Roles of Nuclear Cardiology, Cardiac Computed Tomography Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease

INT 江忠穎

Role of CT Coronary Angiography(CTA)

• spatial resolution of 0.4 mm• high sensitivity and high specificity• fewer heart beats are required for acquisition• low-contrast dose ,<100 mL are routine• be performed in approximately 10 min• can visualize not only the vessel lumen but also the wall • the size of noncalcified coronary plaque• pulmonary embolism,acute coronary syndrome, and aortic

dissection

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

CTA and myocadiac perfusion SPECT

• For intermediate risk patients

CTA-preferred initial test

MPS-seondary test

• For purposes of risk assessment, for patients with known disease or for those known or likely to have extensive coronary calcium, MPS is likely to remain as the dominant approach.

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

Limitation of coronary CTA

• presence of dense calcification of the coronary arteries

• need for a regular heart rhythm and a relatively low heart rate

• a tendency to overestimate the degree of stenosis

• radiationRoles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

PET/CT and SPECT/CT

• provide both detection of coronary stenosis and assessment of functional significance

• Provide information with regard to coronary calcium, coronary stenoses, and stress-induced ischemia.

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

Role of CMR in Detection of CAD

• effective method for comprehensive cardiac assessment• assessment of cardiac chamber volumes and function • myocardial mass and thrombi• valvular function • high resolution• complex congenital and acquired cardiac and vascular dis

ease• Late enhancement with gadolinium-detect MI, both acute

and chronic

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

• ischemic or nonischemic cardiomyopathy• high resolution of CMR allows the discrimination

of subendocardial and subepicardial flow• In comparison to MPS, the advantage of CMR is t

he lack of dependence on regional hypoperfusion • The limitation of balanced reduction of flow is unli

kely to apply to CMR

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

Role of CMR in Detection of CAD

• No radiation, no contrast• Extended study time, needed expertise• Acquisitions are obtained over several heart beat

s, increasing the possibility of misregistration• a meta-analysis of 48 studies in which MSCT has

been shown to have higher sensitivity and specificity than CMR for noninvasive coronary angiography

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006

Conclusion

• CT and CMR techniques are currently undergoing rapid technological development and growth

• nuclear cardiology techniques will continue to be of great practical value and will often be used in combination with the CCT or CMR modalities.

Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease J. Nucl. Med. Jan 01, 2006