AJR Women's Imaging Online
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Attili, A. K.
Right arrow Articles by Chew, F. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Attili, A. K.
Right arrow Articles by Chew, F. S.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
DOI:10.2214/AJR.06.1191
AJR 2006; 187:S500-S504
© American Roentgen Ray Society

CT and MRI of Coronary Artery Disease: Self-Assessment Module

Anil K. Attili1, Jonathan M. Foral2, U. Joseph Schoepf3, Philip N. Cascade1 and Felix S. Chew4

1 Department of Radiology, University of Michigan, Ann Arbor, MI 48109-0302.
2 Department of Radiology, Harborview Medical Center, Seattle, WA 98104.
3 Department of Radiology, Center for Advanced Imaging Research, Medical University of South Carolina, Charleston, SC 29425.
4 Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.

Received September 6, 2006; accepted after revision September 6, 2006.

 
Address correspondence to F. S. Chew (fchew{at}u.washington.edu).

ARRS members earn free CME and SAM credit at www.arrs.org. Select Journals/Integrative Imaging from the navigation menu on the left of the home page.


Abstract
Top
 Abstract
INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
The educational objectives for this self-assessment module on CT and MRI of coronary artery disease are for the participant to exercise, self-assess, and improve his or her knowledge of the clinical applications of CT and MRI in evaluating coronary artery disease.

Keywords: cardiac imaging • coronary artery disease • CT angiography • MDCT • MRI


INTRODUCTION
Top
 Abstract
 INTRODUCTION
EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
This self-assessment module on CT and MRI of coronary artery disease has an educational component and a self-assessment component. The educational component consists of two required articles that the participant should read. The self-assessment component consists of seven multiple-choice questions with solutions. All of these materials are available on the ARRS Web site (www.arrs.org). To claim CME and SAM credit, each participant must enter his or her responses to the questions online.


EDUCATIONAL OBJECTIVES
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
By completing this educational activity, the participant will: A. Exercise, self-assess, and improve his or her knowledge of the clinical application of CT to diseases of the coronary arteries. B. Exercise, self-assess, and improve his or her knowledge of the clinical application of MRI to diseases of the coronary arteries.


REQUIRED READING
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
(available at www.arrs.org)

  1. Attili AK, Cascade PN. CT and MRI of coronary artery disease: evidence-based review. AJR 2006; 187[suppl]:S483-S499
  2. Schoepf UJ. CT angiography of the coronary arteries. In: McAdams HP, Reddy GP, eds. Cardiopulmonary imaging: categorical course syllabus. Leesburg, VA: American Roentgen Ray Society, 2005:151-160


INSTRUCTIONS
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 

  1. Complete the required reading.
  2. Visit www.arrs.org and select the Journals/Integrative Imaging link on the left-hand side of the home page.
  3. Using your member login, order the online SAM as directed.
  4. Follow the online instructions for entering your responses to the self-assessment questions and complete the test by answering the questions online.


QUESTION 1

Regarding coronary artery anomalies, which statement is TRUE?

  1. Anomalous origin of the right coronary artery from the left sinus of Valsalva is clinically benign.
  2. The stress ECG is highly sensitive in detecting coronary artery anomalies.
  3. Catheter angiography is the imaging technique of choice for a suspected coronary artery anomaly.
  4. Myocardial bridging manifests as fixed narrowing of the affected coronary artery segment.
  5. Anomalous origin of the left coronary artery from the right sinus of Valsalva is a high-risk lesion for sudden death.

QUESTION 2

Regarding coronary artery aneurysms, which statement is TRUE?

  1. Atherosclerosis is the most common cause worldwide.
  2. The left main coronary artery is the most common site of occurrence.
  3. Eighty percent of patients with Kawasaki disease develop coronary artery aneurysms.
  4. Catheter angiography is the gold standard for determining their true size.
  5. Myocardial infarction may be caused by secondary thromboembolism.

QUESTION 3

After a myocardial infarction, which imaging technique is most likely to distinguish irreversibly injured myocardium from dysfunctional but viable myocardium?

  1. Unenhanced CT for calcium scoring.
  2. Enhanced CT with pharmacologic stress.
  3. Delayed contrast-enhanced MRI.
  4. Echocardiography.
  5. Catheter angiography.

QUESTION 4

Regarding the technique of delayed contrast-enhanced MRI, which of the following statements is TRUE?

