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Schuijf, J.D. (2007)

Multimodality Imaging of Anatomy and Function in Coronary Artery Disease

Doctoral Thesis
Various modalities are available in the diagnostic and prognostic evaluation of patients presenting with known or suspected coronary artery disease (CAD). A rapidly expanding technique is noninvasive coronary angiography with Multi-Slice Computed Tomography (MSCT), which allows accurate detection of significant stenoses. The main value of the technique lies in the noninvasive exclusion of CAD in patients with intermediate pre-test likelihood. Although imaging in populations such as patients with previous stent placement appears to be more challenging, promising results have been obtained in these populations as well. However, it remains important to realize that the presence of coronary atherosclerosis with luminal obstruction does not invariably imply the presence of ischemia. Accordingly, a noninvasive angiographic imaging technique as MSCT cannot be used to predict the hemodynamical importance of lesions. In patients with borderline stenosis, therefore, functional testing ...Show moreVarious modalities are available in the diagnostic and prognostic evaluation of patients presenting with known or suspected coronary artery disease (CAD). A rapidly expanding technique is noninvasive coronary angiography with Multi-Slice Computed Tomography (MSCT), which allows accurate detection of significant stenoses. The main value of the technique lies in the noninvasive exclusion of CAD in patients with intermediate pre-test likelihood. Although imaging in populations such as patients with previous stent placement appears to be more challenging, promising results have been obtained in these populations as well. However, it remains important to realize that the presence of coronary atherosclerosis with luminal obstruction does not invariably imply the presence of ischemia. Accordingly, a noninvasive angiographic imaging technique as MSCT cannot be used to predict the hemodynamical importance of lesions. In patients with borderline stenosis, therefore, functional testing (which can be performed by nuclear imaging, stress echocardiography or MRI) will remain necessary to determine management. Nonetheless, detection of CAD at a far earlier stage than functional imaging is an important advantage of MSCT. Initial investigations suggest that MSCT may distinguish different plaque characteristics between various presentations. Potentially, this information could be useful for risk stratification. Finally, additional non-coronary information can be derived as well. LV function can be evaluated with high accuracy while also information on the cardiac venous system can be obtained.Show less
Imaging
Coronary angiography
Ischemia
Coronary artery disease
Atherosclerosis
Computed tomography
All authors
Schuijf, J.D.
Supervisor
Wall, E.E. van der; Bax, J.J.; Roos, A. de
Qualification
Doctor (dr.)
Awarding Institution
Leiden University Medical Center (LUMC), Leiden University
Date
2007-10-18
ISBN (print)
9789090221960

Juridical information

Court
LEI Universiteit Leiden

Funding

Sponsorship
Nederlandse Hartstichting, ICIN Toshiba Medical Systems BV, Vital Images BV, Biotronik BV, Stichting EMEX, Foundation Imago, J.E. Jurriaanse Stichting, Medtronic BV, Astellas Pharma BV, St Jude Medical BV, Tyco Healthcare BV, Amgen BV (Breda), Boehringer Ingelheim BV, GE Healthcare Medical Diagnostics (Eindhoven), Pfizer BV, Siemens BV, Bristol-Myers Squibb, Boston Scientific Benelux BV, Merck Sharp & Dohme BV.