CT Imaging of Coronary Arteries

  • Michele Porcu
  • Marco Francone
  • Giovanni Maria Argiolas
  • Giuseppe Cannavale
  • Mario Piga
  • Jasjit S. Suri
  • Iacopo Carbone
  • Carlo Catalano
  • Luca SabaEmail author


Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity in Europe and in the USA, representing high sanitary costs for insurance and national health systems. Coronary angiography is still the gold standard for the real-time visualisation and assessment of coronary circle and a fundamental interventional tool for intravascular thrombolysis and stenting placement procedures, but nowadays a new imaging modality has emerged as reference technique for the diagnostic assessment of the coronary: CT angiography (CTA). This technique allows a non-invasive examination of the coronaries, including the evaluation of vessel lumen, the conditions of the coronary walls, the plaque type and morphology, and the relationships between the vessels and the heart. CTA has become a very important instrument to evaluate coronary arteries in particular for those symptomatic patients with a low-intermediate risk for CAD. In this chapter we present the state of the art of CTA of coronary arteries.


Coronary Artery Bypass Graft Left Anterior Descend Right Coronary Artery Coronary Artery Calcium Score Vessel Lumen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Go AS, et al. Heart disease and stroke statics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–245.CrossRefPubMedGoogle Scholar
  2. 2.
    Hamdan A, et al. A prospective study for comparison of MR and CT imaging for detection of coronary artery stenosis. JACC Cardiovasc Imaging. 2011;4(9):50–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Bastarrika G, et al. CT of coronary artery disease. Radiology. 2009;253(2):317–38.CrossRefPubMedGoogle Scholar
  4. 4.
    Kakouros N, et al. The utility of cardiac CT beyond the assessment of suspected coronary artery disease. Clin Radiol. 2012;67:695e708.CrossRefGoogle Scholar
  5. 5.
    Sundaram B, et al. Anatomy and terminology for the interpretation and reporting of cardiac MDCT: Part 1, Structured report, coronary calcium screening, and coronary artery anatomy. AJR Am J Roentgenol. 2009;192:574–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Cerqueira MD, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation. 2002;105:539–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee J. Coronary artery calcium scoring and its impact on the clinical practice in the era of multidetector CT. Int J Cardiovasc Imaging. 2011;27:9–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Sundaram B, et al. Anatomy and terminology for the interpretation and reporting of cardiac MDCT: Part 2, CT angiography, cardiac function assessment, and noncoronary and extracardiac findings. AJR Am J Roentgenol. 2009;192:584–98.CrossRefPubMedGoogle Scholar
  9. 9.
    Agatston AS, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Patel J, et al. All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000. J Cardiovasc Comput Tomogr. 2014;8:26–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Sun Z, et al. Coronary CT angiography: current status and continuing challenges. Br J Radiol. 2012;85:495–510.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Pannu HK, et al. β-blockers for cardiac CT: a primer for the radiologist. AJR Am J Roentgenol. 2006;186:S341–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Hassan A, et al. Technical challenges of coronary CT angiography: today and tomorrow. Eur J Radiol. 2011;79:161–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Bastarrika G, et al. Cardiac CT in the assessment of acute chest pain in the emergency department. AJR Am J Roentgenol. 2009;193:397–409.CrossRefPubMedGoogle Scholar
  15. 15.
    Cody DD, et al. AAPM/RSNA physics tutorial for residents technologic advances in multi-detector CT with a focus on cardiac imaging. RadioGraphics. 2007;27:1829–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Sun Z. Multislice CT angiography in cardiac imaging: prospective ECG-gating or retrospective ECG-Gating? Biomed Imaging Interv J. 2010;6(1), e4.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Qin J, et al. Prospective versus retrospective ECG gating for 320-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Clin Imaging. 2011;35:193–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Carrascosa P, et al. Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate. J Cardiovasc Comput Tomogr. 2010;4:197–205.CrossRefPubMedGoogle Scholar
  19. 19.
    Stolzmann P, et al. Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. Radiology. 2008;249(1):71–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Schoepf UJ, et al. CT of coronary artery disease. Radiology. 2004;232:18–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Silva AC, et al. Innovations in CT dose reduction strategy: application if the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol. 2010;194:191–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Leipsic J, et al. Adaptive statistical iterative reconstruction: assessment of image noise and image quality in coronary CT angiography. AJR Am J Roentgenol. 2010;195:649–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Scheffel H, et al. Coronary artery plaques: cardiac CT with model-based and adaptive-statistical iterative reconstruction technique. Eur J Radiol. 2012;81:e363–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Siripornpitak S, et al. Cardiac CT angiography in children with congenital heart disease. Eur J Radiol. 2013;82:1067–82.CrossRefPubMedGoogle Scholar
  25. 25.
