CT Imaging of Atherosclerotic Cardiovascular Disease

Abstract

The topic of this thesis is Computed Tomography (CT) imaging of atherosclerotic cardiovascular disease. The first part focusing on the technical developments and the diagnostic performance of CT. We provided a systematic review of the literature which lists the merits and shortcomings of the administration of nitroglycerin in coronary CT angiography; discussed the effect of iterative reconstruction on CT assessment of plaque composition; performed a meta-analysis with the aim to determine the diagnostic accuracy of myocardial perfusion imaging compared with invasive coronary angiography combined with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease; and evaluated the use of low radiation dose scan protocol for acquiring ventricular function with CT compared to magnetic resonance imaging. In the second part the prognostic value of pulmonary CT measurements and coronary calcium score was evaluated in a lung cancer screening population. In the last part, the use of coronary CT angiography in clinical practice and current risk model for statin eligibility was assessed. We evaluated the use of coronary CT angiography for workup of suspected acute coronary syndrome in a patient presenting at the emergency department; finally we incorporated the prognostic value of non-obstructive coronary artery disease into a risk calculator to determine sex and ethnicity based thresholds for reclassification of statin eligibility.