC, Alexander KP, et al. To improve visualization of the mucosa and achieve better bowel distention, a 0.1% wt/vol barium sulfate suspension (VoLumen; Bracco Diagnostics, Princeton, NJ) is administered as a negative oral contrast agent. The authors concluded that in patients with TA, there is a high prevalence of coronary arterial abnormalities at coronary CT angiography, regardless of disease activity or symptoms. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. The authors stated that contemporary stable chest pain populations present with a low prevalence of myocardial ischemia and obstructive CAD, and that in that particular population, CCTA provides better prognostic information than functional testing. The particular type of filter needed is a high-pass filter, or a sharpening filter. Further research is recommended in this area. Per-patient sensitivity, specificity, positive and negative predictive values of CACS were: 97 %, 75 %, 45 %, and 100 %, respectively (Agatston greater than or equal to 1); 73 %, 90 %, 60 %, and 94 %, respectively (Agatston greater than or equal to 100); 30 %, 98 %, 79 %, and 87 %, respectively (Agatston greater than or equal to 1,000). Berry E, Kelly S, Hutton J, et al. SCOT-HEART investigators.. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group, multicentre trial. Harky A, Zywicka E, Santoro G, et al. Rule out obstructive coronary stenosis in persons with a low or intermediate pre-test probability of coronary artery disease or atherosclerotic cardiovascular disease by Framingham risk scoring, Pooled Cohort Equations, or by American College of Cardiology (ACC) criteria (see Appendix) with a positive (i.e., greater than or equal to 1 mm ST segment depression) stress test. Hoffman et al (2017) discussed insights from the prospective, randomized, multicenter PROMISE trial which evaluated the prognostic value of noninvasive cardiovascular testing in patients with stable chest pain. CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries.Its main use is to diagnose pulmonary embolism (PE). 2013;267(1):76-85. An assessment by the Blue Cross Blue Shield Association Technology Evaluation Center's Evidence Street (revised June 2017) concluded that CCTA in individuals with stable chest pain and intermediate risk for CAD, the evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome for patients. For imaging the lungs or bones, we are looking for small, discrete features (i.e. 180 (plus fan angle) degrees of projection data. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2012;156(6):438-444. ACR Appropriateness Criteria chronic chest pain - low to intermediate probability of coronary artery disease [online publication]. Statistical differences between coronary CT angiographic findings and clinical parameters were examined with uni-variate analysis. Current Cardiovascular Imaging Reports. Additionally, when looking only at major adverse cardiovascular events (MACE), a CCTA-guided strategy was also superior (2% vs 5%, p=0.04), predominantly driven by higher rates of myocardial infarction in the standard care cohort. arbitrary interval - less than the slice thickness or even less than the collimator width. CT and MRI for selected clinical disorders: A systematic review of economic evaluations. Circulation. An entire slice is completed when the gantry has covered 180+fan angle
2009;25:147-154. Knapper JT, Khosa F, Blaha MJ, et al. Evaluation of subsecond gated spiral CT for quantification of coronary artery calcium and comparison with electron beam CT. AJR Am J Roentgenol. Hulten E, Bittencourt MS, Singh A, et al. If pitch > 2, then there are gaps in the reconstruction. Coronary CT angiography for suspected ACS in the era of high-sensitivity troponins: Randomized multicenter study. In CTA, 54.0% of events (n=74/137) occurred in patients with non-obstructive CAD (1%-69% stenosis). Electron beam computed tomography and coronary artery disease: Scanning for coronary artery calcification. CT angiography for the detection of coronary artery stenoses in patients referred for cardiac valve surgery: Systematic review and meta-analysis. J Am Coll Cardiol. In fact, the two phenomena are somewhat related - we can use noisier kernels in situations where the inherent contrast
2008;118(5):586-606. Decreasing the reconstruction interval can have two advantages: (1) Increasing visibility of small lesions
