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Coronary Angiography – A Breakthrough in Diagnosis of Coronary Artery Disease  
 
Coronary artery disease is the single largest cause of mortality & morbidity amongst all diseases. It thereby places a very high burden on the health infrastructure of our country. An analysis of the prevalence of coronary artery disease from the 1960’s to 1990’s revealed an approximate 9-fold increase in the prevalence of coronary heart disease in the urban population & a 2-fold increase in coronary heart disease in the rural population.

An increasingly sedentary lifestyle, changing food habits & an ever increasing stressful & competitive work culture have just multiplied the risk factors for coronary artery disease.

The need of the hour is a non-invasive, out patient investigation that accurately diagnoses coronary artery disease early. CT Coronary angiography plays this role to perfection.

What is CT coronary angiography?   
A simple, noninvasive method to evaluate the status of the coronary vessels that supply the heart using an ultrafast 16 slice per rotation Mutislice CT scanner.

How is CT Coronary angio done?   

• The patient is placed on a comfortable CT scanner table.
  A baseline Coronary Calcium Score is calculated within 30seconds.
• A CT angiogram is obtained following contrast injection in one of the peripheral veins of the hand with online ECG monitoring.
• All the images are obtained in one single breathhold of 12-15 secs.
• The entire procedure hardly takes 10 to 15 minutes after which the patient is ready to continue his/her routine.

What information is obtained in this procedure?   
Firstly detection & quantification of calcium within the coronary vessels. Calcification in the vessel wall is an indicator of degree of damage that has occurred to the vessels. A high calcium score is consistent with a moderate to high risk of coronary artery disease. A negative calcium score is predictive of a comparatively very low incidence of coronary artery disease. The coronary arteries are seen similar to as seen on a regular catheter angiogram.

What else can we see?
We can evaluate narrowing of the arteries, blockage of the arteries, presence or absence of collateral vessels & presence of different varieties of plaques(wall thickening) along the arteries causing arterial narrowing.Plaques can be soft plaques(fatty/fibrous) or calcified plaques.Plaques can be stable or unstable, rupture of which is a common cause of sudden death. CT scan can evaluate the types of plaques & decide the various modes of therapy.The status of the heart chambers, heart muscles, valves, aorta & pulmonary vessels can be easily evaluated.

CT Coronary angiography is an excellent investigation to assess the patency of stented vessels, postoperative grafts & to exclude noncardiac causes of chest pain.

 

 

Who should undergo CT Coronary angiogram?
All the patients with high risk factors are potential candidates.

Who are at risk?
Patients with strong family history, heavy smokers,diabetics,patients with high blood pressure, obese patients, with high cholesterol & triglycerides,people with high stress & high tension jobs, alcoholics, etc.

Who should worry?
Changing lifestyle, dietary habits, less physical activity & irregular exercise has certainly created a large section of our society who can be potential heart patients. Hence, such people usually above the age of 40 should worry. CT Coronary angiography is capable of showing & evaluating coronary arteries as good as catheter coronary angiography.

It may be said that CT Coronary angiography is one step ahead, enabling radiologists to detect blocks at the origin of the coronary arteries as well as being able to comment on the type of plaques visualised in the arteries(which cannot be done on regular catheter angiography) & hence comment on the course of treatment.

Thus, CT Coronary angio, is capable of seeing inside the arteries, seeing the walls of the arteries & evaluating structures outside the coronary arteries.
CT Coronary angiogram today is an extremely accurate, reliable, ultrafast, noninvasive, outpatient procedure which is capable of providing detailed information of the heart & coronary vessels, thereby giving the most needed breakthrough in primary evaluation of coronary artery disease.

CT Perfusion
To measure the amount of blood passing through a particular part of the body. 
This is useful in cases of cerebrovascular insults, brain tumours & tumours in other parts of the body.

Virtual Bronchoscopy
To study the tracheobronchial tree from within & without using a bronchoscope. 
It is useful in children with foreign body aspiration & in patients in whom bronchoscopy is contraindicated.

 

 

Virtual Colonoscopy
For noninvasive evaluation of colonic lesions by just distending the colon with air & acquiring axial images. Useful in diagnosing polyps, neoplasms & ulcerative colitis.

 

 

Pulmonary Angiography
With good multiplanar reformatted images, it is useful in suspected cases of pulmonary thromboembolism.

 

 

Peripheral Angiography
Abdominal & renal angiography is useful to study tumor vascularity. Upper & lower limb angiography is useful in cases of polytrauma where early diagnosis is the need of the hour.

Cerebral Angiography
Used for pre operative planning & post operative evaluation of brain tumours, aneurysms & A-V malformations.

CT Temporal Bone
To study inner ear structures with volume rendered images. Of course, regular studies like those to study the brain, neck, chest, abdomen & pelvis can be done with unmatched resolution, at much higher speed & much less radiation dosage to the patient. In fact, the entire body can be scanned in 10 seconds.

 

Ultrafast Imaging
This decreases scan time, increases clarity & contrast. 
Entire brain can be studied in thirty seconds.

Single Breath Hold Imaging
Excellent for abdominal & cardiac studies. 
Entire liver can be studied in one single breath hold.

 

 

Functional MRI
I. This is a revolutionary application of MRI to study the functional aspects of different body organs. 
II. Diffusion MRI : this shows tissue water mobility. Excellent for detecting very early infarcts, ischemia, not seen on routine MRI. 
III. BOLD : excellent for mapping different centres like motor cortex, visual cortex, speech area, etc. highly useful in presurgical localisation of brain centres. 
IV. Perfusion MRI : can measure cerebral blood volume (CBV) & cerebral blood flow (CBF). Useful in grading of tumours, distinguishing viable tumour from necrosis & edema .


MR Spectroscopy 
I. Noninvasive method to measure body metabolites & monitor the biochemistry of acute & chronic stages of disease. 
II. Useful for diagnosis of tumor, differentiation of neoplasm from infarct & infection, to diagnose type & cause of dementia, localization of epileptic centre.

MRS Tumor

 

 

 

 

 

MR Angiography
Excellent noninvasive cerebral, neck, renal, thoracic, abdominal & peripheral angiogram.EPI (Echo Planar Imaging)
I. Revolutionary near real time MR imaging. 
II. Can obtain thirty slices (entire brain) in 4 ms.