|
|
|
Figure
1 |
|
|
|
Figure
2 |
|
|
|
Figure
3 |
|
|
|
Figure
4 |
|
|
|
Figure
5 |
History:
67 year old male with history of hypertension and elevated cholesterol
presented with atypical chest pain. Nuclear medicine cardiac stress
test was negative. The patient was referred to Main Street
Radiology for CT coronary angiography.
Findings:
3D image of the heart (figure 1) shows atherosclerotic changes of the
left main (LCA), left anterior descending (LAD) and left circumflex (LCX)
arteries, manifested by irregular contour of the vessels. Focal
stenosis of the LAD is seen (blue arrow) near the origin of the first
diagonal branch. This finding is confirmed on the 2D image (figure 2)
where "soft" (non-calcified) plaque (arrow) results in
approximately 70% stenosis. Additional 3D images (figures 3 and 4)
show a left dominant system, manifested by prominent LCX supplying
the posterior descending artery (PDA) and small right coronary artery
(RCA).
Conventional angiogram was performed
which confirmed the presence of significant LAD stenosis (arrow on
figure 5). Angioplasty and stenting was subsequently performed with
satisfactory results.
Discussion:
In November 2003, Main Street Radiology performed the first CT
coronary angiography in Queens.
Early reports indicate that CT coronary
angiography may ultimately replace diagnostic cardiac catherization,
with reported sensitivity of 95% (Nieman, Circulation 2002; 106 (16):
2051-4). This is significantly higher than the sensitivity of nuclear
medicine stress test, reported in the range of 80-85%.
|
Indications
for CT Coronary Angiography
|
|
| 1.
Cardiac evaluation of patients with chest
pain. CT coronary angiography may precede a
perfusion stress test, or may be used to clarify
an equivocal stress test. |
| 2.
Patients with known coronary artery disease, to
guide the decision fro repeat invasive
intervention. |
| 3.
Assess suspected congenital coronary artery
anomaly. |
|
|
|
Acceptable
ICD-9 CM Codes
|
|
| 412 |
Old
myocardial infarction |
| 413.0 |
Angina
pectoris |
| 414.00 |
Coronary
atherosclerosis |
| 414.9 |
Chronic
ischemic heart disease |
|
The main advantage of CT coronary
angiography over cardiac catherization, is that it is non-invasive,
only requiring IV injection of iodinated contrast. In addition, the
nature of the plaque, whether soft or hard, can be assessed with CT
coronary angiography. In the past, only endovascular ultrasound was
able to differentiate soft or "vulnerable" plaque.
Medicare announced in 2004 that CT
coronary angiography will be reimbursed in Queens. This decision was
based on reports showing "high correlation with stenotic lesions
noted on diagnostic cardiac catherization, but more importantly, with
atheromas on intracoronary ultrasound."
