When I was a junior in college at Kent State University (Kent, Ohio), I received a terrifying telephone call from my sister. Our father had been rushed to the hospital, complaining of chest pain. He was immediately taken to the cardiac cath lab, where physicians discovered that he was, in fact, having a heart attack. Although the angiogram took only 1 hour to perform, it seemed to last forever; and we all were frightened about any possible complications and risks, as he was overweight and a heavy smoker.

What if the procedure time could have been limited to about 10 minutes, was noninvasive, and gave physicians the same results? My hypothetical question might be a reality in the near future – at least that’s what researchers are trying to determine at the Medical College of Wisconsin’s Froedtert Hospital (Milwaukee). There, a team is comparing patients’ results from traditional angiograms with scans from the LightSpeed 64-slice volume CT (VCT) from GE Healthcare (Waukesha, Wis). “We are very enthusiastic,” said James Youker, MD, chairman of radiology at the Medical College. “We feel that this study is very necessary.”

The study includes about 150 patients who require coronary angiography and will undergo both procedures. At press time, the study had just begun, and no preliminary results were available. However, Youker did disclose his gut feeling to me: “I believe they’ll both offer somewhat separate but complementary results. For example, we’ll see that with plaque in the coronaries, CT is very helpful. And with smaller vessels, angiography is more effective.”

Youker said he feels especially inspired because of results from similar studies comparing 16-slice CT with traditional angiograms. “We think the 64-slice CT is a significant advance over the 16-slice, which already showed promise,” he told me. “Now, we have thinner slices and faster acquisition.” Results from the VCT study are expected in early fall, so stay tuned.

Yes, the concept of CT scans “replacing” the cath lab is exciting to physicians, patients, and nervous families alike. A CT scan is a much quicker procedure and, save for a peripheral injection of contrast, is noninvasive with little to no risk. In fact, Youker shared that the Medical College has had requests from informed patients who want the VCT scan rather than traditional angiography.

However, some don’t know if CT scans will ever truly replace the gold standard. Ronald Razmi, MD, director of cardiovascular MR/CT at the Heart Center of Indiana (THCI of Indianapolis), said that although CT is closing the gap, it’s still not more accurate than angiography. “With a cath, we can just see the coronaries better,” Razmi told me. “If a patient has a lot of calcium, a heart rate higher than 60, or an irregular rhythm, it’s simply not an issue with cath. But CT is getting better.”

He said that a modality making headway in cardiac imaging is MR, and his facility has been using a 1.5T scanner from Siemens Medical Solutions (Malvern, Pa) for 2 years now to do just that. “With cardiac MR, we’re able to find myocarditis using the delayed-enhancement method in patients we thought were having a heart attack,” he said. Cardiac MR – which also helps Razmi’s team determine which patients with congestive heart disease are good candidates for surgery – is THCI’s stress test of choice. “It doesn’t use radiation, the information is accurate, it’s faster, and it’s comprehensive in detailing the function of the heart,” he said. “The whole procedure takes about 30 minutes.” Compare that to the time it takes for a nuclear stress test: half a day, if not the full day.

Razmi noted that MR is still not the best choice for imaging the coronary arteries, as CT has better resolution for imaging very small moving structures. But, like many others in the field, he believes that 3T MRI might be a formidable competitor for CT in this area in the future. You can read many others’ views regarding the debate about using multidetector CT or 3T MRI for cardiac imaging in our cover story this month, “We Got the Beat.” After weighing the pros and cons of both modalities, share with me your thoughts on the issue. Much like I was back in April 1995, I’ll be waiting anxiously.

Andi Lucas