Background Reliable noninvasive assessment of coronary-arterystenoses and occlusions would constitute an advantage in thecare of patients with known or suspected coronary artery disease.We investigated the accuracy of contrast-enhanced electron-beamcomputed tomography (CT) for the detection of high-grade coronary-arterystenoses and occlusions.
Methods Electron-beam CT was performed in 125 patients. Afterintravenous injection of a contrast agent, 40 cross-sectionalimages of the heart were acquired during inspiration, triggeredby the electrocardiogram in diastole. Three-dimensional reconstructionsof the heart and coronary arteries were rendered to facilitateevaluation of the images. The proximal and middle segments ofthe major coronary arteries were evaluated for the presenceor absence of high-grade stenoses and occlusions. The resultswere compared with those of invasive coronary angiography ina blinded fashion.
Results Because of technical problems that impaired the qualityof the images, 124 (25 percent) of the 500 coronary arteriesstudied (left main, left anterior descending, left circumflex,and right coronary) in a total of 125 patients were excludedfrom evaluation. No vessels could be evaluated in 19 patients(15 percent), and another 28 patients (22 percent) had one,two, or three vessels that could not be evaluated. In the remainingcoronary arteries with adequate image quality, electron-beamCT permitted visualization of 69 of 75 high-grade stenoses andocclusions (sensitivity, 92 percent), whereas in 282 of 301arteries, the absence of high-grade stenoses and occlusionswas correctly detected (specificity, 94 percent).
Conclusions When image quality is adequate, electron-beam CTmay be useful to detect or rule out high-grade coronary-arterystenoses and occlusions.
Annually, more than 1 million coronary angiographic proceduresare performed in the United States.1 Replacing even a fractionof these diagnostic procedures with a noninvasive imaging techniquewould constitute an important advance in the care of patientswith known or suspected coronary artery disease. Several noninvasiveimaging techniques have the potential for visualization of thecoronary arteries, including transthoracic and transesophagealechocardiography,2,3,4,5,6 synchrotron dichromography,7,8 andmost important, magnetic resonance imaging (MRI).9,10,11 However,because of limited spatial, temporal, or contrast resolution,none of these techniques have permitted reliable detection ofcoronary-artery stenoses and occlusions in a clinical setting.
Electron-beam computed tomography (CT) is a cross-sectionalimaging technique with high spatial and temporal resolution;it is possible for image acquisition to be triggered by thepatient's electrocardiogram. The technique is therefore wellsuited to cardiac imaging. It is widely used to assess coronarycalcifications,12,13,14,15,16,17,18 and there have been preliminaryreports of the use of electron-beam CT with intravenous injectionof contrast agent to visualize the coronary-artery lumen.19,20,21,22,23,24,25We prospectively evaluated a group of 125 patients by both electron-beamCT and conventional coronary angiography to determine the valueof the method for the noninvasive detection of high-grade stenosesand occlusions of the coronary arteries.
Methods
Subjects
One hundred twenty-five patients (104 men and 21 women) werestudied. Their mean age was 56 years (range, 23 to 82). Theiraverage weight was 81 kg, but nine patients weighed more than100 kg. All patients who were admitted to our institution forinpatient diagnostic coronary angiography on days on which wehad access to the electron-beam CT scanner (a total of 44 days)were asked to participate in the study. Patients with coronarystents or coronary-artery bypass grafts, patients whose clinicalcondition was unstable, patients with atrial fibrillation, andpatients with contraindications to the administration of contrastagent were excluded. All patients gave written informed consentaccording to institutional guidelines. Conventional invasivecoronary angiography was performed by independent investigatorswithin one week after the electron-beam CT investigation. Allselected patients were included in the analysis.
Electron-Beam CT
Acquisition of Data
Electron-beam CT has previously been described in detail.26,27In brief, the unique feature of this CT method is its very highimaging speed (one image can be acquired in 50 to 100 msec),which can be achieved because there is no rotating x-ray tube.The heart can therefore be imaged with substantially less artifactdue to motion than with conventional CT scanners. In addition,scanning can be triggered by the patient's electrocardiogram.In our study, data were acquired with a C-150 XP electron-beamCT scanner (Imatron, South San Francisco, Calif.). Scanningwas performed with the patient in a supine position and holdinghis or her breath after inspiration. Our imaging protocol consistedof three steps, as described below.
To determine the position of the heart, eight cross-sectionalimages of the chest (slice thickness, 7 mm; 4-mm gap betweenslices; field of view, 15 cm; acquisition time, 50 msec) wereacquired simultaneously with the scanner in the multislice mode.
To determine exactly the transit time of the contrast agentfrom injection into an antecubital vein to the appearance ofcontrast enhancement in the aortic root and coronary arteries,a bolus of 10 ml of contrast agent (Ultravist-370 [iopromide],Schering, Berlin, Germany) was injected at a rate of 4 ml persecond. As injection of the contrast agent was begun, the patientwas instructed to breathe in, breathe out, breathe in again,and then hold the breath in inspiration. This sequence of commandswas timed to have a total duration of 10 seconds. With the onsetof breath-holding, 10 seconds after the start of contrast injection,acquisition of 10 axial cross-sectional images at the levelof the aortic root was begun (single-slice mode; slice thickness,3 mm; acquisition time, 100 msec per image). Image acquisitionwas triggered by the electrocardiogram, with an image beingacquired after every other heartbeat at 80 percent of the RRinterval. The average CT density in the aortic root was measuredin each of the 10 acquired images with the scanner software.The interval between the onset of contrast injection and peakenhancement was considered to represent the transit time ofthe contrast agent.
In a final step, 40 axial cross-sectional images of the heartwere acquired in single-slice mode. The acquisition time was100 msec per image. With acquisition triggered by the electrocardiogram,one image was acquired after every heartbeat in diastole (at80 percent of the cardiac cycle). The slice thickness was 3mm, and after the acquisition of each image, the table was advanced2 mm to generate overlapping images. The field of view was 15cm, with an image matrix of 512 by 512, which generated a pixelsize of 0.29 by 0.29 mm to make full use of the in-plane spatialresolution of the scanner (seven line pairs per centimeter).
