It’s in the Field of View!
Coronary Artery Analysis on Chest Computed Tomographic Angiography
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Several questions of great importance to the cardiovascular community loom large in chest CT imaging:
Is the imager responsible for reporting all relevant cardiovascular findings in the field of view?
If imaging of the requested organs (aorta and pulmonary arteries) on computed tomographic angiography is enhanced by simple techniques that enable analysis of the coronary arteries, should the acquisition standard of care be changed to permit coronary analysis and reporting?
Coronary Artery Calcium Analysis on Noncontrast Chest CT Scans
The Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology have answered the first question in the 2016 SCCT/STR Guidelines for Coronary Artery Calcium Scoring of noncontrast noncardiac chest CT scans.1 Because Coronary Artery Calcium Scoring analysis is always feasible and the information provides robust prediction of cardiovascular events in asymptomatic patients, the guideline states that Coronary Artery Calcium Scoring by quantitative or semiquantitative analysis should be part of every noncontract chest CT analysis and report, whether gated or nongated, even though it has not been requested by the referring physician.
Coronary Artery Analysis on Contrast Chest CT Scans
The second question, which has not been addressed by any guideline, relates to coronary artery analysis and reporting on contrast CT scans ordered for the acute scenarios of aortic dissection (AD) and pulmonary embolus (PE) and for the chronic surveillance of thoracic aortic aneurysms, both before and after repair. This should be differentiated from the triple rule out in ED chest pain patients with clinical presentations consistent with coronary artery disease (CAD) in which AD and PE are also of concern. In this ED setting, in 1555 patients, 15.5% had >50% coronary diameter stenosis, 1.1% had PE and 0.4% had AD.2 In a second series of 1192 patients, significant CAD was found in 11.7%, PE in 2.3%, and AD in 0.3%.3
As with all imaging paradigm changes, technical feasibility and a favorable benefit to risk …