Letter from the Guest Editor

Article Outline

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Coronary artery disease is the leading cause of death in the USA. Until recently, noninvasive cross-sectional imaging has had little to offer beyond some probabilistic information gleaned from calcium scoring of the coronary arteries. However, significant technological advances with multidetector computed tomography in the last decade have made imaging of the complex moving coronary arteries possible. This technology is continuously evolving, and in the last 2 years alone, over 300 papers have been written on the subject of cardiac computed tomography (CT). The heart, which for the most part was ignored on the routine chest CT, is now amenable to noninvasive cross-sectional imaging and has become an exciting organ for learning and research. Over the last 3 to 4 years an increasing number of lectures and courses are being offered on the topic of coronary CT, in both the radiology and the cardiology community. We should not be hesitant or have any reservations about learning how to perform and report coronary CT examinations using the language and terminology routinely used by the cardiologists.

Given the tremendous interest and potential of noninvasively diagnosing coronary artery disease with CT, it has become important for us to not only become familiar with this topic, but to gain confidence in conducting and reporting coronary CT examinations. We must learn the very basics of how to acquire the scan, become familiar with the anatomy and pathology, learn the step-by-step approach for evaluation of coronary CT examinations, and recognize the current role and limitations of CT angiography in routine clinical practice as well as in the emergency department.

Cardiac CT has been used as a roadmap by electrophysiologists for a number of years for mapping of the left atrium and pulmonary veins before radiofrequency ablation therapy. Mapping of the cardiac veins and coronary sinus is also being increasingly used for pacemaker placement and as a guide for ventricular ablation.

In this issue of Seminars in Roentgenology we provide a comprehensive review on the subject of cardiac CT, particularly CT coronary angiography. In the first article Drs. Moloo, Shapiro, and Abbrara review the technique of coronary CT angiography and optimization of protocols. An excellent diagnostic quality end result begins with patient preparation and tailoring the examination for individual cases. In the second article I describe the basics of normal coronary artery anatomy as well as anomalies of the coronary arteries. In the third article Drs. Patel, Sundaram, and Kazerooni provide a practical how-to approach for analyzing and reporting coronary CT examinations. In the next article Drs. Patel and Lieberman review the role of CT coronary angiography for the evaluation of coronary artery disease, its limitations, and the clinical data on this topic. The next article by Drs. Flukinger and White describes the role of CT angiography in the evaluation of acute chest pain in the emergency department, where use of appropriate guidelines are essential as the radiation dose from the examination is not insignificant. In the next article, Drs. Abbara, Soni, and Cury review the multidetector computed tomography evaluation of cardiac function. The last article by Drs. Stojanovska and Cronin reviews the role of CT pulmonary venography for radiofrequency ablation for atrial fibrillation.

I would like to thank all the authors for all their hard work and diligence in providing the readers with a comprehensive review on this timely and exciting topic. I would also like to thank Dr. Jannette Collins for giving me this wonderful opportunity to serve as guest editor. A special thanks to Dr. Ella Kazerooni for her guidance, expert advice, and support. And finally, I would like to thank the RSNA for my RSNA Research Scholar Award, which has allowed me the time and opportunity to delve into coronary CT and subsequently develop a tremendous interest in this topic.