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Rofo 2022; 194(06): 613-624
DOI: 10.1055/a-1747-3554
Review

Update zur Durchführung der CT-Koronarangiografie – Evidenzbasierter Einsatz und technische Anleitung entsprechend den aktuellen Empfehlungen sowie praktische Tipps aus der Routine am eigenen Standort

Article in several languages: English | deutsch
Martin Soschynski
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
,
Muhammad Taha Hagar
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
,
Jana Taron
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
2   Cardiac MR PET CT Program, Massachusetts General-Hospital, Harvard Medical School, Boston, United States
,
Tobias Krauss
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
,
Philipp Ruile
3   Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
,
Manuel Hein
3   Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
,
Thomas Nührenberg
3   Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
,
Maximilian Frederik Russe
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
,
Fabian Bamberg
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
,
Christopher L Schlett
1   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
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Zusammenfassung

Hintergrund Die computertomografische Koronarangiografie (cCTA) hat in den aktuellen Leitlinien der European Society of Cardiology (ESC) einen hohen Stellenwert für den Ausschluss signifikanter Koronarstenosen. Für eine optimale Bildqualität bei niedriger Strahlenexposition stehen dem Untersucher verschiedene Scanverfahren zur Verfügung. Aktuelle Konsensusempfehlungen der Society of Cardiovascular Computed Tomography (SCCT) geben Hinweise für die Durchführung.

Methode Der Artikel gibt praktische Empfehlungen zum leitliniengerechten Einsatz und zur Durchführung der cCTA basierend auf der aktuellen Literatur und eigenen Erfahrungswerten.

Ergebnisse und Schlussfolgerung Gemäß den aktuellen Leitlinien der ESC wird die cCTA vor allem bei symptomatischen Patienten mit niedriger und intermediärer klinischer Wahrscheinlichkeit für eine koronare Herzkrankheit (KHK) empfohlen. Vor der Untersuchung empfehlen wir selbst an den modernsten Scannern weiterhin eine Prämedikation mit Beta-Blockern und Nitraten. Für die Akquisition stehen an aktuell verwendeten CT-Scannern 3 Scan-Modi zur Verfügung. Hauptfaktor für die Protokollauswahl ist die Herzfrequenz, Nebenfaktoren können Koronarkalk und Body-Mass-Index (BMI) sein.

Kernaussagen: 

  • Die cCTA kann zunehmend breit bei niedriger und intermediärer klinischer Wahrscheinlichkeit für eine KHK eingesetzt werden.

  • Selbst an modernsten CT-Scannern kann die Verwendung von Beta-Blockern und Nitraten eine Verbesserung der Bildqualität bei Protokollen mit niedriger Strahlendosis bewirken.

  • Aktuell verwendete CT-Scanner ermöglichen in der Regel ein retrospektives EKG-Gating sowie einen prospektiv EKG-getriggerten Scan. An Dual Source-Scannern besteht zusätzlich die Möglichkeit mit einem „High pitch“-Modus das gesamte Herz innerhalb eines Herzschlages abzubilden, bei Single-Source-Scannern mit breitem Detektor gelingt dies z. T. mit einem „Single-heart-beat“-Modus ebenfalls.

  • Neben der verfügbaren CT-Scanner-Technologie ist die Wahl des Scan-Modus primär von der Herzfrequenz sowie der Herzfrequenzvariabilität bzw. dem Vorliegen von Arrhythmien abhängig.

Zitierweise

  • Soschynski M, Hagar MT, Taron J et al. Update for the Performance of CT Coronary Angiography. Fortschr Röntgenstr 2022; 194: 613 – 624

Key words

coronary CT angiography - acquisition - technique - guidelines - cardiac CT - performance


