Cardiac CT: State of the art for the detection of coronary arterial stenosis

The recent evolution of multidetector computed tomography (CT) technology has substantially improved the ability of CT to visualize the heart and coronary arteries. After injection of contrast agent, relatively reliable imaging of the coronary arteries can be achieved, even though some restrictions are caused because the spatial and temporal resolutions are still somewhat limited. Several studies have shown that stenoses of the native coronary arteries can be detected with high sensitivity and specificity if image quality is adequate. More challenging situations include imaging of patients with stents and bypass grafts. Several clinical applications have been defined as “appropriate” and include the use of CT angiography in patients who have symptoms but who cannot exercise or who have an uninterpretable stress test result, or in patients with acute chest pain of intermediate likelihood for coronary artery disease but lack of electrocardiographic changes or myocardial enzyme elevations. It can be expected that further improvement of CT technology will help to more firmly establish the clinical role of CT coronary angiography and to explore further applications of this technique.