Images were acquired with the patient holding his or her breathafter inspiration and with breathing commands identical to thoseused for the determination of the transit time of the contrastagent. The scanner permits the acquisition of one image percardiac cycle for heart rates up to 120 beats per minute. Withheart rates between 44 and 104 beats per minute (mean, 69) duringacquisition of the images, the duration of breath-holding was23 to 54 seconds (mean, 35). Between 120 and 160 ml of contrastagent was injected intravenously at a rate of 4 ml per second.A delay corresponding to the individually determined transittime of the contrast agent was maintained between the initiationof injection of the contrast agent and the acquisition of thefirst image. The radiation dose was estimated to be less than11 mSv.12,28
Evaluation of Data
The images obtained by electron-beam CT were independently evaluatedby two investigators without knowledge of the findings on thepatients' coronary angiograms. The image data were transferredto an off-line workstation (MagicView, Siemens, Erlangen, Germany).The cross-sectional images were screened for artifacts causedby motion and for calcifications of the coronary arteries. Calcificationswere rated as too severe to permit further evaluation if a calcifiedplaque occupied more than half the diameter of the artery intwo consecutive images. Manual segmentation of the images wasperformed on an image-by-image basis to eliminate all structuresthat would obstruct the view of the coronary arteries, suchas the chest wall, pulmonary vessels, and atrial appendages(Figure 1A, Figure 1B, and Figure 1C). Subsequently, three-dimensionalreconstructions of the heart and coronary arteries were renderedby a shaded-surface display technique. A lower threshold of80 Hounsfield units was used for the reconstruction in all patientsto visualize selectively the contrast-enhanced lumina of thecoronary arteries, while ignoring the vessel wall and surroundingconnective tissue (Figure 1A, Figure 1B, and Figure 1C).19 Three-dimensionalreconstructions were rendered interactively from at least sixangles (equivalent to posteroanterior, left anterior oblique,and right anterior oblique projections, each in at least twocraniocaudal angulations). If necessary, reconstructions wererendered from additional angles to depict all coronary segmentsfrom two orthogonal directions.
Panel A shows a cross section of the heart at the level of the aortic root. The origin of the left main coronary artery from the aortic root as well as the proximal left anterior descending coronary artery (arrow) and left circumflex coronary artery (arrowhead) can be seen. Panels B and C show a three-dimensional reconstruction (shaded-surface display) of the heart and coronary arteries. The reconstruction is designed to show only contrast-enhanced structures. Panel B shows a reconstruction of the complete heart. In Panel C, the main stem of the pulmonary artery and the atrial appendages have been removed to show the left main coronary artery (LM), the left anterior descending coronary artery (LAD), and the right coronary artery (RCA).
On the basis of the original cross-sectional images and thethree-dimensional reconstructions, both investigators independentlyrated the left main coronary artery (segment 5 according tothe system of the American Heart Association29) and the proximaland middle segments of the left anterior descending coronaryartery (segments 6 and 7 and the first half of segment 8), theleft circumflex coronary artery (segments 11 and 13), and theright coronary artery (segments 1 and 2) as being occluded orhaving a high-grade stenosis (more than 75 percent reductionin diameter), showing neither high-grade stenosis nor occlusion,or being impossible to evaluate. The side branches and the distalsegments of the coronary arteries were not included in the evaluation.Determination of the severity of stenosis was based on visualestimation of both the axial cross sections and the three-dimensionalreconstructions. In the reconstructions, the severity of thelesion was determined in the projection that showed the highestdegree of stenosis. Cohen's kappa30 was calculated to determineagreement between observers on which of three categories wasapplicable (status impossible to evaluate, high-grade stenosisor occlusion absent, and high-grade stenosis or occlusion present).
Coronary Angiography
In all patients, coronary angiography was performed by the transfemoralJudkins approach. Angiograms were documented on cine film andevaluated by two cardiologists who were independent of the electron-beamCT team. Reductions in diameter of more than 75 percent wereconsidered to represent high-grade stenoses. In cases of disagreementbetween the two readers, agreement was achieved in a joint reading.Cohen's kappa was calculated to determine variability betweenobservers, with regard to the same categories as for electron-beamCT (status impossible to evaluate, high-grade stenosis or occlusionabsent, and high-grade stenosis or occlusion present).
Results
In all the patients, electron-beam CT was performed withoutcomplications. The mean time needed for the investigation was18±3 minutes per patient, including all preparationsfor scanning. Of the 500 coronary arteries (left main, leftanterior descending, left circumflex, and right coronary arteryin 125 patients), 124 were considered impossible to evaluatebecause of technical problems. The main reasons for impairedimage quality were artifacts of respiration (40 vessels) andsevere calcifications (33 vessels) (Figure 2A and Figure 2B),as well as artifacts of movement of the left circumflex coronaryartery (11 vessels) and the right coronary artery (14 vessels).Other reasons included reduced signal-to-noise ratio (12 vessels),superposition of veins (5 vessels), malpositioning of the imagingvolume (5 vessels), and a very small arterial lumen (4 vessels).In 11 patients, one coronary artery could not be evaluated;in 14 patients, two arteries could not be evaluated; and in3 patients, three vessels could not be evaluated. In 19 patients(15 percent), the quality of the image was too poor for anyof the four arteries to be evaluated. The reduction in imagequality in these patients was caused by artifacts of respirationin eight, severe calcifications in five, reduced signal-to-noiseratio in three, and more than one of these factors in three.
Figure 2. Frequently Observed Reasons for Inability to Evaluate Electron-Beam CT Images of the Coronary Arteries.
Panel A shows severe calcifications of the proximal left anterior descending coronary artery (arrow). In Panel B, artifacts of respiration render the left anterior descending coronary artery (arrow), left circumflex coronary artery (arrowhead), and right coronary artery (not seen from this angle) impossible to evaluate.
The left main coronary artery could be evaluated in 105 patients(84 percent), the left anterior descending coronary artery in100 patients (80 percent), the left circumflex coronary arteryin 83 patients (66 percent), and the right coronary artery in88 patients (70 percent).
