Dewey M, Hamm B
Radiologie, Charité, Berlin.
Rofo. 2007 Mar;179(3):246-60. doi: 10.1055/s-2007-962830.
Multislice computed tomography (MSCT) after intravenous contrast agent administration enables visualization of the coronary arteries with high spatial resolution (voxel sizes down to 0.5 x 0.35 x 0.35 mm (3)) and a short scan time. Magnetic resonance imaging (MRI) is also intensively studied with respect to the noninvasive detection of coronary artery stenosis and thus the detection of coronary artery disease (CAD) without radiation exposure but is not equal to MSCT at present. This article provides an overview of the historical development of CT coronary angiography from 4-slice CT to 16-slice CT and 64-slice CT. A crucial aspect of this development is the improvement in image quality resulting from shorter breath-hold periods and the reduced gantry rotation time. Other techniques that appear to considerably improve image quality and accuracy and make CT independent of patient heart rates are multi-segment reconstruction and dual-source CT. Sublingual nitroglycerin as well as oral or intravenous betablocker administration should be considered in relation to the diagnostic question to be answered and the patient's heart rate. In the studies available CT coronary angiography with at least 12 simultaneous detector rows has a sensitivity of 96.9 % and a specificity of 75.3 % at the patient level. Especially the negative predictive value of CT (94.6 %) emphasizes the idea that this technique may reliably exclude CAD in patients with intermediate pretest likelihood. In the near future, 256-slice CT will allow examination of the entire heart during one heartbeat or even 4D CT scanning with simultaneous assessment of myocardial perfusion. Automatic or semiautomatic software tools will assume a central place in detecting and quantifying coronary artery stenoses and plaques as well as in the analysis of cardiac function in the clinical setting over the next years. Prior to its routine clinical use, the cost-effectiveness of CT coronary angiography must be determined and the clinical role of MSCT must be investigated in multi-center studies including different patient populations.
静脉注射造影剂后的多层螺旋计算机断层扫描（MSCT）能够以高空间分辨率（体素大小低至0.5×0.35×0.35 mm³）和短扫描时间显示冠状动脉。磁共振成像（MRI）也在冠状动脉狭窄的无创检测方面得到了深入研究，从而能够在无辐射暴露的情况下检测冠状动脉疾病（CAD），但目前其效果不如MSCT。本文概述了CT冠状动脉造影从4层CT到16层CT再到64层CT的历史发展。这一发展的一个关键方面是由于屏气时间缩短和机架旋转时间减少而导致的图像质量提高。其他似乎能显著提高图像质量和准确性并使CT不受患者心率影响的技术是多段重建和双源CT。应根据要回答的诊断问题和患者心率考虑使用舌下硝酸甘油以及口服或静脉注射β受体阻滞剂。在现有研究中，具有至少12排同步探测器的CT冠状动脉造影在患者层面的敏感性为96.9%，特异性为75.3%。尤其是CT的阴性预测值（94.6%）强调了这样一种观点，即该技术可以可靠地排除预测试验可能性为中等的患者的CAD。在不久的将来，256层CT将能够在一次心跳期间检查整个心脏，甚至能够进行4D CT扫描并同时评估心肌灌注。在未来几年中，自动或半自动软件工具将在临床环境中检测和量化冠状动脉狭窄及斑块以及分析心脏功能方面占据核心地位。在其常规临床应用之前，必须确定CT冠状动脉造影的成本效益，并且必须在包括不同患者群体的多中心研究中研究MSCT的临床作用。
