Coronary CT, also called cardiac CT or coronary CT angiography, is a non-invasive examination that studies the coronary arteries with a contrast medium injected into a vein. In the NefroCenter Group it is performed at the Casa di Salute Santa Lucia, in the province of Napoli, and at the Rome American Hospital in Roma.
The coronary arteries are the arteries that feed the heart: when the physician suspects they are narrowed, coronary CT makes it possible to observe them without invasive examinations.
Coronary CT is a computed tomography scan dedicated to the heart: X-rays pass through the chest and a computer processes the data into three-dimensional images. An iodine-based contrast medium, injected through a peripheral venous line, makes the lumen and wall of the coronary arteries and the chambers of the heart visible.
The heart is always moving: this is why you are connected to an ECG monitor, and the images come out better with a regular rhythm and a heart rate that is not high. The scan requires holding your breath for a few seconds.
The group’s dual-source CT scanners have two X-ray tubes and two detectors: they acquire the images at high speed and reduce motion artifacts.
Coronary CT is not a check-up examination: it should be performed only on the physician’s indication, after estimating the likelihood of coronary artery disease from symptoms, age, sex and risk factors. According to the 2024 ESC guidelines on chronic coronary syndromes it is recommended, or may be considered, in these cases.
Coronary CT shows narrowings (stenoses) of the coronary arteries and atherosclerotic plaques. Unlike functional tests, it also detects non-obstructive plaque, and this helps the physician to estimate long-term risk.
After a bypass or a stent, if symptoms persist despite treatment, coronary CT may be considered to check that bypass grafts and stents (of at least 3 mm) are patent, that is, not obstructed. After revascularization, however, the guidelines generally prefer functional tests; without symptoms, they recommend regular visits to the physician or cardiologist.
The calcium score (coronary artery calcium score) is an ECG-gated CT scan, without contrast, that quantifies the calcium in the coronary arteries. A high score indicates a higher cardiovascular risk; a value of zero makes obstructive coronary artery disease very unlikely, but does not rule it out, especially in younger people. According to the 2024 ESC guidelines it may be considered in those with suspicious symptoms but a low likelihood of disease and in those who, without symptoms, have a risk close to the threshold at which treatment is decided.
You hand over the physician’s request and the test results, and sign the consent for the examination and the contrast medium.
On the table you are connected to an ECG monitor and a peripheral venous line is placed.
If necessary, and in the absence of contraindications, the physician may administer a beta-blocker to slow the heartbeat and/or nitrates by mouth, which dilate the coronary arteries and improve the images.
You practice the breath-hold; then the table enters the ring of the CT scanner, which rotates around the chest: you do not go completely inside the machine.
With the contrast you may feel diffuse warmth or a metallic taste, which pass in a few minutes; then you remain under observation before the venous line is removed.
The radiologist writes the report, which the physician who prescribed the examination explains to the patient.
At the Casa di Salute Santa Lucia in San Giuseppe Vesuviano, in the province of Napoli, cardiac CT is performed with the dual-source Siemens SOMATOM Pro.Pulse CT scanner. Artificial intelligence algorithms adapt the scan to each patient, a 3D camera helps with positioning and tin filters, in some examinations, reduce the radiation dose.
At the Rome American Hospital in Roma, cardiac CT and the calcium score are performed on the Siemens SOMATOM Force CT scanner, a third-generation dual-source system which, thanks to its high temporal resolution, makes it possible to acquire the images even with a higher or less regular heart rate. Whether the examination is indicated and feasible is always assessed by the physician.
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The facility’s precise instructions apply. In general:
Allergies (especially previous reactions to contrast), kidney or liver failure, myeloma, diabetes, asthma, pregnancy and ongoing medicines, including beta-blockers and biguanides (diabetes medicines), must be reported beforehand and must not be stopped on your own initiative. After the examination, unless the physician indicates otherwise (for example in dialysis, with heart failure or with a fluid restriction), it is advisable to drink plenty: the contrast is eliminated in the urine.
Coronary angiography is an invasive examination: a catheter, introduced through an artery in the wrist or groin, reaches the coronary arteries, and the obstructions found can be treated with angioplasty. Coronary CT, which is non-invasive, is used for diagnosis and is increasingly the initial imaging examination of the coronary arteries; if it shows high-risk disease, the physician may directly indicate coronary angiography.
Functional tests, such as the exercise ECG, stress echocardiography and myocardial scintigraphy, look for signs of ischemia; CT shows the anatomy of the arteries and, if the result is doubtful, the physician may request a functional test.
According to the 2024 ESC guidelines, coronary CT is not recommended with severe kidney failure (eGFR below 30) or acutely worsened heart failure, nor when extensive coronary calcifications, a fast and irregular heart rate, severe obesity or difficulty holding the breath prevent good-quality images. Contraindications to iodinated contrast can also make it inappropriate; in elderly people with heavily calcified coronary arteries a functional test may be more suitable.
In common usage they refer to the same ECG-gated contrast CT scan that studies the coronary arteries; strictly speaking, cardiac CT is the CT of the heart in general, which may include other studies. CAT is the historical acronym for computed axial tomography. The calcium score, sometimes also called a coronary CAT scan, is a different examination, without contrast.
Coronary angiography is invasive: a catheter reaches the coronary arteries from an artery in the wrist or groin and also makes it possible to treat obstructions. Coronary CT requires only an injection into a vein and is used for diagnosis.
The scan requires a breath-hold of a few seconds. Between preparation and observation after the contrast, generally half an hour to an hour, you stay longer: the exact times are indicated by the facility. The examination is not painful; the contrast may cause diffuse warmth, a metallic taste or slight nausea, which pass in a few minutes.
The images come out better with a regular rhythm and a heart rate that is not high. If the rate is high or irregular (some protocols indicate over 65 beats per minute), the treating physician or cardiologist assesses whether treatment is needed before the examination; on the day itself, if not contraindicated, the physician may administer a beta-blocker to slow the heartbeat. With uncontrolled arrhythmias the examination may not be indicated.
It uses X-rays, which carry a possible dose-related risk: this is why it should be performed only with a precise indication, when the benefit outweighs the risk, and with the lowest dose compatible with the technology. Reactions to contrast are rare, serious ones even more so; among the possible effects is kidney damage, which is why kidney function and allergies are assessed beforehand. With severe kidney failure it is not recommended; in pregnancy CT is avoided.
It is a score that quantifies the calcium in the coronary arteries, with an ECG-gated CT scan and without contrast medium. A value of zero makes obstructive coronary artery disease very unlikely, but does not rule it out, especially in younger people. The physician may propose it, for example, with a cardiovascular risk close to the threshold at which treatment is decided.
Generally not: without symptoms, contrast coronary CT is not indicated as a screening examination, and the Italian National Institute of Health reminds us that CT is not a tool for periodic check-ups, because of the radiation dose. Moreover, according to the 2024 ESC guidelines, there is no evidence in favor of further imaging examinations on the sole basis of the calcium found in the coronary arteries.
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