Data from the National Cardiovascular Data Registry’s (NCDR) CathPCI Registry demonstrated that, despite a multitude of noninvasive testing modalities available to providers nationwide, 58.4% of patients were found to have no or nonobstructive CAD at the time of elective ICA. Bloomington, MN: ICSI; 2004. Ma and colleagues (2010) examined the relationship between coronary calcium score (CCS) and angiographic stenosis on a patient-based or vessel-based analysis. 2014;69(8):861-869. Improved noninvasive coronary angiography in morbidly obese patients with dual-source computed tomography. If 2714 patients with at least an intermediate Framingham Risk Score (>10%) who had a normal functional test were reclassified as being mildly abnormal, the discriminatory capacity improved to 0.69 (95% CI, 0.64-0.74). Snow V, Barry P, Fihn SD, et al. ; American College of Cardiology Foundation Appropriate Use Criteria Task Force. Mid-term follow-up (29.3 ± 14.9 months) revealed 4 subjects with cardiac events: 3 subjects with unstable angina requiring hospital stay and 1 subject with percutaneous coronary intervention. Compared with functional testing, there was significantly higher use of statins (15.9% vs. 9.1%), aspirin (12.7% vs. 8.5%), invasive coronary angiography (14.7% vs. 10.1%), and percutaneous coronary intervention (3.8% vs. 2.1%); all p < 0.001 after CCTA. reconstruction artifacts and can obscure small features like nondisplaced fractures or small lesions (see simulation above). The investigators studied patients enrolled in a Danish registry who underwent initial noninvasive cardiac testing with either a CCTA or functional testing (exercise electrocardiography or nuclear stress testing) from 2009 to 2015. Unstable angina pectoris. The study included 102 obese patients who had undergone CCTA performed with (third) generation dual-source CT, prospectively ECG-triggered acquisition at 120 kV, and automated tube current modulation. The slices remain the same thickness - but
Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Submillisievert median radiation dose for coronary angiography with a second-generation 320–detector row CT scanner in 107 consecutive patients. Med Clin North Am. Chicago, IL: BCBSA; November 2011;26(9). Coronary CT angiography. In particular, Pitch = Table movement in 360 degrees / Collimator width, If Pitch = 1, then the next 360 degree circuit starts adjacent to where the last one started, with no gap. Am J Cardiol. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Evaluation of other complex congenital heart diseases; Evaluation of sinus venosum atrial-septal defect; Person scheduled or being evaluated for surgical repair of tetralogy of Fallot or other congenital heart diseases; Evaluation of suspected native or prosthetic cardiac valve dysfunction when echocardiographic imaging is inconclusive or there is suspicion for paravalvular abscess formation. The primary end-point was the number of patients identified with significant CAD requiring re-vascularization within 30 days. Laudon DA. Issues in Emerging Health Technologies. Technology, methods, preliminary experience and prospects. Quantification of coronary artery calcium using ultrafast computed tomography. Douglas PS, De Bruyne B, Pontone G, et al. JACC Cardiovasc Imaging. In: EBM Guidelines. only on the thickness of the CT detector. Individuals were randomly assigned in a 2:1 ratio to undergo CCTA or receive traditional care. Spiral or helical CT differs from conventional CT in that the patient is continuously rotated as he is moved. The relationship between speed of rotation and speed of table movement is referred to as pitch. explains the concept of slice broadening - each point reflects data from two z positions, separated by how far the table moves as the beam turns 180 degrees. Slice thickness is determined by the detector width and
is determined by the detector width - with mild slice broadening just based on the pitch of the helical scan. 2004;232(1):18-37. pitch increases the speed of the scan. Individuals were excluded if they had known CAD. UpToDate Inc., Waltham, MA. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. The software provides a non-invasive method of estimating fractional flow reserve using standard coronary CT angiography (CCTA) image data (NICE, 2017). NICE guidance (2017) states that "[t]he case for adopting HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography (CCTA) is supported by the evidence. Thus, these researchers noted that coronary CT angiography may add information on coronary artery lesions in patients with TA. about sinograms, which are simply a display of all of the different projections for a given slice stacked together. Cardiac CT angiography often produces non-cardiac incidental findings. 