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Multislice spiral computed tomography (MSCT) coronary angiography is a promising non-invasive technique for the detection of coronary stenoses.1–4 The advent of the technically improved 16 row MSCT scanner, with higher spatial and temporal resolution, has permitted more reliable detection of coronary plaques and significant obstructive coronary lesions.5 It appears likely that MSCT coronary angiography will mature into a non-invasive diagnostic tool that will become integrated into the management of patients with known or suspected coronary atherosclerosis. This review will focus on the basics of the scanner, the diagnostic performance, and potential future applications.
BASICS OF MSCT CORONARY ANGIOGRAPHY
What is computed tomography?
A CT scanner consists of an x ray tube and a row of detectors, which rotate around the patient who is positioned in the centre. The tube produces a fan shaped x ray beam, which passes through the patient and hits the detector on the other side (fig 1). The atomic density of a tissue that an x ray beam encounters determines its attenuation with a higher atomic tissue density resulting in a higher attenuation. The various tissues in a cross section can be distinguished because they have differences in atomic density and attenuation. The attenuation of the x ray beam is expressed as an absolute value measured in Hounsfield units (HU). The rotation of the x ray tube allows calculation of the attenuation at every single point of the slice, which is used to produce a cross sectional image of the body.
The first generation CT scanners used a sequential acquisition pattern, also known as “step-and-shoot”. These scanners produced an axial image while the table remained motionless and for each other slice the table moved to a different position. This sequence of events was repeated throughout the scan range (fig 2A). …
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