With the 124 coronary arteries that were graded as impossibleto evaluate excluded from the analysis, 41 of 42 substantiallesions (high-grade stenoses and occlusions) of the left anteriordescending coronary artery, 14 of 18 substantial lesions ofthe left circumflex coronary artery, and 14 of 15 substantiallesions of the right coronary artery were correctly detectedby electron-beam CT (Figure 3A, Figure 3B, Figure 4A, Figure 4B,and Figure 4C). In the arteries that could be evaluated,the absence of high-grade stenosis or complete occlusion wascorrectly determined in 104 of 105 cases for the left main coronaryartery, 51 of 58 cases for the left anterior descending coronaryartery, 57 of 65 cases for the left circumflex coronary artery,and 70 of 73 cases for the right coronary artery (Table 1).These numbers correspond to a sensitivity of 92 percent, a specificityof 94 percent, a positive predictive value of 78 percent, anda negative predictive value of 98 percent for the detectionof substantial coronary lesions in the arteries that could beevaluated.
Figure 3. Cardiac Images of a 56-Year-Old Patient with a Complete Occlusion of the Left Circumflex Coronary Artery (Arrow) According to Electron-Beam CT (Panel A) and Coronary Angiography (Panel B).
Figure 4. Cardiac Images of an 81-Year-Old Patient with a High-Grade Stenosis of the Right Coronary Artery (Arrow) According to Electron-Beam CT (Panels A and B) and Coronary Angiography (Panel C).
Table 1. Accuracy of Electron-Beam CT for the Detection of High-Grade Stenoses and Occlusions of the Coronary Arteries.
Whether a vessel could be evaluated by electron-beam CT wasnot associated with the angiographic results for that vessel(Table 2). Of the 376 vessels that could be evaluated by electron-beamCT, 75 (20 percent) had a high-grade stenosis or occlusion onangiography; of the 124 arteries that could not be evaluatedby electron-beam CT, 24 (19 percent) had a high-grade stenosisor occlusion on angiography.
Table 2. Relation between Angiographic Status of the Coronary Arteries and Results of Electron-Beam CT.
Overall, when arteries that could not be evaluated were included,electron-beam CT permitted visualization of 69 of the 99 high-gradecoronary-artery stenoses and occlusions that were detected byangiography in the group of patients we investigated. Of the401 coronary arteries that were documented by angiography tobe free of high-grade lesions, 282 were correctly identifiedby electron-beam CT.
Interobserver agreement was achieved for 453 of the 500 coronaryarteries (91 percent). Cohen's kappa was 0.82, indicating closeagreement between observers. Disagreement concerned mainly thequality of the images: in 31 of the 47 coronary vessels withdiscrepant readings, one of the two observers considered imagequality to be too poor for evaluation. With conventional angiography,agreement between the observers was achieved in 96 percent ofcases without joint reading, and Cohen's kappa was 0.90.
Discussion
Because of its high spatial and temporal resolution as wellas the fact that image acquisition can be triggered by the electrocardiogram,electron-beam CT is well suited for cardiac imaging. In a clinicalsetting, this method, which has also been called "ultrafastCT" or "cine CT," has been applied principally to visualizeand quantify coronary calcifications12,13,14,15,16,17 and toevaluate cardiac function.31 However, preliminary reports haveindicated the potential of the method, after intravenous injectionof contrast agent, to visualize the coronary-artery lumen19,20and to detect stenoses noninvasively.21,22,23,24,25 In our investigation,we found a high sensitivity and specificity, as well as a veryhigh negative predictive value of 98 percent, for the detectionof complete occlusions and high-grade stenoses of the coronaryarteries, provided that sufficiently good image quality couldbe obtained. In the vessels that could be evaluated, the numberof false negative results for stenoses was small (92 percentsensitivity). Most stenoses that were missed were located inthe left circumflex and right coronary arteries. These vesselsare perpendicular to the imaging plane and are therefore visualizedwith lower spatial resolution than those oriented parallel tothe imaging plane. As in earlier, smaller studies, most falsepositive results were for stenoses in smaller vessels23 (again,the left circumflex coronary artery in most cases).
The main drawback of electron-beam CT currently seems to bethat 25 percent of all coronary segments had to be excludedfrom evaluation because of inadequate image quality. Becauseof their position in the coronary groove, the left circumflexand right coronary arteries have more rapid diastolic motionthan the left anterior descending coronary artery. The motionis caused mainly by atrial contraction during end-diastole.In addition, the interpretation of results for all coronaryarteries may be compromised by artifacts of respiration if patientsare unable to obey the breath-holding commands. Although mildlycalcified vessels can be evaluated, extensive calcificationsare a frequent reason for false negative23,25 and false positive22results. We therefore excluded all arteries with more than mildcalcifications from evaluation. Mistriggering of single crosssections (from premature beats, for example) was not observedas frequently as previously reported.22
Before the method is applied on a broad clinical scale, thenumber of studies that cannot be evaluated will have to be reduced.To do this, it will be necessary to ensure, for example, thatthrough more careful instruction and preparation patients holdtheir breath for the full scanning period. Alternatively, theheart rate may be medically increased to shorten the overallimage-acquisition time. Furthermore, choosing different imagingplanes could increase spatial resolution in the vessel segmentsthat are perpendicular to the axial imaging plane we used inthe present study (the middle right coronary artery and theleft circumflex coronary artery).23 Further reducing the image-acquisitiontime or optimizing the time interval in the cardiac cycle thatis used for image acquisition would probably diminish artifactsof motion. Higher spatial resolution of the scanner might improvethe detection of short lesions and of stenoses in small arteries.It might also permit the development of image-processing techniquesto subtract calcified plaques, something that is currently notpossible, because of the overlap of density values between calcificationsand contrast-enhanced vessel lumen.
Our evaluation was limited to the proximal and middle segmentsof the major coronary arteries. Distal segments and side brancheswere excluded because their small diameters do not permit reliableimaging with the spatial resolution the scanner currently provides(seven line pairs per centimeter in the imaging plane), andpartial-volume effects would lead to an unacceptably high numberof false positive results. However, since lesions in distalsegments and side branches are rarely the target of catheterintervention or bypass revascularization, the fact that electron-beamCT imaging is limited to segments of larger diameter does notmean that the technique may not be clinically useful. Similarly,no attempt was made to differentiate between high-grade stenosesand complete occlusions of coronary arteries. In electron-beamCT, the partial-volume effect can cause a very tight stenosisto appear to be a complete occlusion of the vessel lumen. Consequently,it may be impossible to decide whether such a lesion representsa high-grade stenosis or a complete occlusion with filling ofthe distal segment by collateral flow. For clinical applications,however, mistaking complete occlusions for high-grade stenoseswould in most cases be irrelevant, since both conditions usuallyrequire further invasive testing.
