CT calcium and coronary lumen imaging allow efficient exclusion of coronary artery disease (CAD), but cannot assess the hemodynamic significance of obstructive findings. Addition of stress myocardial perfusion imaging, which assesses the functional relevance of coronary narrowing, completes the non-invasive cardiac evaluation. Understand the diagnostic role and limitations of coronary calcium imaging in symptomatic patients. Understand the diagnostic performance of coronary CT angiography and the clinical interpretation of findings. Identify suitable candidates and perform stress myocardial perfusion imaging for clinical decision making. Combine calcium imaging,...

1. Coronary calcium imaging Diagnostic Role in symptomatic patients CT Calcium mostly used for risk stratification A negative Calcium score makes obstructive CAD very unlikely and is associated with an excellent prognosis CT Calcium detection is a reliable means to exclude obstructive CAD in stable symptomatic patients (Figure 1) Protocol Simple, ECG-triggered CT scan without contrast medium to assess the presence and quantity of calcified coronary plaque. In patients with a low-intermediate probability of CAD, the absence of calcium excludes obstructive CAD. Patients with a...

1. CT coronary calcium scan Simple, ECG-triggered CT scan without contrast medium to assess the presence and quantity of calcified coronary plaque. Scan parameters: 80 kV, 80 mAs, collimation 32x1.2 mm, reconstructed as consecutive 3.0/1.5mm slices. Contra-indication to any CT: pregnancy. 2. CT coronary angiography ECG-triggered, contrast-enhanced CT scan to image the coronary artery lumen and detect obstructive coronary disease. The main scan protocol is a prospectively ECG-triggered axial CT scan protocol. In patients with an irregular or very fast heart rate a spiral CT...

CT calcium and coronary lumen imaging allow efficient exclusion of coronary artery disease (CAD), but cannot assess the hemodynamic significance of obstructive findings. Addition of stress myocardial perfusion imaging, which assesses the functional relevance of coronary narrowing, completes the non-invasive cardiac evaluation. This complete comprehensive cardiac CT examination will allow fast, accurate and complete evaluation of suspected CAD.

M.Lubbers, A. Coenen, M. Ouhlous, R. G. Saru, G. P. Krestin, K. Nieman; Erasmus MC Rotterdam, the Netherlands

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