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Cardiac CT: why, when, and how

Update 2019

Herz-CT: warum, wann und wie

Update 2019

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Abstract

Purpose

The aim of this study was to review established and emerging techniques of cardiac computed tomography (CT) and their clinical applications with a special emphasis on new techniques, recent trials, and guidelines.

Technological innovations

Cardiac CT has made great strides in recent years to become an ever more robust and safe imaging technique. The improvements in spatial and temporal resolution are equally important as the substantial reduction in radiation exposure, which has been achieved through prospective ECG-triggering, low tube voltage scanning, tube current modulation, and iterative reconstruction techniques. CT-derived fractional flow reserve and CT myocardial perfusion imaging are novel, investigational techniques to assess the hemodynamic significance of coronary stenosis.

Established and emerging indications

In asymptomatic patients at risk for coronary artery disease, CT coronary artery calcium scoring is useful to assess cardiovascular risk and guide the intensity of risk factor modification. Coronary CT angiography is an excellent noninvasive test to rule out obstructive coronary artery disease in patients with stable chest pain. In acute chest pain with normal ECG and normal cardiac enzymes, cardiac CT can safely rule out acute coronary syndrome although its benefit and role in this indication remains controversial. Cardiac CT is the established standard for planning transcatheter aortic valve implantation and—increasingly—minimally invasive mitral valve procedures.

Practical recommendations

Our review makes practical recommendations on when and how to perform cardiac CT and provides templates for structured reporting of cardiac CT examinations.

Zusammenfassung

Ziel

Ziel des vorliegenden Beitrags ist die Darstellung etablierter und aufkommender Techniken der Computertomographie des Herzens (Herz-CT) und ihrer klinischen Anwendungen mit besonderem Schwerpunkt auf neuen Techniken, aktuellen Studien und Leitlinien.

Technologische Innovationen

Die Herz-CT hat in den letzten Jahren große Fortschritte gemacht und ist eine immer robustere und sicherere Methode geworden. Die Verbesserung der räumlichen und zeitlichen Auflösung ist dabei ebenso wichtig wie die Reduktion der Strahlenexposition, die durch prospektive EKG-Triggerung, niedrige Röhrenspannung, Röhrenstrommodulation und iterative Rekonstruktionstechniken erreicht wurde. Die CT-basierte fraktionelle Flussreserve und die myokardiale Perfusions-CT sind neuartige Untersuchungstechniken zur Beurteilung der hämodynamischen Relevanz von Koronarstenosen.

Etablierte und sich abzeichnende Indikationen

Bei asymptomatischen Patienten mit Risikofaktoren für eine koronare Herzkrankheit (KHK) ist die Quantifizierung des Koronarkalks mittels CT hilfreich, um das kardiovaskuläre Risiko zu bestimmen und die Intensität der Risikofaktormodifikation festzulegen. Die koronare CT-Angiographie ist ein hervorragender nichtinvasiver Test, um eine obstruktive KHK bei Patienten mit stabilem Brustschmerz auszuschließen. Bei akutem Thoraxschmerz mit normalem EKG und normalen Herzenzymen kann die Herz-CT ein akutes Koronarsyndrom sicher ausschließen. Nutzen und Rolle der Methode sind aber für diese Indikation weiterhin umstritten. Die Herz-CT ist der etablierte Standard für die Planung der katheterbasierten Aortenklappenimplantation – und zunehmend auch minimalinvasiver Eingriffe an der Mitralklappe.

Praktische Empfehlungen

Dieser Übersichtsartikel gibt praktische Empfehlungen zur Indikationsstellung und Durchführung der Herz-CT und stellt Vorlagen für die strukturierte Befundung von Herz-CT-Untersuchungen zur Verfügung.

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Author information

Authors and Affiliations

  1. Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

    Anke Busse, Daniel Cantré, Ebba Beller, Felix Streckenbach, Marc-André Weber & Felix G. Meinel MD

  2. Department of Internal Medicine, Division of Cardiology, Rostock University Medical Center, Rostock, Germany

    Alper Öner & Hüseyin Ince

Authors
  1. Anke Busse
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  2. Daniel Cantré
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  3. Ebba Beller
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Corresponding author

Correspondence to Felix G. Meinel MD.

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Conflict of interest

A. Busse, D. Cantré, E. Beller, F. Streckenbach, A. Öner, H. Ince, M.-A. Weber, and F.G. Meinel declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by industry.

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Busse, A., Cantré, D., Beller, E. et al. Cardiac CT: why, when, and how. Radiologe 59 (Suppl 1), 1–9 (2019). https://doi.org/10.1007/s00117-019-0530-9

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