Evidence for Cardiac CT Keeps Growing

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Chris P. Kaiser, Editor

This month’s top stories for the cardiac imaging portal focus on coronary CT angiography (CCTA). Despite, or perhaps because of, the rocky road that CCTA has endured, the evidence regarding its effectiveness, particularly in low- to intermediate-risk patients, continues to mount.

Our first top story looks at a large meta-analysis encompassing more than 1,300 patients from 22 peer-reviewed studies. Not only did the researchers find that 40- or 64-slice CCTA is effective in detecting or ruling out coronary artery disease (CAD), they also compared CCTA’s effectiveness in the proximal versus distal artery segments.

Of no surprise, CCTA is better at detecting CAD in the proximal arteries. Researchers, however, point to evidence that suggests that stenoses in the proximal arteries are more likely to have a clinical impact than stenoses in the distal arteries.

In the second top story, researchers found that CCTA tends to either underestimate or overestimate the degree of stenosis, typically from beam hardening or blooming artifacts. The investigators offer suggestions on how to overcome these shortcomings of CCTA. They concluded, however, that CCTA is an excellent tool to triage low- to intermediate-risk chest pain patients, whose pain is not associated with CAD and who might otherwise go to the cath lab.

In our featured stories, you can read about how a large hospital decreased outpatient CT imaging by enacting a radiology order entry with decision support program.

Be sure to catch up on our coverage of a NEJM study on updated results of the CorE 64 study, which found CCTA couldn't replace catheter angiograpy right now, and the accompanying editorial, which criticized the government for paying for CCTA without good evidence that it is better than current methods.

On these or any other topics regarding cardiac imaging, feel free to send me your comments.

Chris P. Kaiser, Editor
ckaiser@cardiovascularbusiness.com