  1. With delayed enhancement imaging, fibrous tissue actively takes up gadolinium.
  2. Delayed enhancement imaging typically uses a T1-weighted spin-echo sequence.
  3. With an appropriate inversion time, the signal intensity of normal myocardium should be close to null.
  4. A 2D sequence results in more motion artifact than a 3D sequence.
  5. IV-injected gadolinium remains in the intravascular space unless there is capillary leakage.

QUESTION 5

Regarding CT angiography technique, which of the following is TRUE?

  1. Beta-blockers may improve image quality by decreasing a patient's heart rate.
  2. The right coronary artery is best depicted in images reconstructed in late or end-diastole.
  3. In patients with high calcium scores (> 75th percentile), CT angiography is accurate for evaluating coronary artery stenosis.
  4. The effective radiation dose from uncomplicated conventional angiography is greater than CT angiography.
  5. CT angiography has a higher spatial and temporal resolution than conventional catheter angiography.

QUESTION 6

When is contrast-enhanced CT angiography of the coronary arteries NOT indicated?

  1. Evaluation of the patency of a coronary artery bypass graft.
  2. Noninvasive detection of coronary artery stenosis.
  3. Suspected coronary artery anatomic anomalies.
  4. Acute myocardial infarction with elevated cardiac enzymes and diagnostic ECG changes.
  5. Pulmonary vein imaging in the context of ablation therapy for ectopic electrical activity.

QUESTION 7

Regarding coronary CT angiography (CTA) as a triage tool for acute chest pain in the emergency department, which statement is TRUE?

  1. Single-detector CT is adequate to assess the coronary arteries in the emergent setting.
  2. It is indicated in patients with a high pretest probability of coronary artery disease.
  3. Extending the protocol to include the pulmonary arteries and the thoracic aorta is an area of current investigation.
  4. Negative findings on coronary CTA require conventional catheter angiography to exclude significant coronary artery disease.
  5. Acute chest pain as a presenting symptom is usually caused by a coronary syndrome.

 


Solution to Question 1
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
Congenital anomalies of the coronary arteries that are associated with increased risk of myocardial ischemia and sudden death are classified as malignant; those that are not associated with such a risk are classified as benign. The most common of the malignant anomalies is origin of the right coronary artery from the left sinus of Valsalva. Option A is not the best response.

The stress ECG can be normal in the presence of coronary artery anomalies and is not considered reliable as a screening test [1]. Option B is not the best response.

Coronary artery anomalies are often difficult to fully characterize on catheter angiography. Both CT angiography [2] and MR angiography can identify and characterize anomalous coronary arteries with a higher accuracy than catheter angiography [3, 4]. Option C is not the best response.

An epicardial segment of a coronary artery that courses through the myocardium is termed "myocardial bridging." With myocardial bridging, the involved coronary artery is compressed in systole. The clinical significance of myocardial bridges is uncertain, but generally, myocardial bridging is considered a benign condition because most coronary flow occurs during diastole. However, myocardial bridging has been reported as a cause of angina, ischemia, or infarction [5]. Option D is not the best response.

Sudden death, usually during or shortly after vigorous exertion, may be the first clinical manifestation in patients with ectopic coronary artery origin, such as an anomalous left coronary artery arising from the right sinus [6]. However, warning symptoms such as chest pain and syncope may occur in a substantial proportion of these individuals. Option E is the best response.


Solution to Question 2
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
Coronary artery aneurysms are defined as segments of vessels with a diameter greater than 1.5 times that of the normal adjacent artery segment; they can be classified as fusiform or saccular [7]. Kawasaki disease is the most frequent cause of coronary aneurysms worldwide, whereas atherosclerotic coronary disease is the most common cause in the United States. Option A is not the best response.

The most commonly affected coronary artery segments are, in order of frequency, the proximal and mid portions of the right coronary artery, the proximal portion of the left anterior descending artery, and the proximal portion of the circumflex coronary artery. Aneurysms of the left main coronary trunk are unusual [8]. Option B is not the best response.

Kawasaki disease is an acute vasculitis of infancy and childhood. When Kawasaki disease is untreated, only 15-25% of patients develop coronary artery aneurysms [9]. When the disease is treated with corticosteroids, the incidence of aneurysms is even lower. Option C is not the best response.

