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Cardiac multidetector computed tomography (MDCT): method, indications and applications

¹ Peninsula Radiology Academy, Plymouth International Business Park, Plymouth PL6 5WR, ² Department of Radiology, Derriford Hospital, Plymouth PL6 8DH, UK

• Cardiac CT is a rapidly evolving field which provides a clinically useful modality for non invasive assessment of coronary artery and structural cardiac anatomy.
  
• Careful attention to patient preparation is required to produce optimal images.
  
• 64 slice multidetector CT (MDCT) and post-processing algorithms provide excellent diagnostic quality images.
  
• Cardiac MDCT has a range of clinical applications including excluding coronary artery disease in low–intermediate risk patients and the evaluation of complex anatomical anomalies.
  

Cardiac multidetector CT (MDCT) has evolved into a powerful tool in the clinical assessment of many cardiac conditions. With the new generation of 64 slice scanners and the increasingly powerful post-processing software it will have an ever-increasing role to play in clinical practice. The indications for cardiac MDCT include: exclusion of coronary artery disease in specific patient groups (i.e. those with low and intermediate risk of coronary disease); assessment of coronary artery bypass graft patency; evaluation of cardiac anatomy (including complex cardiac anomalies) and as a problem solving tool where a diagnosis remains unclear despite other investigations. It is now possible to obtain dynamic assessments of valve morphology and function in addition to ventricular geometry and function. It is a technique that requires careful patient selection and significant input from the clinicians and radiologists at the time of scanning. Specific equipment such as ECG gating and cardiac MDCT software packages is also mandatory. Whilst it provides a robust non-invasive tool to assess many aspects of cardiac pathology it does involve a significant radiation dose to the patient and does not allow for therapeutic intervention at the time of scanning. It will become increasingly widely available and may in the future have a role to play in the initial assessment of acute coronary syndrome in the emergency setting.