Chinnaiyan Kavitha M, McCullough Peter A
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Rev Cardiovasc Med. 2008 Fall;9(4):215-24.
Cardiac computed tomographic angiography (CCTA) is revolutionizing our approach to the identification and management of coronary artery atherosclerosis. CCTA has the unique ability to assess extracoronary cardiac findings within the standard field of view, including the anatomy of cardiac structures-the atria, ventricles, valves, pericardium, great vessels, and venous anatomy-and any related abnormalities. Appropriate clinical applications include evaluation of intermediate-risk patients with acute chest pain and those with suspected coronary anomalies, uninterpretable or equivocal stress test results, or suspected cardiac morphologic abnormalities. Optimization of this diagnostic examination requires close attention to details such as minimizing motion and attaining sufficient contrast opacification. Iso-osmolar contrast can help achieve maximum patient comfort with the smallest elevation of heart rate and variability, as well as minimize the risk of acute kidney injury. Newer scanning equipment and protocols have improved image quality in difficult cases, including obese patients and those with heavy coronary calcification or metal artifacts. Current imaging protocols have reduced exposure to ionizing radiation and continue to improve safety.
心脏计算机断层血管造影（CCTA）正在彻底改变我们识别和管理冠状动脉粥样硬化的方法。CCTA具有独特的能力，可在标准视野内评估心脏外的心脏表现，包括心脏结构的解剖结构——心房、心室、瓣膜、心包、大血管和静脉解剖结构——以及任何相关异常。适当的临床应用包括评估急性胸痛的中危患者以及疑似冠状动脉异常、负荷试验结果无法解读或不明确、或疑似心脏形态异常的患者。优化这项诊断检查需要密切关注细节，如尽量减少运动并获得足够的对比剂充盈。等渗对比剂有助于在心率升高和变异性最小的情况下使患者获得最大程度的舒适感，并将急性肾损伤的风险降至最低。更新的扫描设备和方案已改善了包括肥胖患者、冠状动脉重度钙化患者或有金属伪影患者等疑难病例的图像质量。当前的成像方案减少了对电离辐射的暴露，并在持续提高安全性。
