INT 江忠穎

1. Roles of Nuclear Cardiology, Cardiac Computed Tomography Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery Disease INT 江忠穎

2. Role of CT Coronary Angiography(CTA) • spatial resolution of 0.4 mm • high sensitivity and high specificity • fewer heart beats are required for acquisition • low-contrast dose ,<100 mL are routine • be performed in approximately 10 min • can visualize not only the vessel lumen but also the wall • the size of noncalcified coronary plaque • pulmonary embolism,acute coronary syndrome, and aortic dissection Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

5. CTA and myocadiac perfusion SPECT • For intermediate risk patients CTA-preferred initial test MPS-seondary test • For purposes of risk assessment, for patients with known disease or for those known or likely to have extensive coronary calcium, MPS is likely to remain as the dominant approach. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

8. Limitation of coronary CTA • presence of dense calcification of the coronary arteries • need for a regular heart rhythm and a relatively low heart rate • a tendency to overestimate the degree of stenosis • radiation Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

9. PET/CT and SPECT/CT • provide both detection of coronary stenosis and assessment of functional significance • Provide information with regard to coronary calcium, coronary stenoses, and stress-induced ischemia. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

10. Role of CMR in Detection of CAD • effective method for comprehensive cardiac assessment • assessment of cardiac chamber volumes and function • myocardial mass and thrombi • valvular function • high resolution • complex congenital and acquired cardiac and vascular disease • Late enhancement with gadolinium-detect MI, both acute and chronic Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

11. ischemic or nonischemic cardiomyopathy • high resolution of CMR allows the discrimination of subendocardial and subepicardial flow • In comparison to MPS, the advantage of CMR is the lack of dependence on regional hypoperfusion • The limitation of balanced reduction of flow is unlikely to apply to CMR Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

13. Role of CMR in Detection of CAD • No radiation, no contrast • Extended study time, needed expertise • Acquisitions are obtained over several heart beats, increasing the possibility of misregistration • a meta-analysis of 48 studies in which MSCT has been shown to have higher sensitivity and specificity than CMR for noninvasive coronary angiography Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006

14. Conclusion • CT and CMR techniques are currently undergoing rapid technological development and growth • nuclear cardiology techniques will continue to be of great practical value and will often be used in combination with the CCT or CMR modalities. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Assessment of Patients with Suspected Coronary Artery DiseaseJ. Nucl. Med. Jan 01, 2006