Computed Coronary Angiography

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What is CT Coronary Angiography?

It is the painless imaging of the heart vessels with new-generation Computed Tomography devices in a very short time of about 10-12 seconds. Today, high-quality images can be obtained with 40- and 64-detector CT devices. Approximately 300-500 slices are obtained from each patient, and the data carry volume information rather than just slices. Thanks to advances in information technology, computer-aided diagnosis programs and advanced, fast computers, the data obtained are processed with high speed and accuracy, and diagnostic images can be obtained that are almost equivalent to conventional catheter angiography performed through the groin artery. In comparative studies with catheter angiography performed through the groin artery, which is accepted as the gold standard, the accuracy, sensitivity and specificity values for coronary stenoses with 40-64 detector devices range between 90% and 100%. In particular, the negative predictive value – that is, coronary arteries assessed as normal on CT angiography actually being normal – has been found to be 100% in many comparative studies.

Who is it performed for?

Situations in which CT coronary angiography can be used:

• Detecting atherosclerotic plaques that cause narrowing in the heart vessels and assessing the degree of narrowing,

• Calcium scoring,

• Check-ups of patients who have no complaints but are at risk,

• Checking vessels used during bypass surgery and vessels opened with a balloon or fitted with a stent,

• Examining coronary artery anatomy to show abnormalities and anatomical variations considered normal,

• Evaluating the coronary arteries in patients at high risk for catheter angiography,

• Obtaining complementary information in cases where catheter angiography is inconclusive or unsuccessful.

CT coronary angiography is an advanced imaging method that should be the first choice in cases where catheter angiography is insufficient or risky and in the situations listed above, and it is expected to eliminate the need for diagnostic catheter angiography in the near future. Over the last year, CT coronary angiography has come to be accepted as the gold standard for assessing the patency of vessels used during bypass surgery and of stents. This examination technique has been accepted by cardiology and radiology associations and societies in Europe and America, and in these countries it is covered by insurance companies. In particular, patients in the low and intermediate risk groups who have complaints, as well as congenital vascular abnormalities, stenoses and plaques, can be evaluated.

How is it performed?

From a technical point of view, CT coronary angiography is performed while the patient is awake and holds their breath for 10-12 seconds. Images are obtained with an iodinated contrast agent given through the veins in the arm or hand. The procedure has a short preparation period. During this period, the patient is informed about how the procedure will be performed, its possible risks and the precautions to be taken against them. The scan can be performed after a short preparation, and patients can return to their normal lives within a few minutes after the scan. CT angiography is performed by the teams of the Radiology Department; the data obtained are processed with various computer programs and converted into different images, including 3D ones, then evaluated by Radiology Specialists, after which the necessary medical and interventional treatments are decided by Cardiology and Cardiovascular Surgery Specialists.

What are its benefits?

CT coronary angiography allows treatment through early diagnosis before a heart attack occurs. As the method becomes more widespread and further developed, many patients with silent coronary artery disease will be able to receive early diagnosis and treatment. With coronary CT angiography, not only the lumen of the coronary arteries (the channel in which blood flows) but also the vessel wall structure, plaque characteristics, and the anatomy and structural disorders of the heart and of the main arteries of the heart and lungs can be examined; in addition, functional studies (related to how the heart works and the work it performs) can be carried out, and the movements of the heart chambers during normal function and heart valve functions can be evaluated with almost real-time cine (moving) images.

What are the future expectations?

Although not yet in routine use, studies performed with 256-detector devices are being published. In the near future, the concept of detector count will disappear, and with flat panel systems (high-resolution flat detectors beyond numbers) images with much higher spatial and temporal resolution will be obtained, and diagnostic catheter angiography procedures will give way to this remarkable technology.

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