The accuracy of electron-beam CT for the diagnosis of high-gradestenoses and occlusions of the coronary arteries seems to besuperior to that of other noninvasive techniques. Echocardiographypermits the assessment of only the most proximal segments ofthe coronary arteries, and the technique is unreliable for identifyingcoronary lesions. Dichromatic synchrotron angiography has notyet been evaluated on a broad scale. Magnetic resonance coronary-angiographytechniques are evolving rapidly. As compared with electron-beamCT, they have the advantage of requiring no exposure to radiationand, in most cases, no injection of contrast agent. However,the spatial and temporal resolution of currently available MRItechniques32,33,34,35,36,37 is inferior to that of electron-beamCT, and except for respiratory-gated acquisitions,36,37 thenecessary respiratory maneuvers require a high degree of cooperationfrom patients.32,33,34,35 The reported accuracy of MRI protocolsthat have been proposed for the detection of coronary-arterystenoses varies widely, from 38 to 90 percent,32,33,34,35,36,37and (with the possible exception of visualizing the course ofanomalous coronary arteries38,39,40) magnetic resonance angiographyis currently considered an investigational technique.10,11,40,41
The high negative predictive value of electron-beam CT for thedetection of high-grade stenoses in patients with adequate imagequality may make this method a clinically useful test. Sincewe found that the results of electron-beam CT could be completelyevaluated in 62 percent of all patients, and that whether ornot they could be evaluated was not related to the angiographicstatus of the arteries, it can be calculated that up to twothirds of the coronary angiographic procedures that demonstratenormal coronary arteries could currently be averted by the useof this noninvasive test. Further research must be directedtoward reducing the number of nondiagnostic studies. Once thisgoal has been achieved, electron-beam CT may become a usefultool to rule out high-grade coronary-artery stenoses or occlusionsin, for example, patients with a low likelihood of obstructivecoronary disease, and also in patients who have undergone balloonangioplasty or bypass grafting. In this way, a substantial numberof the invasive coronary angiographic studies that have negativeresults, which constitute up to 20 percent of all studies performed,42could be replaced by noninvasive outpatient examinations.
Source Information
From the Department of Internal Medicine II, University of Erlangen-Nürnberg, Erlangen, Germany.
Address reprint requests to Dr. Achenbach at the Medizinische Klinik II mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstr. 29, D-91054 Erlangen, Germany.
References
1993 Heart and stroke facts statistics. Dallas: American Heart Association, 1993:8.
Hozumi T, Yoshida K, Ogata Y, et al. Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography. Circulation 1998;97:1557-1562. [Free Full Text]
Feigenbaum H. Transthoracic ultrasonic visualization of coronary atherosclerosis. J Am Soc Echocardiogr 1989;2:253-258. [Medline]
Tardif JC, Vannan MA, Taylor K, Schwartz SL, Pandian NG. Delineation of extended lengths of coronary arteries by multiplane transesophageal echocardiography. J Am Coll Cardiol 1994;24:909-919. [Abstract]
Caiati C, Aragona P, Iliceto S, Rizzon P. Improved detection of proximal left anterior descending coronary artery stenosis after intravenous injection of a lung-crossing contrast agent: a transesophageal Doppler echocardiographic study. J Am Coll Cardiol 1996;27:1413-1421. [Abstract]
Mulvagh SL, Foley DA, Aeschbacher BC, Klarich KK, Seward JB. Second harmonic imaging of an intravenously administered echocardiographic contrast agent: visualization of coronary arteries and measurement of coronary blood flow. J Am Coll Cardiol 1996;27:1519-1525. [Abstract]
Rubenstein E, Brown GS, Chapman D, et al. Synchrotron radiation coronary angiography in humans. In: Chance B, Deisenhofer J, Ebashi S, et al., eds. Synchrotron radiation in the biosciences. New York: Oxford University Press, 1994:639-50.
Hamm CW, Meinertz T, Dix WR, et al. Intravenous coronary angiography with dichromography using synchrotron radiation. Herz 1996;21:127-131. [Medline]
Taylor AM, Pennell DJ. Recent advances in cardiac magnetic resonance imaging. Curr Opin Cardiol 1996;11:635-642. [Medline]
van der Wall EE, van Rugge FP, Vliegen HW, Reiber JH, de Roos A, Bruschke AV. Ischemic heart disease: value of MR techniques. Int J Card Imaging 1997;13:79-89. [Medline]
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832. [Abstract]
Ultrafast CT for coronary calcification. Lancet 1991;337:1449-1450.
Breen JF, Sheedy PF II, Schwartz RS, et al. Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992;185:435-439. [Free Full Text]
Budoff MJ, Georgiou D, Brody A, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation 1996;93:898-904. [Free Full Text]
Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries: 19-month follow-up of 1173 asymptomatic subjects. Circulation 1996;93:1951-1953. [Free Full Text]
Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol 1996;27:285-290. [Abstract]
Rumberger JA, Sheedy PF II, Breen JF, Fitzpatrick LA, Schwartz RS. Electron beam computed tomography and coronary artery disease: scanning for coronary artery calcification. Mayo Clin Proc 1996;7:369-377.
Moshage WE, Achenbach S, Seese B, Bachmann K, Kirchgeorg M. Coronary artery stenoses: three-dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron-beam CT. Radiology 1995;196:707-714. [Free Full Text]
Chernoff DM, Ritchie CJ, Higgins CB. Evaluation of electron beam CT coronary angiography in healthy subjects. AJR Am J Roentgenol 1997;169:93-99. [Free Full Text]
Budoff MJ, Oudiz RJ, Zalace CP, et al. Intravenous three dimensional coronary angiography using contrast enhanced electron beam computed tomography. J Am Coll Cardiol 1997;29:Suppl A:393A-393A.abstract [CrossRef]
Nakanishi T, Ito K, Imazu M, Yamakido M. Evaluation of coronary artery stenoses using electron-beam CT and multiplanar reformation. J Comput Assist Tomogr 1997;21:121-127. [CrossRef][Medline]
Schmermund A, Rensing BJ, Sheedy PF, Bell MR, Rumberger JA. Intravenous electron-beam computed tomographic coronary angiography for segmental analysis of coronary artery stenoses. J Am Coll Cardiol 1998;31:1547-1554. [Free Full Text]
Reddy GP, Chernoff DM, Siripornpitak S, Adams JR, Outtrim RA, Higgins CB. Assessment of coronary artery stenoses with contrast-enhanced electron-beam CT and axial reconstructions. Radiology 1997;205:Suppl:459-459.abstract [Free Full Text]
Achenbach S, Moshage W, Bachmann K. Detection of high-grade restenosis after PTCA using contrast-enhanced electron beam CT. Circulation 1997;96:2785-2788. [Free Full Text]
Boyd D, Gould RG, Quinn J, Sparks R, Stanley R, Hermannsfeldt W. A proposed cardiac 3-d densitometer for easy detection and evaluation of heart disase. IEEE Trans Nucl Sci 1979;26:2724-7.
