"Multislice spiral CT, combined with effective heart-rate control, seems to provide an accurate noninvasive alternative to conventional angiography, which is performed by threading a catheter near the heart and injecting a dye directly into the arteries around the heart," says lead author Koen Nieman, M.D., of the departments of cardiology and radiology at Erasmus Medical Center in Rotterdam, the Netherlands. Some study participants were given beta blockers to slow down their heart rate, thus allowing the scanner to get better images of the heart.
"Because multisclice spiral tomography coronary angiography is safer, requires no hospital admission and involves less patient discomfort, it will become a very suitable alternative in an increasing number of patients with chest pain and suspected coronary heart disease. Earlier detection will improve the treatment of these blockages and may prevent future problems," he says.
In the past decade, considerable progress has been made in noninvasive imaging with MRI, electron beam computed tomography (EBCT), and, most recently, MSCT. During MSCT, a contrast dye is injected through a vein in the arm while the scanner rotates around the body. The reconstruction of multiple cross-sectional slices, or images, is synchronized to the rhythm of the heart using an electrocardiogram (ECG). The resulting three-dimensional images are displayed on a monitor. Earlier generation, four-slice scanners had problems with consistent image interpretability and long scan time. The latest versions of MSCT are able to detect up to 16 images at once, with increased speed and accuracy.
Nieman and colleagues compared the latest 16-slice scanner to conventional angiography. They performed MSCT and then angiography on 59 patients with suspected heart disease. The patients, 53 of whom were male, were between ages 46–70. Thirty-four patients were given beta blockers. Two independent experts reviewed the scans and compared them to angiography. Classification of patients as having no, single, or multivessel disease was accurate in 78 percent of patients and no patients with significant obstructions were incorrectly excluded. "Although no direct comparisons to MRI and EBCT have been conducted, they seem to be outperformed by MSCT with respect to identifying blockages in the coronary arteries," he says.
Co-authors are F. Cademartiri, M.D.; P.A. Lemos, M.D.; R. Raaijmakers, R.T.; P.M.T. Pattynama, M.D., Ph.D.; and P.J. de Feyter, M.D., Ph.D.
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