Multislice Computed Tomography (MSCT)




Last update: 05.01.2015




  A short overview

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 infarction. 

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 here .


This pdf file informs you about a primary prevention pilot study performed at our institution in order to define with more precision, how atherosclerosis imaging might serve as a tool in new risk prediction models. This might help  to improve risk prediction for myocardial infarction and improve allocation of expensive primary care prevention strategies.


This pdf file informs you about my view, when and how to perform MSCT coronary angiography in subjects with known or suspected coronary artery disease.