The true size of an aneurysm may be underestimated on catheter angiography if the aneurysm contains substantial thrombus. ECG-gated CT allows more rapid and accurate delineation of the size and shape of aneurysms [10]. MRI offers an alternative imaging technique for evaluating coronary artery aneurysms, but the spatial resolution of MRI is inferior to that of CT. Option D is not the best response.

Myocardial infarction may be caused by thromboembolism from coronary artery aneurysms. Option E is the best response.


Solution to Question 3
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
Identification of irreversibly injured myocardium from dysfunctional, but viable and potentially salvageable, myocardium is of crucial importance for the management of cardiac patients. Revascularization of an infarcted area is justified only if the patient is likely to benefit from the procedure. Delayed contrast-enhanced MRI is an excellent tool to evaluate myocardial viability and differentiate between patients who are likely to benefit from revascularization and patients who are not likely to benefit [11, 12]. Dysfunctional, predominantly viable segments will have no or minimal hyperenhancement, whereas predominantly scarred segments will show extensive hyperenhancement. Dysfunctional segments with extensive enhancement on delayed contrast-enhanced MRI are unlikely to exhibit functional recovery after percutaneous or surgical revascularization. Option C is the best response.

Calcium scoring has no role in the evaluation of myocardial viability. Calcium scoring is used as a risk factor for coronary artery disease. Option A is not the best response.

Enhanced CT with pharmacologic stress, echocardiography, and catheter angiography may show dysfunctional myocardial motion, but those techniques do not evaluate myocardial viability. Options B, D, and E are not the best responses.


Solution to Question 4
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 
The delayed contrast-enhanced MRI technique for detection of myocardial viability relies on the extracellular distribution of gadolinium chelates in the myocardium. In regions with increased extracellular space (e.g., infarction and fibrosis), higher concentrations of gadolinium accumulate, with concomitant slower clearance and higher signal on delayed enhancement sequences [13]. Option A is not the best response.

The typical pulse sequence for myocardial delayed enhancement is an inversion recovery-prepared segmented gradient-echo sequence, which exhibits an increased signal intensity of tissue that is superior to other imaging techniques such as spin-echo techniques [14]. Option B is not the best response.

"Nulling" of the normal myocardium is critical if areas of hyperenhancement are to be properly displayed. The gradient-echo technique used consists of an inversion prepulse chosen so that there is no or little longitudinal magnetization in the normal myocardium. Selection of the appropriate inversion time is crucial. In clinical settings, this is usually performed visually by applying a 2D inversion sequence with variable prepulse delays (200-300 milliseconds in steps of 25 milliseconds) or a Look-Locker sequence. The optimal TI (time to inversion) is the delay with the best visual suppression of myocardium. The typical signal intensity is a dark myocardium, a slightly brighter blood pool, and a very bright infarct. Option C is the best response.

Three-dimensional sequences are subject to more motion artifact because of the larger number of k-space lines that must be acquired compared with 2D sequences. Option D is not the best response.

IV-injected gadolinium rapidly diffuses into the extracellular space, regardless of whether there is capillary leakage. Option E is not the best response.


Solution to Question 5
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
Solution to Question 6
 Solution to Question 7
 References
 
A slow, regular heart rate increases the portion of the cardiac cycle spent quietly in diastole and is ideal for image quality. Heart rates greater than 65 beats per minute increase motion artifacts and reduce the image quality of portions of the coronary arteries, particularly the right coronary artery. Premedication with ß-adrenergic receptor blocking agents (ß-blockers) is recommended to reduce the heart rate before CT angiography [15], particularly in patients with heart rates greater than 65 beats per minute. Contraindications for ß-blocker therapy include asthma, atrioventricular conduction block, heart failure, diabetes, and Raynaud syndrome. Option A is the best response.

Retrospective ECG gating is used for coronary CT angiography studies performed on an MDCT scanner [15]. Because the individual coronary vessels have different motion patterns, performing individual reconstruction for each vessel with regard to position in the cardiac cycle may optimize coronary segment visualization. The right coronary artery is best seen in early diastole, the left circumflex artery is best seen in mid cycle, and the left anterior descending artery is best seen in late diastole [16]. Option B is not the best response.

Calcium deposits in the coronary arteries attenuate the X-ray beam, resulting in beam-hardening and partial volume artifacts. Extensive calcification may interfere with accurate assessment of stenosis [17, 18]. Option C is not the best response.

