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Rofo 2022; 194(06): 613-624
DOI: 10.1055/a-1747-3554
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Update for the Performance of CT Coronary Angiography – Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine

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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Abstract

Background Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure.

Method The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience.

Results and Conclusion According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI).

Key Points: 

  • CCTA is a valid method to exclude coronary artery disease in patients with a low to intermediate clinical likelihood.

  • Even with the latest generation CT scanners, premedication with beta blockers and nitrates can improve image quality at low radiation exposure.

  • Current CT scanners usually provide retrospective ECG gating and prospective ECG triggering. Dual-source scanners additionally provide a “high pitch” scan mode to scan the whole heart during one heartbeat, which may also be achieved using single-source scanners with broad detectors in some cases.

  • Besides the available scanner technology, the choice of scan mode primarily depends on heart rate and heart rate variability (e. g., arrhythmia).

Citation Format

  • 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

 

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