Recent developments in coronary computed tomography imaging.

Author(s): Leschka, Stolzmann & Alkadhi

Cardiac computed tomography (CT) has recently emerged as a noninvasive alternative to catheter angiography for the assessment of coronary artery disease. Rapid technological advances have rendered CT coronary angiography a robust, accurate and fast imaging modality to assess coronary artery disease in selected patients. Difficulties in imaging coronary arteries are mainly due to the small vessel size, the tortuous course of the coronary arteries along the heart surface and the fact that the coronary vessels are in constant motion with varying motion velocity during the cardiac cycle. The rotation speed of modern CT systems, the increased spatial and temporal resolution and the ability to time the scan to match the cardiac cycle by means of the ECG signal all assist to minimize cardiac-motion artifacts and allow for the accurate analysis of coronary conditions. Cardiac CT has been established as a comprehensive evaluation method allowing not only assessment of coronary artery stenosis and coronary anomalies, but also permitting analysis of cardiac function, cardiac valve morphology and aortocoronary bypass grafts, and providing highly detailed information about the aorta, pulmonary arteries and veins, lung and mediastinum. This article describes the technical requirements for coronary CT imaging, traces the technical evolution of CT and diagnostic performance of CT coronary angiography, and discusses the limitations and future perspective of coronary CT imaging.