Gould RG. Principles of ultrafast computed tomography: historical aspects, mechanism of action, and scanner characteristics. In: Stanford W, Rumberger JA, eds. Ultrafast computed tomography in cardiac imaging: principles and practice. Mount Kisco, N.Y.: Futura Publishing, 1992:1-16.
Stanford W, Thompson BH, Weiss RM. Coronary artery calcification: clinical significance and current methods of detection. AJR Am J Roentgenol 1993;161:1139-1146. [Free Full Text]
A reporting system on patients evaluated for coronary artery disease: report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51:Suppl:5-40. [Medline]
Cohen J. A coefficient for agreement on nominal scales. Educ Psychol Meas 1960;20:37-46.
Rumberger JA. Quantifying left ventricular regional and global systolic function using ultrafast computed tomography. Am J Card Imaging 1991;5:29-37. [Medline]
Manning WJ, Li W, Edelman RR. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993;328:828-832. [Erratum, N Engl J Med 1994;330:152.] [Free Full Text]
Post JC, van Rossum AC, Hofman MB, Valk J, Visser CA. Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography. AJR Am J Roentgenol 1996;166:1399-1404. [Free Full Text]
Pennell DJ, Bogren HG, Keegan J, Firmin DN, Underwood SR. Assessment of coronary artery stenosis by magnetic resonance imaging. Heart 1996;75:127-133. [Free Full Text]
Mohiaddin RH, Bogren HG, Lazim F, et al. Magnetic resonance coronary angiography in heart transplant recipients. Coron Artery Dis 1996;7:591-597. [Medline]
Kessler W, Achenbach S, Moshage W, et al. Usefulness of respiratory gated magnetic resonance coronary angiography in assessing narrowings> or = 50% in diameter in native coronary arteries and in aortocoronary bypass conduits. Am J Cardiol 1997;80:989-993. [CrossRef][Medline]
Muller MF, Fleisch M, Kroeker R, Chatterjee T, Meier B, Vock P. Proximal coronary artery stenosis: three-dimensional MRI with fat saturation and navigator echo. J Magn Reson Imaging 1997;7:644-651. [Medline]
McConnell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 1995;92:3158-3162. [Free Full Text]
Post JC, van Rossum AC, Bronzwaer JGF, et al. Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course? Circulation 1995;92:3163-3171. [Free Full Text]
Task Force of the European Society of Cardiology, Association of European Paediatric Cardiologists. The clinical role of magnetic resonance in cardiovascular disease. Eur Heart J 1998;19:19-39. [Free Full Text]
Duerinckx AJ. MR angiography of the coronary arteries. Top Magn Reson Imaging 1995;7:267-285. [Medline]
Johnson LW, Lozner EC, Johnson S, et al. Coronary arteriography 1984-1987: a report of the Registry of the Society for Cardiac Angiography and Interventions. I. Results and complications. Cathet Cardiovasc Diagn 1989;17:5-10. [Medline]
Schmermund, A., Nowak, B., Voigtlander, T.
(2008). Non-invasive CT coronary angiography: can high diagnostic image quality be achieved with less radiation exposure?. Eur Heart J
29: 2955-2956
[Full Text]
Lima, J. A.C.
(2008). Another Step Forward in CT Angiography.. J Am Coll Cardiol Img
1: 187-189
[Full Text]
Schroeder, S., Achenbach, S., Bengel, F., Burgstahler, C., Cademartiri, F., de Feyter, P., George, R., Kaufmann, P., Kopp, A. F., Knuuti, J., Ropers, D., Schuijf, J., Tops, L. F., Bax, J. J.
(2008). Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J
29: 531-556
[Abstract][Full Text]
Wong, T. Y., Cheung, N., Islam, F. M. A., Klein, R., Criqui, M. H., Cotch, M. F., Carr, J. J., Klein, B. E. K., Sharrett, A. R.
(2008). Relation of Retinopathy to Coronary Artery Calcification: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol
167: 51-58
[Abstract][Full Text]
Budoff, M. J., Achenbach, S., Blumenthal, R. S., Carr, J. J., Goldin, J. G., Greenland, P., Guerci, A. D., Lima, J. A.C., Rader, D. J., Rubin, G. D., Shaw, L. J., Wiegers, S. E.
(2006). Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation
114: 1761-1791
[Full Text]
Hoffmann, U., Pena, A. J., Cury, R. C., Abbara, S., Ferencik, M., Moselewski, F., Siebert, U., Brady, T. J., Nagurney, J. T.
(2006). Cardiac CT in Emergency Department Patients with Acute Chest Pain.. RadioGraphics
26: 963-978
[Abstract][Full Text]
Hoffmann, U., Ferencik, M., Cury, R. C., Pena, A. J.
(2006). Coronary CT Angiography. JNM
47: 797-806
[Abstract][Full Text]
Raggi, P., Taylor, A., Fayad, Z., O'Leary, D., Nissen, S., Rader, D., Shaw, L. J.
(2005). Atherosclerotic Plaque Imaging: Contemporary Role in Preventive Cardiology. Arch Intern Med
165: 2345-2353
[Abstract][Full Text]
Donnelly, P M, Higginson, J D S, Hanley, P D
(2005). Multidetector CT coronary angiography: have we found the holy grail of non-invasive coronary imaging?. Heart
91: 1385-1388
[Abstract][Full Text]
Sakuma, H., Ichikawa, Y., Suzawa, N., Hirano, T., Makino, K., Koyama, N., Van Cauteren, M., Takeda, K.
