Coronary artery CT - disconnect between current status & publications
In June this year, there was an article titled "Coronary artery disease: new insights and their implications for radiology". This was accepted in Nov 2003 and published online in Dec 2003 in European Radiology and discussed newer issues related with CAD. Most of these issues are related to the "plaque" which is now the centre of attention in CAD. Most acute coronary syndromes today occur because of plaque rupture even when there is minor to moderate stenosis. Initially plaque cause positive remodelling and there may even be dilatation of the
artery rather than narrowing. This makes the ability to visualize and
characterize plaque extremely important.
In this context, the article describes the use of MDCT for the initial evaluation of CAD and suggests that it will probably replace conventional angiography in patients suspected to have CAD and prove to be cost-effective for this.
The July issue of Radiology has two articles on this important subject. The first is by Schoepf et al and the second by Schoenhagen P et al. Schoepf et al's article is titled "CT of coronary artery disease". The majority of images are from a 4-detector row CT and the abstract has this statement "...the accuracy of CT coronary angiography for detection of coronary artery stenoses appears promising enough to warrant pursuit of this application, but sensitivity is still not high enough for routine diagnostic needs". This article has been submitted in April 2003, accepted in August and updated in September and published nine months later. Today, in July 2004, 16-detector CTs have become the de facto standard for coronary artery imaging and though no large study has yet been published, anecdotal experience from multiple centres has shown extremely good sensitivity for picking up disease. Four-detector CT scanners cannot be and should not be used for coronary artery imaging in today's day and age and to even talk about four-detector CT today is useless, unless there is a historical reason for doing so. To give the article credit, the images do portray well, the principles that the article sets out to elucidate.
The other article titled "Non-invasive imaging of coronary arteries: current and future role of multi-detector row CT" is even worse-off in terms of dates, submitted in Dec 2002 and accepted in May 2003, a full one year and two months before publication. The article is completely outdated, though the basic clinical concepts described obviously are relevant and important. All images are from four-detector scanners.
I was excited when I saw all these articles, hoping for some really important and interesting information. Though the information on coronary artery disease, the pathophysiology of plaque and the statistical data on calcium scoring is relevant, the articles do no give us current perspective on where things stand with current technology. Four-detector row CT is not current standard of care for CAD and one year is too long in this field to wait for publication.
These articles should have ideally been published pre-RSNA last year. Sixty-four slice and detector scanners are already upon us and 40-slice scanners are already being commercially sold. The editors of Radiology I am sure know about these things. It is true that publications and data have not kept up with the march of technology especially in the field of coronary CTA. Yet, a year is just too long in these situations.
