The role of coronary MSCT in the diagnosis of coronary artery disease

Article by Doctor Nguyen Van Phong - Cardiovascular Center, Vinmec Times City International General Hospital.

In recent years, CT has become an important and familiar imaging tool in cardiovascular disease in general and especially in coronary artery disease. With the improvement of temporal and spatial resolution as well as the coverage volume of one rotation, CT machines ≥ 64 slices allow the evaluation of coronary artery anatomy with high image quality.

With the support from software that can render 2D and 3D coronary images with high accuracy, it helps to assess more and more accurately the extent of coronary artery damage as well as the image of atherosclerotic plaque.

1. The role of coronary MSCT angiography with contrast injection

According to the results of the studies, coronary MSCT is an imaging probe with high sensitivity and specificity. Coronary MSCT has a 97-100% ability to rule out coronary stenosis, making coronary CT a very reliable test for excluding coronary artery disease.
Coronary CT can evaluate both the lumen and wall of the coronary arteries, that is, can examine the morphological and structural features of the atherosclerotic plaque.
In addition, a negative stress test only excludes significant coronary artery disease (usually over 70%), does not exclude cases of atherosclerotic plaque causing mild coronary artery stenosis - fit.
Identification of non-coronary atherosclerotic plaques on coronary CT can be helpful in risk assessment and in planning aggressive preventive treatment...

Hình MSCT động mạch vành của một bệnh nhân nam, 42 tuổi, đau ngực không điển hình, chụp CT mạch vành: A/Hình Curved MPR của động mạch vành phải cho thấy có 2 mảng xơ vữa vôi hóa ở đoạn 2 trong đó mảng xơ vữa thứ 2 (mũi tên xanh) gây hẹp lòng động mạch vành 50-70%. B/ Hình cắt ngang lòng động mạch vành đoạn tham khảo (ref) ngay trên chỗ hẹp. C/ Hình cắt ngang lòng động mạch vành phải đoạn 2 qua mảng xơ vữa thứ 2.

Thus, depending on the characteristics of age, sex, cardiovascular risk factors, chest pain characteristics and clinical picture of each patient, doctors may assign patients to have CT coronary angiography. Contrast is used to determine if the patient has coronary artery stenosis.
In patients who have previously undergone coronary stenting or coronary bypass surgery, if the doctor suspects that there is restenosis in the coronary stent or bypass, a CT coronary angiogram may also be ordered to confirm the diagnosis. diagnose .

A/ Hình CT mạch vành của 1 bệnh nhân nam, 73 tuổi, đau ngực không đặc hiệu, có 1 stent (> 5 năm) ở động mạch vành LAD1-2, không bị tái hẹp; B -C/ Hình 3D của 1 bệnh nhân nữ 73 tuổi, có 3 cầu mạch vành, 2 cầu bên trái và 1 cầu bên phải, cầu không bị tái hẹp

2. Indications and contraindications

Indications:
Patients with risk factors for coronary heart disease: Hyperlipidemia, diabetes, hypertension, heavy smoking, family history of coronary artery disease Atypical chest pain Check ECG and stress electrocardiogram are not clearly identified People who have been treated for coronary artery disease with balloon angioplasty, percutaneous coronary intervention or coronary bypass surgery and need follow-up examination Treatment Contraindications:
Severe asthma Renal disease with high creatinine levels or chronic renal failure History of allergy to seafood or contrast agents. It may be necessary to see an allergist and use allergy prophylaxis before the scan Pregnant women

Đau ngực — Đối tượng đau ngực không điển hình cần được chụp MSCT mạch vành

3. Things to pay attention to when taking MSCT coronary angiography

Before coronary CT scan: need to fast for 4 hours before the scan, need to have kidney function test results before the scan. After the scan is complete: drink plenty of water for 1-2 days to allow the contrast to be eliminated in the urine. Coronary CT angiography is a non-invasive diagnostic technique with high value in diagnosing coronary artery disease, helping doctors plan treatment and monitor patients.

Chụp CT để chẩn đoán lâm sàng u màng não — Trang thiết bị hiện đại tại Vinmec giúp các bác sĩ chẩn đoán bệnh chính xác

Vinmec International General Hospital applies the technique of coronary computed tomography, without beta block, to ensure image quality and accurate reading success rate >95%. This technique helps customers to limit the use of drugs to slow the rhythm (not using Betablocker), limit the risk of having to take drugs, and reduce the time customers wait to perform the service.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE
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Computed tomography - gold standard in diagnosing coronary artery disease CT scan to assess the degree of coronary calcification Notes on coronary angiography