ACC.14: Recent advances in CT scanner technology, ED research improving care

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 - 3D CCTA
Images in 54-year-old man with atypical chest pain. Contrast-enhanced ECG-synchronized CCTA obtained after SPECT and displayed as 3D volume-rendered image.
Source: Radiology (doi: 10.1148/radiol.12112426)

WASHINGTON, D.C.—An update on trends in cardiac CT, presented March 30 at the American College of Cardiology (ACC) scientific session, focused on improvements in speed and coverage from vendors and highlighted studies showing the utility of CT angiography (CTA) in the emergency department.

Ricardo C. Cury, MD, of Baptist Hospital of Miami, began by breaking down the advances in scanner technology unveiled in recent months at the 2013 Radiological Society of North America annual meeting and other international conferences:

IQon Spectral CT – Philips’ scanner introduces a dual layer detector, and can perform simultaneous conventional and spectral CT imaging to better characterize tissue composition.

Aquilion ONE – This scanner from Toshiba features a 320-row detector and improved coverage for whole heart imaging, said Cury.

Somatom Force – Seimens’ scanner is a dual source CT and Cury noted its increased temporal resolution.

Revolution CT – Cury said this scanner from CT was designed to improve both coverage and speed with its Gemstone Clarity detector.

“Beyond the technology, I think one of the areas that is most exciting and really going to clinical practice…is CT in the ER,” said Cury, who discussed three of the most headline-grabbing recent studies.

The CT-STAT (Coronary CTA for Systematic Triage of Acute Chest Pain Patients to Treatment) trial from Goldstein et al showed use of coronary CTA for acute low-risk chest pain was feasible and resulted in more rapid and cost-effective diagnosis that rest-stress myocardial perfusion imaging. Costs of care with CTA were 38 percent lower than the standard of care.

These findings were furthered by the ACRIN-PA trial from Litt et al, which showed a coronary CTA-based strategy low and intermediate risk patients sped discharge from the ED for those with possible acute coronary syndrome.

Cury also outlined the findings of the ROMICAT-II trial, in which Hoffmann et al demonstrated improved efficiency of clinical decision making when coronary CTA was incorporated into a triage strategy for patients suspected of acute coronary system. In the study, early CTA resulted in patient length of stay reductions of more than 7 hours, more discharges directly from the ED and no undetected acute coronary syndromes compared with the standard of care.