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Controversies in Imaging

Noninvasive Diagnostic and Prognostic Assessment of Individuals With Suspected Coronary Artery Disease

Coronary Computed Tomographic Angiography Perspective

James K. Min, MD and Leslee J. Shaw, PhD

From the Departments of Medicine and Radiology (J.K.M.), Weill Medical College of Cornell University and the New York Presbyterian Hospital, New York, NY; and Department of Medicine (L.J.S.), Emory University School of Medicine.

Correspondence to James K. Min, MD, Department of Medicine, Division of Cardiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY 10021. E-mail jkm2001@med.cornell.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Despite significant advances in medical and interventional therapies, coronary artery disease (CAD) remains the most common cause of mortality and morbidity worldwide. In the United States alone, CAD is responsible for approximately one third of all deaths in individuals <75 years of age.¹ Each year, upwards of 800 000 individuals within the United States will present with a symptomatic myocardial infarction (MI), and an additional 200 000 will occur as "silent," or clinically unrecognized infarctions.²

Response by Gibbons p 281

Traditionally, evaluation of individuals at risk for CAD events has used the noninvasive cardiac imaging modalities, primarily by evaluation of myocardial perfusion with single-photon emission computed tomography (MPS CT), positron-emission tomography, echocardiography, and MRI or by identification of regional wall motion abnormalities with stress echocardiography.^3,4 These functional methods of assessment, aimed primarily at indirect identification of flow-limiting coronary artery stenoses, have proven robust in the diagnosis and risk stratification of individuals with and without CAD.

Recently, coronary computed tomographic angiography (CCTA) has emerged as a promising method for anatomic detection of atherosclerotic plaque within coronary arteries.^5–7 Developments in CT—driven primarily by improvements in temporal and spatial resolution and volume coverage—now permit routine evaluation of the coronary arteries and cardiovascular structures with exquisite clarity. Given the recent introduction of 64-detector row CCTA in 2005, numerous questions remain as to when it should be used in clinical practice and if so, before, after, in conjunction with or in lieu of functional stress testing.

The purpose of the following review is to provide . . . [Full Text of this Article]