(2005). Assessment of Coronary Arteries with Total Study Time of Less than 30 Minutes by Using Whole-Heart Coronary MR Angiography. Radiology
237: 316-321
[Abstract][Full Text]
Namdar, M., Hany, T. F., Koepfli, P., Siegrist, P. T., Burger, C., Wyss, C. A., Luscher, T. F., von Schulthess, G. K., Kaufmann, P. A.
(2005). Integrated PET/CT for the Assessment of Coronary Artery Disease: A Feasibility Study. JNM
46: 930-935
[Abstract][Full Text]
Heuschmid, M., Kuettner, A., Schroeder, S., Trabold, T., Feyer, A., Seemann, M. D., Kuzo, R., Claussen, C. D., Kopp, A. F.
(2005). ECG-Gated 16-MDCT of the Coronary Arteries: Assessment of Image Quality and Accuracy in Detecting Stenoses. Am. J. Roentgenol.
184: 1413-1419
[Abstract][Full Text]
Schroeder, S, Kuettner, A, Wojak, T, Janzen, J, Heuschmid, M, Athanasiou, T, Beck, T, Burgstahler, C, Herdeg, C, Claussen, C D, Kopp, A F
(2004). Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations. Heart
90: 1471-1475
[Abstract][Full Text]
Hofmann, L. K., Zou, K. H., Costello, P., Schoepf, U. J.
(2004). Electrocardiographically Gated 16-Section CT of the Thorax: Cardiac Motion Suppression. Radiology
233: 927-933
[Abstract][Full Text]
Lu, B., Zhuang, N., Mao, S.-S., Child, J., Carson, S., Budoff, M. J.
(2004). Baseline Heart Rate-adjusted Electrocardiographic Triggering for Coronary Artery Electron-Beam CT Angiography. Radiology
233: 590-595
[Abstract][Full Text]
Schoenhagen, P., Halliburton, S. S., Stillman, A. E., Kuzmiak, S. A., Nissen, S. E., Tuzcu, E. M., White, R. D.
(2004). Noninvasive Imaging of Coronary Arteries: Current and Future Role of Multi-Detector Row CT. Radiology
232: 7-17
[Abstract][Full Text]
Schoepf, U. J., Becker, C. R., Ohnesorge, B. M., Yucel, E. K.
(2004). CT of Coronary Artery Disease. Radiology
232: 18-37
[Abstract][Full Text]
Hoffmann, U., Millea, R., Enzweiler, C., Ferencik, M., Gulick, S., Titus, J., Achenbach, S., Kwait, D., Sosnovik, D., Brady, T. J.
(2004). Acute Myocardial Infarction: Contrast-enhanced Multi-Detector Row CT in a Porcine Model. Radiology
231: 697-701
[Abstract][Full Text]
Choi, H. S., Choi, B. W., Choe, K. O., Choi, D., Yoo, K.-J., Kim, M.-I., Kim, J.
(2004). Pitfalls, Artifacts, and Remedies in Multi- Detector Row CT Coronary Angiography. RadioGraphics
24: 787-800
[Abstract][Full Text]
Desjardins, B., Kazerooni, E. A.
(2004). ECG-Gated Cardiac CT. Am. J. Roentgenol.
182: 993-1010
[Full Text]
Achenbach, S.
(2004). Detection of coronary stenoses by multidetector computed tomography: it's all about resolution. J Am Coll Cardiol
43: 840-841
[Full Text]
Budoff, M. J., Achenbach, S., Duerinckx, A.
(2003). Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. J Am Coll Cardiol
42: 1867-1878
[Abstract][Full Text]
Hull, M. C., Morris, C. G., Pepine, C. J., Mendenhall, N. P.
(2003). Valvular Dysfunction and Carotid, Subclavian, and Coronary Artery Disease in Survivors of Hodgkin Lymphoma Treated With Radiation Therapy. JAMA
290: 2831-2837
[Abstract][Full Text]
Gurevitch, J., Gaspar, T., Orlov, B., Amar, R., Dvir, D., Peled, N., Aravot, D. J.
(2003). Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography. Ann. Thorac. Surg.
76: 1523-1527
[Abstract][Full Text]
Manger, K, Kusus, M, Forster, C, Ropers, D, Daniel, W G, Kalden, J R, Achenbach, S, Manger, B
(2003). Factors associated with coronary artery calcification in young female patients with SLE. Ann Rheum Dis
62: 846-850
[Abstract][Full Text]
Peebles, C R
(2003). Non-invasive coronary imaging: computed tomography or magnetic resonance imaging?. Heart
89: 591-594
[Full Text]
Leber, A W, Knez, A, Becker, C, Becker, A, White, C, Thilo, C, Reiser, M, Haberl, R, Steinbeck, G
(2003). Non-invasive intravenous coronary angiography using electron beam tomography and multislice computed tomography. Heart
89: 633-639
[Abstract][Full Text]
Enzweiler, C. N.H., Wiese, T. H., Petersein, J., Lembcke, A. E., Borges, A. C., Dohmen, P., Hoffmann, U., Hamm, B.
(2003). Diameter changes of occluded venous coronary artery bypass grafts in electron beam tomography: preliminary findings. Eur. J. Cardiothorac. Surg.
23: 347-353
[Abstract][Full Text]
Morin, R. L., Gerber, T. C., McCollough, C. H.
(2003). Radiation Dose in Computed Tomography of the Heart. Circulation
107: 917-922
[Full Text]
Wang, A. Y.-M., Wang, M., Woo, J., Lam, C. W.-K., Li, P. K.-T., Lui, S.-F., Sanderson, J. E.
(2003). Cardiac Valve Calcification as an Important Predictor for All-Cause Mortality and Cardiovascular Mortality in Long-Term Peritoneal Dialysis Patients: A Prospective Study. J. Am. Soc. Nephrol.
14: 159-168
[Abstract][Full Text]
Hunold, P., Vogt, F. M., Schmermund, A., Debatin, J. F., Kerkhoff, G., Budde, T., Erbel, R., Ewen, K., Barkhausen, J.
