Pitfalls in 16–Detector Row CT of the Coronary Arteries

http://radiographics.rsna.org/content/25/2/425.full

Tadashi Nakanishi, MD ; Yasuyo Kayashima, MD ; Rintaro Inoue, MD ; Kotaro Sumii, MD ; Yukihiko Gomyo, MD

1 From the Departments of Radiology (T.N., Y.K.) and Cardiology (R.I., K.S., Y.G.), Mazda Hospital, Mazda Motor Corporation, 2–15 Aosakiminami, Fuchu-cho, Aki-gun, Hiroshima 735-8585, Japan. Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received May 3, 2004; revision requested June 16 and received July 28; accepted July 29. All authors have no financial relationships to disclose.

Recently developed 16–detector row computed tomography (CT) has been introduced as a reliable noninvasive imaging modality for evaluating the coronary arteries. In most cases, with appropriate premedication that includes β-blockers and nitroglycerin, ideal data sets can be acquired from which to obtain excellent-quality coronary CT angiograms, most often with multiplanar reformation, thin-slab maximum intensity projection, and volume rendering. However, various artifacts associated with data creation and reformation, postprocessing methods, and image interpretation can hamper accurate diagnosis. These artifacts can be related to pulsation (nonassessable segments, pseudostenosis) as well as rhythm disorders, respiratory issues, partial volume averaging effect, high-attenuation entities, inappropriate scan pitch, contrast material enhancement, and patient body habitus. Some artifacts have already been resolved with technical advances, whereas others represent partially inherent limitations of coronary CT angiography. Familiarity with the pitfalls of coronary angiography with 16–detector row CT, coupled with the knowledge of both the normal anatomy and anatomic variants of the coronary arteries, can almost always help radiologists avoid interpretive errors in the diagnosis of coronary artery stenosis.