Indications and limitations for cardiovascular CT
| Indication | Detail |
| Coronary artery disease | Assessment of calcific and non-calcific plaque for assessment of coronary atherosclerosis with CT calcium scoring and CT coronary angiography Assessment of patency of grafts after coronary artery bypass grafting |
| Prior to transcatheter aortic valve implantation | Evaluation of anatomy and morphology of aortic dimensions to guide procedure and device sizing Assessment of patency of intravenous access routes including iliofemoral and subclavian arteries |
| Prior to mitral valve intervention | Evaluate anatomy and morphology of mitral valve apparatus to guide sizing of devices |
| Prior to radiofrequency ablation | Anatomy and morphology of atrial and pulmonary venous system |
| Prior to biventricular pacemaker | Delineate coronary venous drainage to guide lead placement |
| Adult congenital heart disease | Assessment of anomalies of the coronary arteries and complex congenital heart disease |
| Cardiac masses | Assessment of intracardiac and extracardiac mass anatomy and morphology |
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Limitations Use of ionising radiation, although doses have considerably reduced—2016 UK median dose 200 mGy cm (5–6 mSv). Significant motion and arrhythmia can result in artefact and thus reduce image quality and diagnostic utility. Stents and heavily calcific coronary lesions can lead to blooming artefact and thus difficulty in lesion quantification. Test of anatomical disease rather than functional consequence of coronary artery lesions (unless in conjunction with CT-fractional flow reserve [FFR]). Optimal imaging requires heart rate control, usually with intravenous/oral beta blocker. | |
Successful service delivery necessitates an integrated working relationship between cardiologists and radiologists and regular audit of radiation, image quality and reporting for continued quality control. Cardiologists in all disciplines need to engage with cardiac imaging specialists through multidisciplinary meetings and two-way feedback to ensure usefulness and diagnostic utility for patient benefit.