Journal of cardiovascular computed tomography
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J Cardiovasc Comput Tomogr · Mar 2009
Cardiac computed tomographic angiography in an outpatient setting: an analysis of clinical outcomes over a 40-month period.
Cardiac computed tomographic angiography (CTA) provides for accurate noninvasive diagnosis of coronary artery disease (CAD). ⋯ In symptomatic patients with an intermediate likelihood of CAD referred for CTA, normal coronary arteries or nonobstructive CAD portends an excellent prognosis. The finding of obstructive CAD identifies patients at higher risk of subsequent MI, independent of cardiovascular risk factors and coronary artery calcium.
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J Cardiovasc Comput Tomogr · Jan 2009
ReviewRole of computed tomography in the evaluation of acute chest pain.
Chest pain is common and the initial clinical presentation is often nonspecific. The emergency physician faces the challenge of correctly identifying those patients with a life-threatening cause of chest pain while avoiding unnecessary hospital admissions. Three important life-threatening causes of chest pain are aortic dissection, pulmonary embolism, and acute coronary syndrome. ⋯ Improvements in CT scanner technology now enable in-depth data on the coronary arteries. Although angiographic information is limited in its relation to physiologic lesion significance, coronary CT is used to safely diagnose or exclude coronary disease as a source of chest pain in emergency department patients. "Triple rule-out" protocols designed to simultaneously assess the aorta, pulmonary arteries, and coronary arteries are a compromise between dedicated protocols for each diagnosis. The diagnostic value and appropriate clinical use of these protocols remain to be shown by randomized, controlled, outcomes-based trials.
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J Cardiovasc Comput Tomogr · Sep 2008
Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease.
Dilatation of the aortic root and other segments of the thoracic aorta is important in the pathogenesis of aortic regurgitation and of aortic dissection. Although echocardiographic criteria exist to detect aortic root dilation, comparably standardized methods have not been developed to detect enlargement of the remainder of the thoracic aorta. Nongated axial chest computed tomography (CT), traditionally used to evaluate aortic size, does not account for the obliquity, systolic expansion, and nonaxial motion of the aorta during the cardiac cycle. Reference values for aortic diameters in anatomically correct double-oblique short axis images have not been established with the use of electrocardiogram (ECG)-gated 64-detector row multidetector CT (MDCT). ⋯ This study establishes age- and sex-specific ECG-gated MDCT reference values for thoracic aortic diameters in healthy, normotensive, nonobese adults to identify aortic pathology by MDCT. MDCT measurements of the thoracic aorta should use ECG-gated double-oblique short-axis images for accurate quantification.
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J Cardiovasc Comput Tomogr · Jul 2008
Case ReportsInflammatory aortitis with coronary arterial involvement by multidetector cardiac computed tomography.
A 40-year-old man with a history of hypertension was admitted for a non-ST-segment myocardial infarction. A multidetector coronary computed tomography (MDCCT) showed proximal aortic intramural thickening with extrinsic thickening and luminal compression of the proximal left circumflex coronary artery. Subsequent surgical evaluation and positron emission tomography imaging showed evidence of active inflammation of the proximal aorta and coronary arteries. Hence, this case illustrates an uncommon cause of myocardial ischemia and the emerging complimentary role that MDCCT can play in such patients.
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J Cardiovasc Comput Tomogr · Mar 2008
ReviewCurrent status and future directions in technical developments of cardiac computed tomography.
Labeled as a dying modality in the late 1980s, the remarkable resurgence of computed tomography (CT) was the commercial availability of the helical CT and the multidetector-row CT (MDCT) scanners. The MDCT scanners in particular were responsible for creating new and promising opportunities for imaging the heart and the vascular system in a noninvasive manner. ⋯ Work in progress on the potential of the dual-energy CT, the 256-slice MDCT, and the flat-panel volume CT, suggest the possibility of new and interesting cardiac applications. This review article describes the present status of CT in noninvasive cardiac imaging and highlights the future directions of the technology.