CT coronary angiography or conventional angiography? CT coronary angiography changed diagnostic approach to coronary artery disease. Who should have CT angiography rather than invasive conventional angiography? Leading CT radiologist discusses the advantages of computed tomography angiography and conventional angiography of the heart. What is the best use of coronary CT angiography today?
CT coronary angiography or conventional angiography? Dr. Anton Titov, MD. What is the difference between computed tomography CT angiogram and invasive angiogram? Dr. Anton Titov, MD. Video interview with leading expert in radiology, CT and MRI specialist. Can noninvasive CT scans replace conventional coronary angiography? Dr. Anton Titov, MD. CTA and invasive cardiac catheterization are done for overlapping but distinct indications. Dr. Kent Yucel, MD. CT coronary angiogram - why it is done? Dr. Anton Titov, MD. CTA is best to screen patients with suspected but not obvious coronary heart disease. Medical Second Opinion can confirm signs of coronary artery disease on CT angiogram. Medical Second Opinion also helps to select optimal treatment for coronary artery disease. Seek medical Second Opinion on heart disease and be confident that your treatment is the best. What are the different types of angiograms? Dr. Anton Titov, MD. Traditional angiography involves puncture of femoral or radial artery and threading wire to the coronary arteries. Dr. Kent Yucel, MD. CT Coronary Angiogram is a multi slice cardiac CT scan after injection of intravenous contrast. That is the difference between conventional and CT coronary angiogram. Coronary Computed Tomography Angiogram is best to evaluate likely but not certain coronary artery disease. Diagnosing heart disease with cardiac computed angiography is less invasive and safer for the patient. It is also less radiation exposure than invasive angiography. Non-invasive CT angiography or invasive angiography. Dr. Anton Titov, MD. For coronary artery evaluation, is CT angiography as good as the traditional invasive angiography by endovascular methods? Dr. Anton Titov, MD. Dr. Kent Yucel, MD (Vascular CT and MRI specialist, Tufts Medical Center): Is CT angiography as good as classic endovascular cardiac angiography? Dr. Anton Titov, MD. Probably not. It depends on the application whether it is as good or not. For the most part for actual coronary artery bypass surgery (CABG) that level of detail, patients will still need cardiac catheterization. But the real role of non-invasive cardiac CT angiography is in patients who might have coronary artery disease. But they are not sure if they have coronary heart disease. And CT angiography is a great intermediate step before doing the cardiac catheterization. Before cardiac CT angiography almost half of "caths" (cardiac catheterization procedures) where normal. Because patients had symptoms that might be coronary artery disease. Or they might not had heart disease symptoms. It is almost the flip of the coin (50/50 chance). And so they would get an invasive cardiac a catheterization to make sure it wasn't coronary artery disease. Those were the patients for whom cardiac CT angiography is the most helpful. Because CT angiography can eliminate a lot of normal invasive cardiac catheterizations. Dr. Anton Titov, MD. Traditional coronary angiography will probably give patient a much higher radiation exposure. What are the approximate numbers of radiation exposure in cardiac CT angiography? Dr. Anton Titov, MD. Dr. Kent Yucel, MD. Compared to a normal CT scan cardiac gating increases the radiation exposure for a patient. ( Cardiac gating is one technique of doing coronary CT angiography). When it started, cardiac CT angiography radiation dose exposure was similar to classic cardiac catheterization in radiation dose. But there have been certain things that have been done in recent years. Advance in technology reduced the radiation dose. Non-invasive CT angiography radiation exposure now is only 20% or 25% of the level of radiation exposure during invasive cardiac catheterization. Radiation exposure is still substantial. It is higher than normal CT scan. But it is significantly less today than radiation exposure during classic cardiac catheterization study. Dr. Anton Titov, MD. So for patients who might not necessarily be going to the surgery or coronary artery bypass grafting CABG, non-invasive CT Angiography might offer enough detail of heart arteries. It can help to decide whether to continue medical therapy or to proceed with invasive studies. Dr. Kent Yucel, MD. Or no therapy. (Or to decide that no treatment is necessary). Many of these patients who present with chest pain, they may have problems with their GI tract (gastrointestinal tract) or esophagus. Or they may have other problems in their chest that are not heart-related. Dr. Kent Yucel, MD. CT angiography may be helpful in saying to patients: Dr. Anton Titov, MD. You do not have coronary artery disease at all. Or if there is coronary disease, as you mentioned, coronary CT angiography can be helpful. It can tell patients: "Dr. Anton Titov, MD. You don't need a cardiac catheterization, you can just have medical therapy." Or for a third group of patients you can say: "Dr. Anton Titov, MD. You do need therapy." (stenting of coronary arteries or cardiac artery bypass grafting surgery). In that case those patients will all get cardiac catheterization. Dr. Anton Titov, MD. This is very important for patients to know that there is a very strong negative predictive value of non-invasive study (of cardiac CT angiography) Dr. Kent Yucel, MD. That is a real strength of coronary CT angiography: negative predictive value. CT coronary angiography or conventional angiography? Dr. Anton Titov, MD. Video interview with leading expert in radiology, CT and MRI specialist. How to decide which one to have? Dr. Anton Titov, MD.