Dual Energy CT Imaging for the Assessment of Coronary Artery Stenosis

RODRIGUEZ GRANILLO GA; CARRASCOSA P; GARCIA MJ

Dual-Energy CT in Cardiovascular Imaging

Springer

Año: 2015; p. 173 - 193

Epidemiologicaldata assembled during the past decade has demonstrated a significant reductionin death rates attributed to cardiovascular disease. Nevertheless, despite suchenduring efforts in prevention and treatment of coronary artery disease (CAD),one third of deaths in the United States are cardiovascular.1Accordingly, there is still large span for improvement in prevention andtreatment. Thefield of cardiovascular imaging provides different methods to approach patientswith suspected CAD. These methods can be discriminated into two major groups:anatomical (computed tomography coronary angiography, CTCA; magnetic resonancecoronary angiography; MRA), and functional (stress-echocardiography, nuclearmedicine, stress-magnetic resonance).Likewise,an additional distinction should be made between methods that evaluate coronaryartery atherosclerosis, and those that evaluate coronary stenosis. At firstsight it might seem that there are no differences between both, although themild semantical variation conceals large diagnostic and prognosticimplications.Methodsthat evaluate CAD, either by means of functional tests of by invasiveangiography, target the sole evaluation of the luminal impact of the disease.On the contrary, CTCA has the unique ability to characterize not only thelumen, but the vessel wall as well.2,3 The principle of dual energycomputed tomography (DECT) is closely related to material decomposition andtherefore warrants a comprehensive description.    CTCA hassignificantly contributed to visualize atherosclerosis in the earlier phasesand therefore to reduce the blind gap between the onset of coronaryatherosclerosis and the development of obstructive CAD.4 This has greatprognostic implications since most acute thrombotic coronary events arise fromangiographically non-obstructive lesions.