Publication History

Received: 31 May 2021

Accepted: 20 December 2021

Article published online:
01 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Knuuti J, Wijns W, Saraste A. et al. (2020) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal 41: 407-477
    CrossrefPubMedGoogle Scholar
  • 2 Dewey M, Hamm B. CT-Koronarangiografie: Untersuchungstechnik, klinische Ergebnisse und Ausblick in zukünftige Entwicklungen [CT coronary angiography: examination technique, clinical results, and outlook on future developments]. Rofo 2007; 179: 246-260
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Haase R, Schlattmann P, Gueret P. et al. COME-CCT Consortium. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ 2019; 365: l1945
    CrossrefPubMedGoogle Scholar
  • 4 Newby DE, Adamson PD, Berry C. SCOT-HEART Investigators. et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med 2018; 379: 924-933
    CrossrefPubMedGoogle Scholar
  • 5 Achenbach S, Barkhausen J, Beer M. et al. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. Kardiologe 2012; 6: 105-125
    CrossrefPubMedGoogle Scholar
  • 6 Busse A, Cantré D, Beller E. et al. Cardiac CT: why, when, and how. Radiologe 2019; 59: 1-9
    CrossrefPubMedGoogle Scholar
  • 7 Mahnken AH. Imaging of Coronary Stents by Coronary CT-Angiography: Current Status. Curr Cardiovasc Imaging Rep 2012; 5: 274-281
    CrossrefPubMedGoogle Scholar
  • 8 Andreini D, Pontone G, Mushtaq S. et al. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner. International Journal of Cardiology 2019; 274: 382-387
    CrossrefPubMedGoogle Scholar
  • 9 Baumgartner H, Falk V, Bax JJ. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2017; 38: 2739-2791
    CrossrefPubMedGoogle Scholar
  • 10 Collet JP, Thiele H, Barbato E. ESC Scientific Document Group. et al 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42: 1289-1367 . Erratum in: Eur Heart J. 2021 May 14;42(19):1908. Erratum in: Eur Heart J. 2021 May 14;42(19):1925. Erratum in: Eur Heart J. 2021 May 13;: PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575.
    CrossrefPubMedGoogle Scholar
  • 11 Abbara S, Blanke P, Maroules CD. et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2016; 10: 435-449
    CrossrefPubMedGoogle Scholar
  • 12 Pannu HK, Alvarez Jr W, Fishman EK. Beta-blockers for cardiac CT: a primer for the radiologist. Am J Roentgenol 2006; 186: S341-S345
    CrossrefPubMedGoogle Scholar
  • 13 Khan M, Cummings KW, Gutierrez FR. et al. Contraindications and side effects of commonly used medications in coronary CT angiography. Int J Cardiovasc Imaging 2011; 27: 441-449
    CrossrefPubMedGoogle Scholar
  • 14 Miller RJH, Eisenberg E, Friedman J. et al. Impact of heart rate on coronary computed tomographic angiography interpretability with a third-generation dual-source scanner. Int J Cardiol 2019; 295: 42-47
    CrossrefPubMedGoogle Scholar
  • 15 Li M, Zhang GM, Zhao JS. et al. Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. Clin Radiol 2014; 69: 163-171
    CrossrefPubMedGoogle Scholar
  • 16 Takx RA, Suchá D, Park J. et al. Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review. Eur Radiol 2015; 25: 3536-3542
    CrossrefPubMedGoogle Scholar
  • 17 Jiménez-Juan L, Nguyen ET, Wintersperger BJ. et al. Failed heart rate control with oral metoprolol prior to coronary CT angiography: effect of additional intravenous metoprolol on heart rate, image quality and radiation dose. Int J Cardiovasc Imaging 2013; 29: 199-206
    CrossrefPubMedGoogle Scholar
  • 18 Kim C, Ha M, Kim W. et al. Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography. Eur Radiol 2021; 31: 515-524
    CrossrefPubMedGoogle Scholar
  • 19 Pfister M, Seiler C, Fleisch M. et al. Nitrate induced coronary vasodilatation: differential effects of sub-lingual application by capsule or spray. Heart 1998; 80: 365-369
    CrossrefPubMedGoogle Scholar
  • 20 Sato K, Isobe S, Sugiura K. et al. Optimal starting time of acquisition and feasibility of complementary administration of nitroglycerin with intravenous beta-blocker in multislice computed tomography. J Comput Assist Tomogr 2009; 33: 193-198
    CrossrefPubMedGoogle Scholar
  • 21 Dewey M, Hoffmann H, Hamm B. Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries. Röfo 2006; 178: 600-604
    PubMedGoogle Scholar
  • 22 Akers SR, Panchal V, Ho VB. Expert Panel on Cardiac Imaging. et al. ACR Appropriateness Criteria Chronic Chest Pain-High Probability of Coronary Artery Disease. J Am Coll Radiol 2017; 14: S71-S80
