Busse Anke, Cantré Daniel, Beller Ebba, Streckenbach Felix, Öner Alper, Ince Hüseyin, Weber Marc-André, Meinel Felix G
Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Department of Internal Medicine, Division of Cardiology, Rostock University Medical Center, Rostock, Germany.
Radiologe. 2019 Dec;59(Suppl 1):1-9. doi: 10.1007/s00117-019-0530-9.
The aim of this study was to review established and emerging techniques of cardiac computed tomography (CT) and their clinical applications with a special emphasis on new techniques, recent trials, and guidelines.
Cardiac CT has made great strides in recent years to become an ever more robust and safe imaging technique. The improvements in spatial and temporal resolution are equally important as the substantial reduction in radiation exposure, which has been achieved through prospective ECG-triggering, low tube voltage scanning, tube current modulation, and iterative reconstruction techniques. CT-derived fractional flow reserve and CT myocardial perfusion imaging are novel, investigational techniques to assess the hemodynamic significance of coronary stenosis.
In asymptomatic patients at risk for coronary artery disease, CT coronary artery calcium scoring is useful to assess cardiovascular risk and guide the intensity of risk factor modification. Coronary CT angiography is an excellent noninvasive test to rule out obstructive coronary artery disease in patients with stable chest pain. In acute chest pain with normal ECG and normal cardiac enzymes, cardiac CT can safely rule out acute coronary syndrome although its benefit and role in this indication remains controversial. Cardiac CT is the established standard for planning transcatheter aortic valve implantation and-increasingly-minimally invasive mitral valve procedures.
Our review makes practical recommendations on when and how to perform cardiac CT and provides templates for structured reporting of cardiac CT examinations.
本研究旨在回顾心脏计算机断层扫描（CT）的既定技术和新兴技术及其临床应用，特别强调新技术、近期试验和指南。
近年来，心脏CT取得了长足进步，成为一种越来越强大且安全的成像技术。空间和时间分辨率的提高与辐射暴露的大幅减少同样重要，这是通过前瞻性心电图触发、低管电压扫描、管电流调制和迭代重建技术实现的。CT衍生的血流储备分数和CT心肌灌注成像是评估冠状动脉狭窄血流动力学意义的新型研究技术。
在有冠状动脉疾病风险的无症状患者中，CT冠状动脉钙化评分有助于评估心血管风险并指导危险因素修正的强度。冠状动脉CT血管造影是排除稳定型胸痛患者阻塞性冠状动脉疾病的优秀无创检查。在心电图和心肌酶正常的急性胸痛患者中，心脏CT可以安全地排除急性冠状动脉综合征，尽管其在该适应症中的益处和作用仍存在争议。心脏CT是规划经导管主动脉瓣植入术以及越来越多的微创二尖瓣手术的既定标准。
我们的综述就何时以及如何进行心脏CT提出了实用建议，并提供了心脏CT检查结构化报告的模板。
