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The combination of 64 multislice CT angiography and optical coherence tomography optimally characterizes coronary plaques

Objective The European Society of Cardiology designated 2008 as the year of imaging. However, despite the intense focus on the many types of imaging and the relative benefi ts of each one, the optimal modality for the diagnosis of coronary artery disease remains controversial. Among the currently available techniques, coronary angiography (CA) is the most widely used. In light of the many recent improvements in imaging, a comparison of the different modalities for CAD diagnosis and treatment evaluation is urgently needed. Material and methods Of the 1583 patients examined by computed tomography CA (CTCA) in the past 2 years, 28 with unstable angina also underwent CA and optical coherence tomography (OCT) evaluation. The coronary artery indices obtained with the three modalities were compared in this subset of patients. Results Minimal lumen diameter and reference lumen diameter were calculated independently based on the data obtained from each modality. The diameters measured by CTCA were signifi cantly larger than those measured by CA or OCT (p < 0.05). Minimal cross-section area calculation was feasible only from the CTCA and OCT data, but not from the CA data. Again, the cross-sectional area measured by CTCA was signifi cantly larger than that measured by OCT. Plaque diameter, remodelling index, plaque volume, and CT value could be measured only by CTCA. Disease extent was measured by CTCA using the method of J.K. Min and by CA using the Syntax Score. Intimal thickness and the thickness of the thrombus and fi brous cap could be evaluated only by OCT. Conclusion A comparison of the three diff erent imaging modalities (CA, CTCA, and OCT) in CAD pointed out the benefi ts as well as the limits. A combination of CA, CTCA, and OCT was found to provide the best approach to evaluating the coronary arteries. CTCA best revealed the vessel wall while OCT provided optimal visualization of the intima. The extent of coronary artery disease was best determined with CA and CTCA.