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New coronary imaging techniques: what to expect?
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  1. P J de Feyter,
  2. K Nieman
  1. University Hospital Rotterdam, Thoraxcenter Bd 410, PO Box 2040, 3000 CA Rotterdam, The Netherlands
  1. Correspondence to:
    PJ de Feyter, MD, University Hospital Rotterdam, Thoraxcenter Bd 410, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
    E-mail: defeyter{at}card.azr.nl

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Coronary imaging is the ultimate challenge. During the last decade there have been great advances in this imaging technique, partly as a result of improved scanner hardware, but more because of advances in microprocessor technology

Coronary imaging is the ultimate challenge for any imaging technique. This is because the coronary arteries are small (2–4 mm in diameter) and have a tortuous, complex, three dimensional course and are continuously in motion, except for a short period during mid diastole.

During the last decade we have witnessed great advances in cardiac imaging. This was partly as a result of improved scanner hardware, but more because of advances in microprocessor technology, which allow for rapid processing of extremely large quantities of data necessary for the acquisition, post-processing, and construction of hitherto unimaginable, non-invasively obtained images of the coronary lumen and plaque.

This raises two important questions. Firstly, has progress in non-invasive coronary imaging techniques gone so far that conventional invasive diagnostic coronary angiography has become redundant? Secondly, are these new imaging techniques capable of detecting which coronary plaque is stable, unstable or vulnerable?

NON-INVASIVE CORONARY LUMEN IMAGING

Magnetic resonance coronary angiography (MR-CA), electron beam computed tomography (EBCT), and multi-slice computed tomography (MS-CT) have recently emerged as new non-invasive diagnostic techniques that possess the potential to replace conventional diagnostic angiography.1–4 The diagnostic accuracy to detect a significant coronary stenosis is presented in table 1. However, it should be noted that: firstly, the diagnostic value only concerns the detection of stenoses in the proximal and mid segment of the coronary tree, because the smaller distal segments cannot be adequately visualised; and secondly, only in 70–80 % of these proximal and mid segments is image quality sufficient to allow a semiquantitative assessment.

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Table 1

Approximate diagnostic value of non-invasive coronary imaging techniques to detect significant coronary stenosis (> 50 % …

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