STATE-OF-THE-ART PAPER

The Present State of Coronary Computed Tomography Angiography
A Process in Evolution

James K. Min, MD*, Leslee J. Shaw, PhD and Daniel S. Berman, MD,*
* Department of Medicine and Radiology, Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, New York
 Emory University School of Medicine, Atlanta, Georgia
 Cedars-Sinai Medical Center, Los Angeles, California
Manuscript received May 14, 2009; revised manuscript received July 29, 2009, accepted August 4, 2009.

* Reprint requests and correspondence: Dr. Daniel S. Berman, Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 1258, Los Angeles, California 90048 (Email: bermand@cshs.org).


In the past 5 years since the introduction of 64-detector row cardiac computed tomography angiography (CCTA), there has been an exponential growth in the quantity of scientific evidence to support the feasibility of its use in the clinical evaluation of individuals with suspected coronary artery disease (CAD). Since then, there has been considerable debate as to where CCTA precisely fits in the algorithm of evaluation of individuals with suspected CAD. Proponents of CCTA contend that the quality and scope of the available evidence to date support the replacement of conventional methods of CAD evaluation by CCTA, whereas critics assert that clinical use of CCTA is not yet adequately proven and should be restricted, if used at all. Coincident with the scientific debate underlying the clinical utility of CCTA, there has developed a perception by many that the rate of growth in cardiac imaging is disproportionately high and unsustainable. In this respect, all noninvasive imaging modalities and, in particular, more newly introduced ones, have undergone a higher level of scrutiny for demonstration of clinical and economic effectiveness. We herein describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention not only to the significance but also the limitations of such studies. These points may trigger discussion as to what future studies will be both necessary and feasible for determining the exact role of CCTA in the workup of patients with suspected CAD.

Key Words: cardiac computed tomography angiography • coronary artery disease • diagnosis
Abbreviations and Acronyms
  CAD = coronary artery disease
  CACS = coronary artery calcium score(s)
  CCTA = cardiac computed tomography angiography
  CT = computed tomography
  ICA = invasive coronary angiography
  MPS = myocardial perfusion scintigraphy
  NPV = negative predictive value
  PPV = positive predictive value