    CrossrefPubMedGoogle Scholar
  • 23 Brodoefel H, Burgstahler C, Tsiflikas I. et al. Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology 2008; 247: 346-355
    CrossrefPubMedGoogle Scholar
  • 24 Raff GL, Gallagher MJ, O’Neill WW. et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005; 46: 552-557
    CrossrefPubMedGoogle Scholar
  • 25 Ochs MM, Siepen FAD, Fritz T. et al. Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT. Clin Res Cardiol 2017; 106: 485-492
    CrossrefPubMedGoogle Scholar
  • 26 Busse A, Cantré D, Beller E. et al. Cardiac CT: why, when, and how. Radiologe 2019; 59: 1-9
    CrossrefPubMedGoogle Scholar
  • 27 Osawa K, Nakanishi R, Budoff M. Coronary Artery Calcification. Glob Heart 2016; 11: 287-293 DOI: 10.1016/j.gheart.2016.08.001.
    CrossrefPubMedGoogle Scholar
  • 28 Mitchell JD, Fergestrom N, Gage BF. et al. Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring. Journal of the American College of Cardiology 2018; 72: 3233-3242
    CrossrefPubMedGoogle Scholar
  • 29 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary. Journal of the American College of Cardiology 2019; 73: 3168-3209
    CrossrefPubMedGoogle Scholar
  • 30 Mihl C, Kok M, Altintas S. et al. Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography. Eur J Radiol 2016; 85: 830-836
    CrossrefPubMedGoogle Scholar
  • 31 Scholtz JE, Ghoshhajra B. Advances in cardiac CT contrast injection and acquisition protocols. Cardiovasc Diagn Ther 2017; 7: 439-451
    CrossrefPubMedGoogle Scholar
  • 32 Ramos-Duran LR, Kalafut JF, Hanley M. et al. Current contrast media delivery strategies for cardiac and pulmonary multidetector-row computed tomography angiography. J Thoracic Imaging 2010; 25: 270-277
    CrossrefPubMedGoogle Scholar
  • 33 Meyer M, Henzler T. Stellenwert der Herz-CT in der Diagnostik der koronaren Herzerkrankung: Update 2017. Radiologe 2017; 57: 577-590
    CrossrefPubMedGoogle Scholar
  • 34 Zhang LJ, Qi L, Wang J. et al. Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol 2014; 24: 1537-1546
    CrossrefPubMedGoogle Scholar
  • 35 Meyer M, Haubenreisser H, Schoepf UJ. et al. Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 2014; 273: 373-382
    CrossrefPubMedGoogle Scholar
  • 36 Gordic S, Husarik DB, Desbiolles L. et al. High-pitch coronary CT angiography with third generation dual-source CT: limits of heart rate. Int J Cardiovasc Imaging 2014; 30 DOI: 10.1007/s10554-014-0445-5.
    CrossrefPubMedGoogle Scholar
  • 37 Ochs MM, Andre F, Korosoglou G. et al. Strengths and limitations of coronary angiography with turbo high-pitch third-generation dual-source CT. Clin Radiol 2017; 72: 739-744
    CrossrefPubMedGoogle Scholar
  • 38 Goetti R, Baumüller S, Feuchtner G. et al. High-pitch dual-source CT angiography of the thoracic and abdominal aorta: is simultaneous coronary artery assessment possible?. Am J Roentgenol 2010; 194: 938-944
    CrossrefPubMedGoogle Scholar
  • 39 Leschka S, Scheffel H, Desbiolles L. et al. Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol 2007; 42: 543-549
    CrossrefPubMedGoogle Scholar
  • 40 Araoz PA, Kirsch J, Primak AN. et al. Optimal image reconstruction phase at low and high heart rates in dual-source CT coronary angiography. Int J Cardiovasc Imaging 2009; 25: 837-845
    CrossrefPubMedGoogle Scholar
  • 41 Bamberg F, Sommer WH, Schenzle JC. et al. Systolic acquisition of coronary dual-source computed tomography angiography: feasibility in an unselected patient population. Eur Radiol 2010; 20: 1331-1336
    CrossrefPubMedGoogle Scholar
  • 42 Secinaro A, Curione D, Mortensen KH. et al. Dual-source computed tomography coronary artery imaging in children. Pediatr Radiol 2019; 49: 1823-1839
    CrossrefPubMedGoogle Scholar
  • 43 Booij R, Dijkshoorn ML, van Straten M. et al. Cardiovascular imaging in pediatric patients using dual source CT. J Cardiovasc Comput Tomogr 2016; 10: 13-21
    CrossrefPubMedGoogle Scholar
  • 44 Ghekiere O, Salgado R, Buls N. et al. Image quality in coronary CT angiography: challenges and technical solutions. Br J Radiol 2017; 90: 20160567
    CrossrefPubMedGoogle Scholar
  • 45 Cury RC, Abbara S, Achenbach S. et al. CAD-RADS(TM) Coronary Artery Disease – Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr 2016; 10: 269-281
    CrossrefPubMedGoogle Scholar