CT Coronary Angiography: An underused and underestimated imaging modality!

It is not always possible to cut open the human body to evaluate every small internal ailments. Had it been so easy, God would for sure, have sent us with a zipper in the chest or abdomen so that it becomes easier to look inside. We all want to evaluate the pathologies without having to undergo surgeries or invasive techniques just for the diagnosis and this is where the radiological imaging comes into play. With imaging modalities as ultrasonogram, CT and MRI we can get a good insight of the internal organs in different planes and views non-invasively. With better and advanced imaging modalities, as multislice/ multidetector CTs, it has now become possible to evaluate even the millimeter diametered coronary arteries in a very detailed way non-invasively.

Cardiovascular disease continues to be a leading cause of morbidity and mortality worldwide, making timely and accurate diagnosis crucial for effective treatment and prevention. CT coronary angiography (CTCA) is an imaging modality for non-invasive visualization of the coronary arteries and identification of areas of stenosis or plaque formation. CTCA involves the use of computed tomography (CT) scanning to generate detailed images of the coronary arteries and surrounding structures. Specialized software creates a three-dimensional reconstruction of the heart and its vessels, allowing radiologists to evaluate the degree of stenosis and identify potentially vulnerable plaques in a precise and reliable manner.

By providing high-resolution images of the heart in minutes, CTCA allows us to look into the coronaries and beyond. One of the primary advantages of CTCA is its non-invasiveness, avoiding the need for invasive procedures like catheterization and reducing associated risks such as bleeding and infections. Its non-invasive nature makes it an attractive modality for patients, reducing anxiety and minimizing complications. Patients with suspected or known coronary artery disease can benefit immensely from CTCA as a first-line tool for diagnosis, ensuring accurate risk assessment and appropriate intervention if needed. Moreover, CTCA provides detailed anatomical information beyond luminal narrowing, allowing us to evaluate the vulnerability of the plaques and the vessel wall characteristics.

Another notable advantage of CTCA is its speed and efficiency. Unlike conventional coronary angiography, which requires hospital admission, CTCA can be performed as an outpatient procedure, minimizing inconvenience and reducing the burden on healthcare facilities. Moreover, CTCA delivers results quickly, enabling prompt decision-making by clinicians and timely interventions such as percutaneous coronary interventions or bypass surgery. This expeditious approach plays a vital role in achieving better outcomes and improving patient satisfaction.

Although CTCA brings numerous benefits, it is not without limitations. Firstly, the technique requires ionizing radiation, which may pose concerns over radiation exposure, particularly in younger patients or those requiring repeated imaging (though the radiation dose is usually lower than that in conventional invasive coronary angiography). However, advancements in technology have significantly reduced radiation doses, and the benefits of accurate diagnosis often outweigh the potential risks. Secondly, the presence of coronary calcification can impact image quality, leading to false-positive findings. Nonetheless, newer algorithms and techniques help mitigate these limitations, allowing for better image quality and interpretation.

Moreover, the integration of CTCA into clinical practice facilitates early detection of coronary disease, enabling preventive measures to be initiated. For instance, identification of vulnerable plaques can prompt the initiation of aggressive medical therapy, lifestyle modifications, and risk factor management, reducing the risk of acute coronary events. Such proactive interventions have the potential to significantly reduce mortality and morbidity associated with cardiovascular disease, making CTCA an indispensable tool in preventive cardiology.

In conclusion, CT coronary angiography has transformed the landscape of cardiovascular imaging, offering accurate, non-invasive visualization of the coronary arteries and aiding in the diagnosis and management of coronary artery disease. Its advantages, such as speed, efficiency, and ability to identify vulnerable plaques, have uplifted patient care with improved outcomes. Despite its proven ability in the fight against cardiovascular diseases, CTCA remains a modality much underused by clinicians in our setting. Public and clinicians awareness in the new imaging modalities can open new doors in the field of cardiac care, patients wellbeing being in the centre of all.

(Dr. Nirmal Prasad Neupane is Radiologist at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu.)