2004;5(2):89-98. There were no cardiac deaths in the traditional group. More importantly, tube current should be adjusted to the total volume of soft tissues within the scanned region. There was insufficient evidence to support this. Available at: http://nzhta.chmeds.ac.nz. Moreover, various studies have shown a strong correlation between EBCT calcium scores and quantities of atherosclerotic plaque. Coronary CT angiography in obese patients using 3(rd) generation dual-source CT: effect of body mass index on image quality. Thus, for these tissues, we prefer a softer kernel that will decrease noise. 2014;64(18):1929-49. Coronary calcium scoring for long-term mortality prediction in patients with and without a family history of coronary disease. On the other hand, the results of randomized trials with a fractional flow reserve (FFR)-guided coronary intervention (DEFER, FAME I, FAME II) showed that it is not the angiographically determined morphological severity of CAD but the functional severity determined by FFR that is critical for prognosis and the indications for re-vascularization. "Filtered BP Reconstruction"). Kishi S, Giannopoulos AA, Tang A, et al. There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In that case, at any given time, data may be acquired for multiple slices. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: A randomized controlled trial. Ratko T. Electron beam computed tomography. 2016;9(10):1188-1194. Thus, the early detection of CAD is necessary in those diabetic patients who are at risk of cardiovascular events. However, there remains a great need for better and more sensitive and specific screening methods, as well as more effective treatments that may allow clinicians to more accurately target diabetic patients who really are at high risk. CT and MRI for selected clinical disorders: A systematic review of clinical systematic reviews. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: A multicenter study. Accessed May 16, 2018. 10/02/2020 Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis. CCTA lowered direct medical costs by 34% (p<0.01) when compared to hs-troponins and there was less downstream testing following the index ED visit (4% vs 10%, p<0.01). The CCTA group had lower direct medical costs (€337 versus €511, p < 0.01) and less outpatient testing after the index ED visit (10 [4 %] versus 26 [10 %], p < 0.01). Of note, there was more downstream testing and radiation exposure was higher in the CCTA cohort.In another randomized trial, Litt et al (2012) compared individuals at low-to-intermediate risk with possible acute coronary syndromes who presented to the emergency room. Aetna considers a single calcium scoring by means of low-dose multi-slice CT angiography, ultrafast [electron-beam] CT, or spiral [helical] CT medically necessary for screening the following: In a retrospective study, Kang et al (2014) evaluated coronary arterial lesions and assessed their correlation with clinical findings in patients with Takayasu arteritis (TA) by using coronary CT angiography. undulations as the CT tube rotates around the patient, which is how this image got its name. Jacoby DS, Mohler III ER, Rader DJ. Their aim was to evaluate the effects of mean heart rate (HR) and heart rate variation (HRV) on image quality and analyze the diagnostic accuracy. Unstable angina not previously stabilized by medical therapy. Ivan M, Kreisz F, Merlin T, et al. ; American Heart Association Task Force on Practice Guidelines. Significant medical and radiological advancements, including CCTA, mean that it is now possible to examine the characteristics of plaques, instead of solely evaluating the calcium level of the coronary artery. After a single DSCT acquisition, standard quarter-scan image reconstructions at a temporal resolution of 83 milliseconds were compared with temporal resolution reconstructions at 105, 125, and 165 milliseconds. Evidence-Based Medicine [CD-ROM]. A photon
1996;94:1175-1192. ), an unstable or vulnerable plaque may go undetected by ultrafast CT, and may rupture and cause thrombosis and obstruction of the coronary artery. Filtered backprojection is the standard method of CT reconstruction. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis.