Multislice CT offers unique
features for the workup of patients both as a diagnostic test for
coronary artery disease and as a preventive test for myocardial
There is a lot of debate, who
should indicate and do these tests (cardiologists, radiologists).
This is of course a battle field that entails a huge revenue in a
large medical market that continuously increases it's demands.
At our institution we used MSCT
mainly for calcium scoring, e.g. within the framework of studies
or in clincial daily practice since the year 2000.
A real breakthrough was observed
with the 16 slice scanners and even more so for the 64 slice
scanners, which now offer unique opportunity to rule out coronary
obstruction, pulmonary embolism and aortic dissection within a few
seconds - a specially helpful technique in the emergency room.
For the cardiologist taking care
mainly of ambulatory patients, MSCT offers some opportunities,
that are unique to the technique.
1) in subjects with intermediate coronary
risk assessed e.g. by PROCAM, a coronary calcium score may further
stratify the risk in such subjects. The theoretical background for
this is given
here. In subjects with
suspicion of coronary artery disease and inconclusive results from
ischemia testing, MSCT coronary angiography may be used as a rule
out test for coronary obstruction. This however is reserved to
subjects without large amounts of coronary calcium, with a stable
heart rate around 60 bpm (with or without betablockers) and
without pacemaker implants. Some more detailed thoughts about the
indications of this technique in ambulatory patients is given