Coronary angiography with multi-slice computed tomography

Background A new generation of subsecond multi-slice computed tomography (M SCT) scanners, which allow complete coronary coverage, are becoming widely available. We investigated the potential value of MSCT angiography in a ran ge of coronary disorders. Methods We studied 35 patients, including 11 who had undergone percutaneous transluminal coronary angioplasty and four who had had coronary-artery byp ass grafts, by both MSCT and conventional coronary angiography. After intra venous injection of a non-ionic contrast medium with high iodine content, t he entire heart was scanned within a single breath-hold. The total examinat ion time was no more than 20 min. The retrospective electrocardiographicall y gated reconstruction source images and three-dimensional reconstructed vo lumes were analysed by two investigators, unaware of the results of convent ional angiography. Findings In the 31 patients without previous coronary surgery, 173 (73%) of the 237 proximal and middle coronary segments were assessable. In the asse ssable segments, 17 of 21 significant stenoses (>50% reduction of vessel di ameter) were correctly diagnosed. The non-assessable segments included four lesions. Misinterpretations were mainly the result of severe calcification of the vessel wall. Segments with implanted stents were poorly visualised, but stent patency could be assessed in all cases. Of the 17 segments of by pass grafts, 15 were assessable and four of five graft lesions were detecte d. Two cases of anomalous coronary anatomy could be visualised well. Interpretation These preliminary data suggest that MSCT allows non-invasive imaging of coronary-artery stenoses and has potential to develop into a re liable clinical technique.