March/April 2008
Coming October 2008
Applications of Cardiac CT in the Context of Electrophysiology Interventions
Laurens F. Tops, MD, and Jergen Bax, MD, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Acute Chest Pain
Charles S. White, MD, Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD
Introduction
Stephan Achenbach, MD, FACC, FESC, Department of Cardiology, University of Erlangen, Erlangen, Germany
Computed tomography (CT) technology has gone through a very rapid evolution in recent years. Spatial resolution has increased, volume coverage has grown with the use of larger and larger detectors, and temporal resolution has improved tremendously. All of these developments have contributed to an increasing clinical utility of CT for cardiovascular imaging. The entirely new field of coronary CT angiography (CTA) has received especially widespread attention. Although initially there was some significant dispute whether or not this new modality had any clinical utility, it is now steadily finding its way into clinical practice. Through a recently published consensus document, jointly sponsored by cardiology, radiology, and multidisciplinary professional societies, some guidance has become available as to potential clinical applications.1
However, the appearance of a new imaging modality is not without problems. While initial enthusiasm about the new possibilities may lead to some inappropriate applications, others may be overly reluctant to adopt the new method, even for patients who may well benefit from it. Certainly, a great deal of education is necessary when a new diagnostic modality has become available. On the one hand, potential users need to be informed in a very realistic manner about possible clinical applications, but also about all limitations, so that the new technique will be appropriately applied, avoiding both under- and overutilization. On the other hand, thorough education about the “how-to” is required, especially for a technically challenging modality such as cardiovascular CT. Cardiac imaging stretches the temporal and spatial resolution of CT to its very limits. Both data acquisition and image interpretation require special knowledge and experience, and the quality of the data set as well as the experience of the interpreter very directly influence the degree to which the obtained information will be accurate and clinically useful.
In the field of cardiac and cardiovascular CT, the necessary expertise is not restricted to one single area of medical practice. Knowledge of radiology, cardiology, and vascular disease is necessary to competently perform and evaluate the CT scan. Radiologists, cardiologists, and other specialists have to learn from one another in order to maximize the benefit to their patients by appropriately ordering, performing, and interpreting these new tests.
Certainly, the professional discussion about the most appropriate, effective, and efficient applications of cardiac and cardiovascular CT will continue for a while to come. Further technology improvement and increasing ex-perience as well as appropriately designed scientific studies will help identify more and more clinical situations in which CT imaging will be the test of choice.
As a “snapshot” of the current state of affairs, this supplement to Applied Radiology—and a second one to follow in October/November 2008—will provide thorough information as to potential indications of CT imaging for coronary angiography and in the context of peripheral vascular disease. Two in-depth reviews are complemented by a case report that further highlights some applications of cardiac CT. I hope that this supplement will provide you with useful information that you will be able to apply as you return to your office tomorrow.
REFERENCE
- Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006;48: 1475-1497.