    Sun Z, et al. Coronary CT angiography: how should physicians use it wisely and when do physicians request it appropriately? Eur J Radiol. 2012;81:e684–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Habib PJ, et al. Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography: a systematic review and meta-analysis. Int J Cardiol. 2013;169:112–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Dougoud S, et al. Prognostic value of coronary CT angiography on long-term follow-up of 6.9 years. Int J Cardiovasc Imaging. 2014;30(5):969–76. doi: 10.1007/s10554-014-0420-1.CrossRefPubMedGoogle Scholar
  28. 28.
    Han BK, et al. Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population. J Cardiovasc Comput Tomogr. 2012;6:252–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Zheng M, et al. Image quality of ultra-low-dose dual-source CT angiography using high-pitch spiral acquisition and iterative reconstruction in young children with congenital heart disease. J Cardiovasc Comput Tomogr. 2013;7:376–82.CrossRefPubMedGoogle Scholar
  30. 30.
    Angelini P, et al. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449–54.CrossRefPubMedGoogle Scholar
  31. 31.
    Yu F-F, et al. Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual-source CT. J Cardiovasc Comput Tomogr. 2013;7:383–90.CrossRefPubMedGoogle Scholar
  32. 32.
    Pleva L, et al. Congenital coronary anomalies. Cor Vasa. 2014;56:e27–36.CrossRefGoogle Scholar
  33. 33.
    Torres FS. Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries. J Cardiovasc Comput Tomogr. 2010;4:246–54.CrossRefPubMedGoogle Scholar
  34. 34.
    Diaz-Zamudio M, et al. Coronary artery aneurysms and ectasia: role of coronary CT angiography. RadioGraphics. 2009;29:1939–54.CrossRefPubMedGoogle Scholar
  35. 35.
    Alegria JR, et al. Myocardial bridging. Eur Heart J. 2005;26:1159–68.CrossRefPubMedGoogle Scholar
  36. 36.
    Choi HS, et al. Pitfalls, artifacts, and remedies in multi-detector row CT coronary angiography. RadioGraphics. 2004;24:787–800.CrossRefPubMedGoogle Scholar
  37. 37.
    Aldana-Sepulveda N, et al. Single coronary artery: spectrum of imaging findings with multidetector CT. J Cardiovasc Comput Tomogr. 2013;7:391e399.CrossRefGoogle Scholar
  38. 38.
    Kumar V, Abbas AK, Fausto N. Robbins and Contran pathologic bases of disease—Italian Version—Capitolo 11: Frederick J. Schoen: Vasi sanguigni. Philadelphia, PA: Elsevier; 2006. p. 511–554.Google Scholar
  39. 39.
    Bogot NR, et al. Cardiac CT of the transplanted heart: indications, technique, appearance, and complications. RadioGraphics. 2007;27:1297–309.CrossRefPubMedGoogle Scholar
  40. 40.
    Sun Z, et al. CT virtual intravascular endoscopy assessment of coronary artery plaques: a preliminary study. Eur J Radiol. 2010;75:e112–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Brodoefel H, et al. Accuracy of dual-source CT in the characterisation of non-calcified plaque: use of a colour-coded analysis compared with virtual histology intravascular ultrasound. Br J Radiol. 2009;82:805–12.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Vliegenthart R, et al. Dual-energy CT of the heart. AJR Am J Roentgenol. 2012;199:S54–63.CrossRefPubMedGoogle Scholar
  43. 43.
    Kang DK, et al. Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. Semin Ultrasound CT MR. 2010;31(4):276–91.CrossRefPubMedGoogle Scholar
  44. 44.
    Sun Z, et al. Multislice CT angiography assessment of left coronary artery: correlation between bifurcation angle and dimensions and development of coronary artery disease. Eur J Radiol. 2011;79:e90–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Soto ME, et al. Coronary CT angiography in Takayasu arteritis. JACC Cardiovasc Imaging. 2011;4(9):958–66.CrossRefPubMedGoogle Scholar
  46. 46.
    Ozcan OU, et al. Coronary artery ectasia. Cor Vasa. 2013;55:e242–7.CrossRefGoogle Scholar
  47. 47.
    McMahon MA, et al. Multidetector CT of aortic dissection: a pictorial review. RadioGraphics. 2010;30:445–60.CrossRefPubMedGoogle Scholar
  48. 48.
    Sharma N, et al. Spontaneous left main coronary artery dissection in pregnancy. Int J Cardiol. 2012;159:e11–3.CrossRefPubMedGoogle Scholar
  49. 49.
    Zenooz NA, et al. Coronary artery fistulas: CT findings. RadioGraphics. 2009;29:781–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Pugliese F, et al. Multidetector CT for visualization of coronary stents. RadioGraphics. 2006;26:887–904.CrossRefPubMedGoogle Scholar
  51. 51.
    Frazier AA, et al. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. RadioGraphics. 2005;25:881–96.CrossRefPubMedGoogle Scholar
  52. 52.
    Khedr SA, et al. Diagnostic value of MDCT angiography in assessment of coronary artery bypass graft. Egypt J Radiol Nucl Med. 2013;44:183–91.CrossRefGoogle Scholar
  53. 53.
    Romagnoli A, et al. Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries. Radiol Med. 2010;115:1167–78.CrossRefPubMedGoogle Scholar
  54. 54.
    Gao SZ, et al. Accelerated coronary vascular disease in the heart transplant patient: coronary arteriographic findings. J Am Coll Cardiol. 1988;12:334–40.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Michele Porcu
    • 1
  • Marco Francone
    • 2
  • Giovanni Maria Argiolas
    • 3
  • Giuseppe Cannavale
    • 2
  • Mario Piga
    • 4
  • Jasjit S. Suri
    • 5
  • Iacopo Carbone
    • 2
  • Carlo Catalano
    • 2
  • Luca Saba
    • 1
    Email author
  1. 1.University of CagliariCagliariItaly
  2. 2.Department of Radiology, Oncology and PathologyLa Sapienza UniversityRomeItaly
  3. 3.Department of RadiologyAzienda Ospedaliero Brotzu (A.O.B.)CagliariItaly
  4. 4.Department of RadiologyAzienda Ospedaliero Universitaria (A.O.U.)CagliariItaly
  5. 5.AtheroPoint LLCRosevilleUSA

Personalised recommendations