(2003). Radiation Exposure during Cardiac CT: Effective Doses at Multi-Detector Row CT and Electron-Beam CT. Radiology
226: 145-152
[Abstract][Full Text]
Funabashi, N., Kobayashi, Y., Perlroth, M., Rubin, G. D.
(2003). Coronary Artery: Quantitative Evaluation of Normal Diameter Determined with Electron-Beam CT Compared with Cine Coronary Angiography--Initial Experience. Radiology
226: 263-271
[Abstract][Full Text]
Kopp, A.F., Schroeder, S., Kuettner, A., Baumbach, A., Georg, C., Kuzo, R., Heuschmid, M., Ohnesorge, B., Karsch, K.R., Claussen, C.D.
(2002). Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J
23: 1714-1725
[Abstract][Full Text]
Nieman, K., Cademartiri, F., Lemos, P. A., Raaijmakers, R., Pattynama, P. M.T., de Feyter, P. J.
(2002). Reliable Noninvasive Coronary Angiography With Fast Submillimeter Multislice Spiral Computed Tomography. Circulation
106: 2051-2054
[Abstract][Full Text]
Fayad, Z. A., Fuster, V., Nikolaou, K., Becker, C.
(2002). Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging: Current and Potential Future Concepts. Circulation
106: 2026-2034
[Full Text]
Treede, H., Becker, C., Reichenspurner, H., Knez, A., Detter, C., Reiser, M., Reichart, B.
(2002). Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease. Ann. Thorac. Surg.
74: S1398-1402
[Abstract][Full Text]
Coladonato, J. A., Szczech, L. A., Friedman, E. A., Owen, W. F. Jr
(2002). Does calcium kill ESRD patients--the skeptic's perspective. Nephrol Dial Transplant
17: 229-232
[Full Text]
Arai, Y., Hirose, N., Yamamura, K., Kimura, M., Murayama, A., Fujii, I., Tsushima, M.
(2002). Long-Term Effect of Lipid-Lowering Therapy on Atherosclerosis of Abdominal Aorta in Patients with Hypercholesterolemia: Noninvasive Evaluation by a New Image Analysis Program. ANGIOLOGY
53: 57-68
[Abstract]
Gerber, T. C., Kuzo, R. S., Karstaedt, N., Lane, G. E., Morin, R. L., Sheedy, P. F II, Safford, R. E., Blackshear, J. L., Pietan, J. H.
(2002). Current Results and New Developments of Coronary Angiography With Use of Contrast-Enhanced Computed Tomography of the Heart. Mayo Clin Proc.
77: 55-71
[Abstract]
Kim, W. Y., Danias, P. G., Stuber, M., Flamm, S. D., Plein, S., Nagel, E., Langerak, S. E., Weber, O. M., Pedersen, E. M., Schmidt, M., Botnar, R. M., Manning, W. J.
(2001). Coronary Magnetic Resonance Angiography for the Detection of Coronary Stenoses. NEJM
345: 1863-1869
[Abstract][Full Text]
Achenbach, S., Daniel, W. G.
(2001). Noninvasive Coronary Angiography -- An Acceptable Alternative?. NEJM
345: 1909-1910
[Full Text]
Eltzschig, H. K., Ehlers, R., Lee, T. H.
(2001). Noninvasive Tests in Patients with Stable Coronary Artery Disease. NEJM
345: 1351-1351
[Full Text]
Hunold, P, Schmermund, A, Seibel, R.M, Gronemeyer, D.H, Erbel, R
(2001). Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification. Eur Heart J
22: 1748-1758
[Abstract]
Fayad, Z. A., Fuster, V.
(2001). Clinical Imaging of the High-Risk or Vulnerable Atherosclerotic Plaque. Circ. Res.
89: 305-316
[Abstract][Full Text]
deFilippi, C. R., Rosanio, S., Tocchi, M., Parmar, R. J., Potter, M. A., Uretsky, B. F., Runge, M. S.
(2001). Randomized comparison of a strategy of predischarge coronary angiography versus exercise testing in low-risk patients in a chest pain unit: in-hospital and long-term outcomes. J Am Coll Cardiol
37: 2042-2049
[Abstract][Full Text]
Achenbach, S., Giesler, T., Ropers, D., Ulzheimer, S., Derlien, H., Schulte, C., Wenkel, E., Moshage, W., Bautz, W., Daniel, W. G., Kalender, W. A., Baum, U.
(2001). Detection of Coronary Artery Stenoses by Contrast-Enhanced, Retrospectively Electrocardiographically-Gated, Multislice Spiral Computed Tomography. Circulation
103: 2535-2538
[Abstract][Full Text]
Rauch, U., Osende, J. I., Fuster, V., Badimon, J. J., Fayad, Z., Chesebro, J. H.
(2001). Thrombus Formation on Atherosclerotic Plaques: Pathogenesis and Clinical Consequences. ANN INTERN MED
134: 224-238
[Abstract][Full Text]
Haberl, R., Becker, A., Leber, A., Knez, A., Becker, C., Lang, C., Bruning, R., Reiser, M., Steinbeck, G.
(2001). Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol
37: 451-457
[Abstract][Full Text]
von Schulthess, G. K., Schwitter, J.
(2001). Cardiac MR Imaging: Facts and Fiction. Radiology
218: 326-328
[Full Text]
Moshage, W., Achenbach, S., Daniel, W. G.
(2001). Novel approaches to the non-invasive diagnosis of coronary-artery disease. Nephrol Dial Transplant
16: 21-28
[Full Text]
Achenbach, S., Ulzheimer, S., Baum, U., Kachelrie{beta}, M., Ropers, D., Giesler, T., Bautz, W., Daniel, W. G., Kalender, W. A., Moshage, W.
(2000). Noninvasive Coronary Angiography by Retrospectively ECG-Gated Multislice Spiral CT. Circulation
102: 2823-2828
[Abstract][Full Text]
Atar, S., Nagai, T., Cercek, B., Naqvi, T. Z., Luo, H., Siegel, R. J.
(2000). Pacing stress echocardiography: an alternative to pharmacologic stress testing. J Am Coll Cardiol
36: 1935-1941
[Abstract][Full Text]
Eifinger, F., Wahn, F., Querfeld, U., Pollok, M., Gevargez, A., Kriener, P., Gronemeyer, D.
