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CT of Coronary Artery Disease

Herzog, Christopher MD* †; Zangos, Stefan MD* †; Zwerner, Peter MD; Costello, Philip MD; Vogl, Thomas J. MD*; Schoepf, U. Joseph MD† ‡

doi: 10.1097/RTI.0b013e318032394f

The clinical relevance of coronary artery disease has considerably driven the recent development of radiologic tools for noninvasive cardiac imaging. Modern multidetector row computed tomographic (MDCT) systems combine high temporal and spatial resolution, electrocardiographic synchronization, and ease of use. In cardiac imaging, MDCT has not only replaced electron-beam CT, but also challenges competing methods such as magnetic resonance imaging, echocardiography, or even coronary catheterization. Noncontrast material-enhanced assessment of atherosclerotic plaques (CT calcium scoring) seems useful for the cardiac risk stratification in asymptomatic patients and monitoring of medical (statin) therapy. Contrast material-enhanced CT coronary angiography has become established as a valuable method for several clinical indications such as evaluation of coronary artery anomalies, bypass patency, or preoperative planning. Particularly, the high negative predictive value of a normal CT coronary angiogram allows reliable exclusion of coronary artery stenosis. Plaque characterization is another promising area of research in MDCT cardiac imaging. However, with current technology a reliable distinction between atheroma and fibroatheroma is impaired by restrictions in spatial resolution. Recent studies indicate that CT angiography may also be suited for other clinical applications such as triage of patients with acute coronary syndrome and inconclusive clinical presentation, patients with symptomatic chest pain, and intermediate risk profile or cardiac risk stratification in asymptomatic patients.

*Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany

Department of Radiology

Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina

Reprints: Christopher Herzog, MD, Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.