Scanning with 16-MDCT using standard protocols for coronary CT angiography (120 kV, 400 mAs, 12 x 0.75 mm collimation) results in an effective radiation dose of 8.1 mSv for men and 10.9 mSv for women [19]. This dose is higher than that of selective conventional coronary angiography (3-5 mSv). Option D is not the best response.

Coronary arteries are small and move rapidly. Thus, imaging of the coronary arteries requires high spatial and high temporal resolutions. Invasive, catheter-based coronary angiography has a temporal resolutions ("shutter speed") of approximately 6 milliseconds and a spatial resolution of approximately 0.25 mm [20]. The current generation of 64-MDCT scanners allow an isotropic resolution of 0.4 x 0.4 x 0.4 mm at a gantry rotation speed of 330 milliseconds [21]. By applying a half-scan algorithm (only data from a 180° gantry rotation are used for image reconstruction), acquisition time can be reduced to 165 milliseconds. Thus, temporal and spatial resolutions of CT angiography are still inferior to those of conventional angiography. Option E is not the best response.


Solution to Question 6
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
Solution to Question 7
 References
 
Evaluation of coronary bypass grafts is one of the first widely accepted indications for contrast-enhanced CT angiography [22]. CT with ECG gating may be particularly useful in symptomatic patients during the immediate postoperative setting, not only to evaluate graft patency but also to evaluate for other conditions that can elicit similar symptoms to those of graft stenosis or occlusion, such as pericardial effusion, pleural effusion, sternal infection, and pulmonary embolism [23]. Delayed complications, including late-onset graft occlusion or aneurysm formation, are also well evaluated with CT. Further, if a revision or repeat bypass surgery is needed, CT is useful in delineating the existing grafts and complex postoperative anatomy for planning before the procedure [23]. An emerging application is 3D-rendered volumetric CT of the thorax and coronary arteries before the initial bypass surgery, especially with the advent of minimally invasive direct coronary artery bypass (MIDCAB) [22]. Option A is not the best response.

In the United States, up to two thirds of conventional cardiac angiograms are obtained solely for diagnostic purposes. With the latest generation of MDCT scanners, CT has become the noninvasive technique of choice for evaluating coronary artery stenosis. Sensitivity ranges between 80% and 90% for hemodynamically significant proximal coronary artery stenosis [22]. Furthermore, a high negative predictive value (reported to be 97% with 16-MDCT) suggests a role for noninvasive CT coronary angiography to rule out significant coronary artery disease in patients with equivocal clinical presentations and findings [22]. Option B is not the best response.

Cross-sectional imaging has been recognized as the preferred diagnostic strategy for the evaluation of coronary artery anomalies [22]. MRI is an excellent technique for evaluating suspected coronary artery anomalies; however, MRI has shown limitations in determining the distal course of the coronary vessels [23]. Therefore, CT is preferred for evaluating small collaterals, fistulas, aneurysms, and vessels originating outside the normal sinuses [22]. Option C is not the best response.

Coronary artery CT has no role in the management of acute myocardial infarction when the diagnosis can be established by clinical features, elevation of cardiac enzymes, and typical ECG changes. Option D is the best response.

Pulmonary veins are an important source of ectopic atrial electrical activity, causing atrial fibrillation. CT is ideally suited for noninvasive visualization of the pulmonary venous return and the left atrium before ablation therapy [22]. Option E is not the best response.


Solution to Question 7
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
References
 
Patients presenting with acute chest pain are more likely to have rapid, irregular heart rates and are unlikely to be able to perform a lengthy breath-hold. The use of slower, older-generation CT scanners is therefore not practical. With the CT scanners now available—namely, 64-MDCT—temporal resolution is vastly improved, thereby decreasing breath-hold times and achieving diagnostic examinations even with higher, more irregular heart rates [22, 24]. Option A is not the best response.

CT angiography is best indicated for patients with an equivocal presentation, nondiagnostic ECG, and initially negative serum markers for acute myocardial infarctions. Those patients with a high pretest probability of coronary artery disease (unstable angina with known coronary disease, sinus tachycardia, ischemic ECG changes, or positive cardiac enzyme markers) will likely require a conventional workup, including catheter angiography. Option B is not the best response.

