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Understanding the pathophysiology of the arterial wall: which method should we choose? Electron beam computed tomography

R. Erbell*,1, T. Budde2, G. Kerkhoff2, S. Möhlenkamp1 and A. Schmermund1

a Department of Cardiology, University Essen, Essen, Germany
b Department of Internal Medicine and Cardiology, Alfried Krupp Hospital, Essen, Germany

* Correspondence: Raimund Erbcl,MD, FESC, FACC, FAHA, University Professor of Medicine/Cardiology, European Cardiologist, Department of Cardiology, Division of Internal Medicine, University Essen, Hufelandstr. 55, D-45122 Essen, Germany.

Abstract

Coronary imaging techniques may be direct or indirect. Indirect methods permit visualization of the coronary artery lumen but not the diseased coronary artery vessel wall. In the early stages of coronary arteriosclerosis, vessel size enlargement compensates for up to 50% stenosis from plaque formation. Indirect methods are therefore unable to visualize early signs of coronary arteriosclerosis. Direct techniques are those that permit visualization of non-calcified and calcified plaque deposits within the coronary artery vessel wall. Electron beam computed tomography (EBCT) is currently the standard technique for assessing calcified lesions. It allows direct visualization of the coronary arteries in a non-invasive manner. Coronary calcium within a plaque is accurately detected and quantified by EBCT. This modality therefore holds promise as a method for studying the natural history of coronary artery disease, irrespective of symptomatic status. Studies have shown that the presence of calcification almost invariably indicates the presence of coronary artery disease, and that the absence of calcification can almost rule out significant coronary artery disease. Moreover, a close correlation exists between the degree of calcification and severity of coronary artery disease. EBCT may also be used in young patients with risk factors in order to detect disease in pre-clinical stage, and to provide new information on the natural history of coronary artery disease.

Key Words: Arteriosclerosis • atherosclerosis • calcification • coronary artery disease • electron beam computed tomography • non-invasive imaging


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