Computed tomographic coronary angiography: an alternative to invasive coronary angiography.

Over the past decade, enormous progress has been made in the technology of computed tomography (CT) imaging. Substantial improvements in spatial resolution, temporal resolution, hardware and software now permit imaging of the entire coronary artery tree within a single breath-hold. Several studies have demonstrated a high sensitivity and specificity for the detection of significant coronary artery stenoses. In addition to imaging of the native coronary arteries, CT angiography may also be used to assess arterial and venous bypass grafts, and to detect the presence and composition of atherosclerotic plaque. Because CT angiography images are acquired with electrocardiogram gating, the data sets permit the assessment of left ventricular function (ejection fraction and regional wall motion), left ventricular volumes and, potentially, myocardial perfusion at no extra cost. The practical advantages of CT angiography (in regard to safety and cost) along with its future anticipated advancements make it an attractive alternative to diagnostic coronary angiography.