Three-dimensional CT coronary angiography is an imaging method that allows for a detailed visualization of the heart vessels (coronary arteries). This method uses computed tomography (CT) technology to create three-dimensional images of the coronary arteries. It is a diagnostic tool used as an alternative to traditional coronary angiography (catheter angiography). It plays a significant role in the early detection of coronary artery disease, especially in low-to-moderate risk patients, and can be safely applied to a wide group of patients due to its non-invasive nature. Recognized as the first-line imaging method for the diagnosis of coronary artery disease in modern cardiology, this technique opens the door to both a comfortable and safe diagnostic process for patients.
Working Principle of Three-Dimensional CT Coronary Angiography
The method is performed using multi-slice computed tomography devices. High-tech devices such as 64-slice, 128-slice, or 256-slice scanners can capture images of the entire heart in fractions of a second. Thanks to ECG synchronization, images are captured at the moment the heart is stationary, thus obtaining sharp vascular images. The hundreds of slices obtained are processed by specialized software to create a three-dimensional map of the heart and vessels. Images can be examined from different angles, and the degrees of stenosis can be expressed numerically through intravascular cross-sectional images. AI-supported analysis programs shorten the evaluation time and increase the accuracy rate.
In Which Diseases Is It Used?
Diagnosis of Coronary Artery Disease
It is used to detect narrowing and blockages in coronary vessels in patients complaining of chest pain, shortness of breath, or a decrease in exercise capacity. Early-stage coronary artery disease can be detected, and the need for treatment can be determined. This method determines whether advanced diagnostic tests are needed in patients with atypical chest pain.
Atherosclerotic Plaque Assessment
The characteristics, quantity, and location of soft and hard plaques on the vessel wall can be evaluated in detail. Long-term heart attack risk can be calculated with calcium scoring. Since soft plaques are considered more risky, early detection of these plaques allows for the initiation of appropriate medical treatment.
Detection of Coronary Anomalies
Congenital coronary artery anomalies, abnormal vessel origins, and courses can be clearly visualized. This examination provides important information regarding the risk of sudden cardiac death in young athletes. Screening for coronary anomalies in young individuals planning a sports career can be life-saving.
Bypass and Stent Follow-up
It can be used to evaluate vessel patency in patients who have previously undergone bypass surgery or had stents placed. Graft occlusions and restenosis can be detected in a non-invasive manner. Patients who develop new symptoms are evaluated quickly to determine the appropriate treatment option.
Pre-Cardiac Surgery Assessment
It is frequently used to evaluate the presence of concomitant coronary artery disease before major operations such as valve surgery. In this way, if necessary, the addition of a bypass can be planned in the same session.
Procedural Steps of Three-Dimensional CT Coronary Angiography
Preparation and Contrast Agent Injection
A contrast agent is injected into the coronary arteries to be examined. This substance allows for the visualization of the blood within the vessels and ensures that the vessels appear more clearly during the CT scan. Some patients may be given beta-blocker medication before the procedure to ensure a slow and regular heart rate. Sublingual nitrate is administered to ensure vasodilation.
CT Scan
After the contrast agent injection, the CT scan is performed. The CT scan quickly captures images of the heart from various angles. These are processed by a computer to create detailed three-dimensional images of the coronary arteries. The procedure usually takes less than ten seconds, and the patient is asked to hold their breath during this time.
Imaging and Evaluation
The generated three-dimensional images are examined by a radiologist or cardiologist. The widths, blockages, narrowings, plaque accumulations, and other abnormalities of the coronary arteries are evaluated. If there is any abnormality or pathology, a diagnosis is made, and an appropriate treatment plan is determined. The result report is prepared in detail and forwarded to the patient's physician.
Advantages of Three-Dimensional CT Coronary Angiography
- Non-invasive nature: No catheter is inserted, and no operation is performed via blood vessels.
- Short procedure time: The entire examination is completed in 15 to 20 minutes.
- Rapid results: Images can be evaluated within the same day.
- Low complication rate: It is much safer than traditional angiography.
- Detailed plaque analysis: The structure of plaques on the vessel wall can be examined.
- No hospitalization required: It is an outpatient procedure.
- Anatomical information: Heart chambers and large vessels are also evaluated simultaneously.
- High accuracy rate: The negative predictive value is very high, meaning the disease can be ruled out in patients with normal results.
Treatment Process
Before the procedure, the patient is kept fasting for four hours and asked to avoid caffeinated beverages. Kidney functions are evaluated with blood tests. Blood pressure and pulse are measured to determine the pre-procedure status. During the procedure, the patient is placed on the CT device, an intravenous line is opened in the arm, and an ECG is connected. If the heart rate is appropriate, the contrast agent is administered, and images are taken in a short time. The patient is given breath-holding instructions, and a few trials are performed. After the procedure, the patient is kept under observation for about half an hour and then discharged. Results are usually evaluated and communicated to the patient on the same day. If an additional examination or treatment is required, planning is done by the physician.
Points to Consider
The procedure may not be suitable for every patient. Alternative methods are preferred for patients with advanced kidney failure, a history of allergy to contrast agents, or uncontrolled rhythm disorders. It is not applied to pregnant women due to radiation exposure. Consuming plenty of fluids after the procedure facilitates the excretion of the contrast agent. If additional imaging or treatment is required, appropriate guidance is provided by the cardiologist. If diabetic patients use metformin, it may be necessary to discontinue the medication before and after the procedure. If symptoms of an allergic reaction occur after the procedure, the hospital should be contacted immediately. Regular heart health check-ups and keeping risk factors under control are critical for the prevention of coronary artery disease.
As Koru Hospital, we offer the safest and most accurate methods in the diagnosis of coronary artery diseases with our state-of-the-art multi-slice CT devices and our experienced cardiology and radiology team. We know the importance of early diagnosis to protect our patients' heart health and continue to provide services in this direction.
