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Professor Dr. Kent Yucel MD, prominent MRI and CT expert and interventional radiologist with particular focus on heart disease diagnosis by MRI and CT Angiography, and treatments by minimally invasive interventional radiology methods, and Dr. Anton Titov MD / Exclusive interview
- For coronary artery evaluation, is CT angiography as good as the traditional invasive angiography by endovascular methods? Is CT angiography as good as classic endovascular cardiac angiography? Probably not. It depends on the application whether it's as good or not. For the most part, for actual coronary artery bypass surgery- that level of detail - people will still need cardiac catheterization. But the real role of non-invasive cardiac CT angiography is in people who might have coronary artery disease, but they are not really sure. 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 people had symptoms that might be coronary artery disease. Or they might not had heart disease symptoms. It's almost the flip of the coin. And so they would get an invasive cardiac a catheterization to make sure it wasn't coronary artery disease. Those were the people for whom cardiac CT angiography is the most helpful. Because CT angiography can eliminate a lot of normal invasive cardiac catheterizations. Traditional coronary angiography will probably give patient a much higher radiation exposure. What is a radiation exposure in cardiac CT angiography? Compared to a normal CT scan, cardiac gating actually increases the radiation exposure for a patient. When it started, cardiac CT angiography radiation dose exposure was actually similar to classic cardiac catheterization in radiation dose. But there have been certain things that have been done in recent years to reduce radiation dose. CT angiography radiation exposure now is only 20% or 25% of that during cardiac catheterization. Radiation exposure is still substantial. It is higher than normal CT scan. But it is significantly less - today - than for cardiac catheterization. So, for people who might not necessarily be going to the surgery or coronary artery bypass grafting [CABG], CT Angiography might offer enough detail of heart arteries to decide whether to continue medical therapy or to proceed with invasive studies. Or no therapy. 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. CT angiography may be helpful in saying to people, "You do not have coronary artery disease at all." Or, if there is coronary disease, as you mentioned, coronary CT angiography can be helpful in telling people, "You don't need a cardiac catheterization, you can just have medical therapy." Or, for a third group of patients, you can say, "You do need therapy." In that case those patients will all get cardiac catheterization. This is very important for people to know that there is a very strong negative predictive value of non-invasive study. That's a real strength of coronary CT angiography - negative predictive value.
Cardiac CT Angiography or Traditional Invasive Coronary Angiography? (3) best treatment for damaged hair | |
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| Science & Technology | Upload TimePublished on 10 Jul 2018 |
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