Discussion about cardiac dual source CT (DSCT)

In CT coronary angiography, an improvement of image quality is obtained with DSCT, especially in patients with high Agatston scores and higher heart rate, because of less coronary motion and blooming artefact due to vessel wall calcifications. First experience of DSCT cornary angiography provides high diagnostic accuracy in evaluating coronary artery disease in a high pre-test probability population with extensive coronary calcifications and without heart rate control. However, heavy calcifications still preclude precise delineation of coronary lumen in thin arteries because of insufficient spatial resolution, even when applying sharp kernels, like demonstrated in this web-based self-assessment remote learning module (1,4).

The dose performance of ECG-gated coronary DSCT is comparable to or up to a factor of two lower than the doses at multidetector row CT depending on heart rate and with equivalent image noise (6).

The use of coronary calcium screening to identify intermediate-risk patients with traditional risk factors for whom aggressive risk-reducing strategies for the treatment of atherosclerotic disease should be indicated, has been suggested by Shaw et al. Coronary artery calcium provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality because the survival at 5 years worsened substantially as the screening calcium scores increase from levels of 10 or less to those of greater than 1000 (7). Other data suggest that an initial calcium score should be used as a quality control measure to limit CT coronary angiography to patients who are likely to have a high quality and reliable diagnostic study (8).