(2000). Coronary artery calcifications in children and young adults treated with renal replacement therapy. Nephrol Dial Transplant
15: 1892-1894
[Full Text]
Achenbach, S, Ropers, D, Regenfus, M, Muschiol, G, Daniel, W G, Moshage, W
(2000). Contrast enhanced electron beam computed tomography to analyse the coronary arteries in patients after acute myocardial infarction. Heart
84: 489-493
[Abstract][Full Text]
Ohnesorge, B., Flohr, T., Becker, C., Kopp, A. F., Schoepf, U. J., Baum, U., Knez, A., Klingenbeck-Regn, K., Reiser, M. F.
(2000). Cardiac Imaging by Means of Electrocardiographically Gated Multisection Spiral CT: Initial Experience. Radiology
217: 564-571
[Abstract][Full Text]
Enzweiler, C. N. H., Kivelitz, D. E., Wiese, T. H., Taupitz, M., Höhn, S., Borges, A. C., Pietsch, L., Dohmen, P., Baumann, G., Hamm, B.
(2000). Coronary Artery Bypass Grafts: Improved Electron-Beam Tomography by Prolonging Breath Holds with Preoxygenation. Radiology
217: 278-283
[Abstract][Full Text]
Fischer, A., Gutstein, D. E, Fayad, Z. A, Fuster, V.
(2000). Predicting plaque rupture: enhancing diagnosis and clinical decision-making in coronary artery disease. Vasc Med
5: 163-172
[Abstract]
Becker, C. R., Knez, A., Ohnesorge, B., Schoepf, U. J., Reiser, M. F.
(2000). Imaging of Noncalcified Coronary Plaques Using Helical CT with Retrospective ECG Gating. Am. J. Roentgenol.
175: 423-424
[Full Text]
Achenbach, S., Ropers, D., Holle, J., Muschiol, G., Daniel, W. G., Moshage, W.
(2000). In-Plane Coronary Arterial Motion Velocity: Measurement with Electron-Beam CT. Radiology
216: 457-463
[Abstract][Full Text]
Worthley, S. G., Helft, G., Fuster, V., Fayad, Z. A., Rodriguez, O. J., Zaman, A. G., Fallon, J. T., Badimon, J. J.
(2000). Noninvasive In Vivo Magnetic Resonance Imaging of Experimental Coronary Artery Lesions in a Porcine Model. Circulation
101: 2956-2961
[Abstract][Full Text]
Goodman, W. G., Goldin, J., Kuizon, B. D., Yoon, C., Gales, B., Sider, D., Wang, Y., Chung, J., Emerick, A., Greaser, L., Elashoff, R. M., Salusky, I. B.
(2000). Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis. NEJM
342: 1478-1483
[Abstract][Full Text]
Kwok, B. W. K., Lim, Y. T., Quek, S. T., Tan, L. K. A., Kwok Wing Kuin, B., Lim, Y. T., Quek, S. T., Tan Kheng Ann, L.
(2000). Electron-Beam Computed Tomography for Symptomatic Coronary Disease. Asian Cardiovasc. Thorac. Ann.
8: 46-49
[Abstract][Full Text]
Manzi, S, Kuller, L H, Edmundowicz, D, Sutton-Tyrrell, K
(2000). Vascular imaging: changing the face of cardiovascular research. Lupus
9: 176-182
[Abstract]
Schwarz, U., Buzello, M., Ritz, E., Stein, G., Raabe, G., Wiest, G., Mall, G., Amann, K.
(2000). Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure. Nephrol Dial Transplant
15: 218-223
[Abstract][Full Text]
Nishino, M., Malloy, M. J., Naya-Vigne, J., Russell, J., Kane, J. P., Redberg, R. F.
(2000). Lack of association of lipoprotein(a) levels with coronary calcium deposits in asymptomatic postmenopausal women. J Am Coll Cardiol
35: 314-320
[Abstract][Full Text]
Pump, H., Möhlenkamp, S., Sehnert, C. A., Schimpf, S. S., Schmidt, A., Erbel, R., Grönemeyer, D. H. W., Seibel, R. M. M.
(2000). Coronary Arterial Stent Patency: Assessment with Electron-Beam CT. Radiology
214: 447-452
[Abstract][Full Text]
Sechtem, U.
(2000). Electron beam computed tomography: on its way into mainstrem cardiology?. Eur Heart J
21: 87-91
Margulis, A. R., Sunshine, J. H.
(2000). Radiology at the Turn of the Millennium1. Radiology
214: 15-23
[Abstract][Full Text]
Hunink, M. G.M., Kuntz, K. M., Fleischmann, K. E., Brady, T. J.
(1999). Noninvasive Imaging for the Diagnosis of Coronary Artery Disease: Focusing the Development of New Diagnostic Technology. ANN INTERN MED
131: 673-680
[Abstract][Full Text]
Rensing, B J, Bongaerts, A H H, van Geuns, R J, van Ooijen, P M A, Oudkerk, M, de Feyter, P J
(1999). In vivo assessment of three dimensional coronary anatomy using electron beam computed tomography after intravenous contrast administration. Heart
82: 523-525
[Abstract][Full Text]
Michaels, A. D., Popovic, Z., Achenbach, S., Daniel, W. G., Moshage, W.
(1999). Noninvasive Detection of Coronary Artery Disease. NEJM
340: 1595-1596
[Full Text]
Siegel, M. J., Evens, R. G.
(1999). Advances in the Use of Computed Tomography. JAMA
281: 1252-1254
[Full Text]
(1999). Electron Beam CT of the Coronary Arteries. JWatch General
1999: 2-2
[Full Text]
Celermajer, D. S.
(1998). Noninvasive Detection of Atherosclerosis. NEJM
339: 2014-2015
[Full Text]
Taylor, A. J., O'Malley, P. G.
(1998). Self-Referral of Patients for Electron-Beam Computed Tomography to Screen for Coronary Artery Disease. NEJM
339: 2018-2020
[Full Text]
Kopp, A. F., Schroeder, S., Kuettner, A., Heuschmid, M., Georg, C., Ohnesorge, B., Kuzo, R., Claussen, C. D.
(2001). Coronary Arteries: Retrospectively ECG-gated Multi-Detector Row CT Angiography with Selective Optimization of the Image Reconstruction Window. Radiology
221: 683-688
[Abstract][Full Text]
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