With the use of 64-MDCT scanners, the concept of extending cardiac angiography to include the pulmonary arteries and the thoracic aorta has been actively discussed. The ability to evaluate for hemodynamically significant coronary artery stenosis, pulmonary embolism, and thoracic aortic dissection has obvious appeal to the emergency department clinician. However, adequately evaluating for these entities with one examination would require a much larger field of view and volume of coverage as well as a longer bolus of IV contrast material to enhance both the pulmonary and thoracic vasculature [24]. Before implementation, this protocol needs to be compared with the standard individual examinations, and the clinical indication for this type of examination must be carefully defined [22, 24]. Option C is the best response.

CT coronary angiography has a high negative predictive value; therefore, significant coronary artery disease in patients with acute chest pain should be safely ruled out by a negative examination [22]. Option D is not the best response.

Acute chest pain is a common presenting symptom in emergency department patients. Most patients will not actually have coronary syndromes. Option E is not the best response.


References
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 Solution to Question 6
 Solution to Question 7
 References
 

  1. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35:1493 -1501[Abstract/Free Full Text]
  2. Schmitt R, Froehner S, Brunn J, et al. Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. Eur Radiol 2005;15 : 1110-1121[CrossRef][Medline]
  3. Post JC, van Rossum AC, Bronzwaer JG, et al. Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course? Circulation1995; 92:3163 -3171
  4. Bunce NH, Lorenz CH, Keegan J, et al. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography. Radiology 2003;227 : 201-208[Abstract/Free Full Text]
  5. Alegria JR, Herrmann J, Holmes DR Jr, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J 2005;26 : 1159-1168[Abstract/Free Full Text]
  6. Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation2002; 105:2449 -2454
  7. Robinson FC. Aneurysms of the coronary arteries. Am Heart J 1985; 109:129 -135[CrossRef][Medline]
  8. Swaye PS, Fisher LD, Litwin P, et al. Aneurysmal coronary artery disease. Circulation 1983;67 : 134-138
  9. Wooditch AC, Aronoff SC. Effect of initial corticosteroid therapy on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis of 862 children. Pediatrics 2005;116 : 989-995[Abstract/Free Full Text]
  10. Murthy PA, Mohammed TL, Read K, Gilkeson RC, White CS. MDCT of coronary artery aneurysms. AJR 2005;184 [suppl]:S19 -S20[Free Full Text]
  11. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000;343 : 1445-1453[Abstract/Free Full Text]
  12. Selvanayagam JB, Kardos A, Francis JM, et al. Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation 2004;110 : 1535-1541
  13. Edelman RR. Contrast-enhanced MR imaging of the heart: overview of the literature. Radiology 2004;232 : 653-668[Abstract/Free Full Text]
  14. Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001;218 : 215-223[Abstract/Free Full Text]
  15. Lawler LP, Pannu HK, Fishman EK. MDCT evaluation of the coronary arteries, 2004: how we do it—data acquisition, postprocessing, display, and interpretation. AJR 2005;184 : 1402-1412[Abstract/Free Full Text]
  16. Kopp AF, Schroeder S, Kuettner A, et al. Coronary arteries: retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the image reconstruction window. Radiology 2001;221 : 683-688[Abstract/Free Full Text]
  17. Ropers D, Baum U, Pohle K, et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation2003; 107:664 -666
  18. Nieman K, Rensing BJ, van Geuns RJ, et al. Usefulness of multislice computed tomography for detecting obstructive coronary artery disease. Am J Cardiol 2002;89 : 913-918[CrossRef][Medline]
  19. Trabold T, Buchgeister M, Kuttner A, et al. Estimation of radiation exposure in 16-detector row computed tomography of the heart with retrospective ECG-gating. Rofo 2003;175 : 1051-1055[Medline]
  20. Achenbach S, Daniel WG. Computed tomography of the coronary arteries: more than meets the (angiographic) eye. J Am Coll Cardiol 2005; 46:155 -157[Free Full Text]
  21. Leber AW, Knez A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol2005; 46:147 -154[Abstract/Free Full Text]
  22. Schoepf UJ. CT angiography of the coronary arteries. Radiology 2004;232 : 18-37[Abstract/Free Full Text]
  23. Frazier AA, Qureshi F, Read KM, Gilkeson RG, Poston RS, White CS. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. RadioGraphics2005; 25:881 -896[Abstract/Free Full Text]
  24. Hoffman U, Pena AF, Cury RC, et al. Cardiac CT in emergency department patients with acute chest pain. RadioGraphics 2006;26 : 963-980[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Attili, A. K.
Right arrow Articles by Chew, F. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Attili, A. K.
Right arrow Articles by Chew, F. S.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS