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  • CT Heart Scan - Does it yield useful results??

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    Old 07-13-2007, 07:50 PM   #1
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    CT Heart Scan - Does it yield useful results??

    Hi, I have the opportunity to have a "64-slice" CT scan of my heart and associated blood vessels. I don't know a lot about the technique and wondered if others here had found it useful in indentifying the nature and extent of their own disease.

    I have exercise-induced angina and have significant blockages - mainly, it seems, in the LAD1 and LAD2 blood vessels (80-90%). That's based on a single angiogram I had about 2 years ago. The imaging of these blockages was quite good, but that's about all the information I have.

    What other valuable information is provided by the CT scan? I wonder does it complement that provided by the angiogram, or does it just show the same sort of details? The other thing I have no information on is the %EF, and degree of heart enlargement, if any.

    The cost of the CT scan is quite high so I have to carefully weigh up what might be obtained from it. The other point of course is that it is now about two years since I had any proper check on my heart and arteries, so I suppose it's about time for another scan of some sort. (Here in Australia thallium or similar isotope scans don't seem to be used that often. Not sure why that is.)

    Thanks for your help.

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    Old 07-14-2007, 05:18 AM   #2
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    Re: CT Heart Scan - Does it yield useful results??

    Goo morning, Beefsteak,

    I think the angiogram is still the gold standard of testing for cardiac artery blockages. I doubt that the CAT scan will add more to what you already know.

    Let me guess, you'd LIKE to find out that your arterial blockages have REGRESSED?

    So I say have nothing or have another angiogram or a radioactive isotope scan.

    Generally speaking, I think an angiogram is too risky for strictly informational purposes but if you are thinking of getting the blockages repaired, then it is the ideal first step.
    Why didn't they angioplasty those large blockages back when they discovered them two years ago?

    The cost of the CT scan is quite high
    I gather it's not covered under your national health? Is it considered experimental?

    For myself, before any test that is going to be pricey or risky I try to answer the question: What will I do if I get result A?, and What will I do if I get result B? And if the answers to these quuestions is basically NOTHING, then I forgo the expensive or risky procedure.

    Last edited by Lenin; 07-14-2007 at 05:18 AM.

    Old 07-14-2007, 06:59 AM   #3
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    Re: CT Heart Scan - Does it yield useful results??

    I had the 64 slice cat scan. It discovered that I had 100% blockage in my RCA - and had collaterols. All of my other arteries looked good. It can show calcium build-up, plaque, size of arteries --- and I think I also read that it shows "soft plaque" better than a regular angiogram. I personally felt it was worth the cost.

    Old 07-14-2007, 10:35 AM   #4
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    Re: CT Heart Scan - Does it yield useful results??

    From what I understand, this test is still being perfected. The angiogram is still the "gold standard" as Lenin says, but second to that is a nuclear stress test. This is per my cardiologist at Mayo Clinic (one of the premier medical facilities in the US), so I'm fairly confident of this being accurate, though it does perhaps need to be tempered by the fact my cardiologist is primarily an interventional cardiologist.

    At this point, I undergo an angiogram only when I'm having symptoms (last was in '05 due to unexplained chest pain which turned out to be non-cardiac). Otherwise, a nuclear stress test about every 12 to 18 mos along with blood tests, etc. is what my cardiologist uses to monitor what is going on. (I had a stent placed in my LAD due to 99% blockage in '04; RCA was still only 40 to 50% so nothing done with that).

    I don't understand how national health works in Australia, but if you are considering self-paying for the CAT scan, and have the capability to self-pay for a nuclear stress test, I'd compare the cost of the two before making a decision. Of course, if they don't do the nuclear stress test very often, then you might have a problem finding a cardiologist who really knows how to read the darn things!!!

    I do think you probably want to have SOMETHING done at this point to try to determine what is going on in your arteries. I definitely would not undergo an angiogram, however, unless I was having symptoms...too risky.

    Old 07-14-2007, 03:58 PM   #5
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    Re: CT Heart Scan - Does it yield useful results??

    Hello there Downunder

    Why weren't your blockages stented or otherwise removed, back when? You have what is sometimes called a "widowmaker" type blockage. I have trouble in the same artery. You cannot survive total occlusion of the LAD. It or one or more of the LAD branches supplies the left ventricle and part of the septum, I believe. Your doctors passed up a real medical emergency!

    I have had a 64 slice coronary artery ct scan, with very strong contrast dye. Same dye I believe that is used during an angiogram (cardiac cath). You have to drink lots of water before you leave, after the scan in order to flush your kidneys. Your kidneys have to be good in order to have this scan.

    The scan itself was 100% correct as shown by a followup cath in my case. Tomah mentioned the differentiation of plaque, stable or unstable (soft or with a calcium covering). It may also give a "calcium score", I forgot.

    There are other guidelines on who may benefit from this scan. You can do a search for them. One indication is when you have had a positive result from a stress test without any history of CAD.

    Once you have a stent, the cardios say they do not trust this technology to see into or through the stent. This is what I was told by a cardiologist at the Cleveland Clinic.

    There is also a significant dose of ionizing radiation received during this scan. They are working hard on lowering the dose, I have read. The value of the scan is kind of proportional to the ionizing dose, as I understand it.

    Wealthy folks that got the "whole body" scans way back when it was a status quo type deal, and not covered by insurance, are having some problems with cancer, I read awhile ago. Nothing sensational, but worthwhile to take note of for myself at least. I have also had an abdominal ct scan long ago.

    I would rather deal with the ct scan radiation than have a cardiac cath, where you also receive an ionizing dose of radiation, but not nearly as much.

    Good luck in whatever you do

    Old 07-14-2007, 06:33 PM   #6
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    Re: CT Heart Scan - Does it yield useful results??

    Hi, Thanks for all your responses.
    Firstly, Lenin,
    I did not have a stent because the cardiologist said the location was too difficult and that, on balance, it would cause me too much grief. My GP could not quite understand this and added that very small stents, down to about 1mm can be placed these days. The main partial block (90%) is right at the start of the LAD2 - the rest of the LAD2 is okay - why it formed just there I don't know. The other significant block is well down the LAD1. I should add that the performing cardiologist was not a "stent" specialist - more of a general consulting cardiologist. I feel had I gone to someone else (i.e., a stent man) I might well have ended up with 1 or 2 stents.
    From what I know, and that's just what my GP has said, the CT scan is safer and less invasive than an angiogram. I am told the X-ray dose, being a "slice" rather than the whole heart, is a lot less.
    You are also right of course about me wanting an update on the progression of my disease. I am also embarking on a course of EECP treatment, and wanted a reference point for that. (My thinking was that the CT scan may be a better reference than the angiogram.)

    The cost of the CT scan is about $850USD and I get almost $450USD back, so the cost is not huge. Also, they have a new multi-$mill facility close by.
    Yes, for the reasons above, I do feel I want to have something done now.

    Although the CT facility is new the operator I am told is a top man.

    Rather than have a stent placed by someone who was not a top person I would rather be where I am now. At least now I still have the option and I know a lot more about it. Two years ago I hardly knew what a stent was.
    I can still find a top cardiologist who can deal better with my "tricky" stent placement.
    The diffentiation of the plaque and other information about the calcium layer is important. My GP says it's how the plaque breaks off and where it goes that's important.

    Again, thanks to all,

    Old 07-15-2007, 06:50 AM   #7
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    Re: CT Heart Scan - Does it yield useful results??


    See if you can find an expert in atherectomy. I think that would be my choice over a "tricky" stent placement.

    Old 08-09-2007, 06:15 AM   #8
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    Re: CT Heart Scan - Does it yield useful results??

    I just want to add to this conversation: I had 2 catherizations done and was told that i have 60% blockage in a left main and that i need double bypass surgery.
    I went for second opinion to a very good Doctor in NYC and they performed a CT, this is a relatively new test, year ago they did not have it. Now they use CT instead of catherization since CT is less invasive, less dangerous and more accurate.
    After i had this test done, Doctors told me i never had a blockage. CT is 99,9% accuracy, meanwhile catherization is not as accurate. Why did it happened to me and a millions other people?? I was explained that during catherization they inject a substance (i believe it's a dye) and vessels may react to it (and i many cases it does) in a form of a spasm which on a picture may look like a blockage.
    Doctor told me that if they would have CT many years ago would be a lot less unneeded bypass surgeries.
    I was shocked; just imagined myself having 2 bypass surgeries, risking my life for nothing if i would not go for second opinion "to the best of the best".
    So go ahead, i strongly recommend CT - i been through hell and back with this experience. Do you homework regarding those 2 procedure, they have a lot of info on Internet, talk about it with couple of good Doctors and than make your decision.
    Good luck to you!

    Old 08-09-2007, 06:44 AM   #9
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    Re: CT Heart Scan - Does it yield useful results??

    An angiogram gives a real time video of the arteries no? How could that not be better then a ct scan still image picture? Both use a dye to contrast the pictures and I assume the dye is similar so if you had a reaction to one of them i assume you would also have one with the other. Also the 64 slice does do your whole heart not just a slice though I may have misread what you posted.

    Old 02-23-2008, 04:37 PM   #10
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    Re: CT Heart Scan - Does it yield useful results??

    Hi I had a 64 ct slice, results were:
    1 99% blockage of the lower LAD, two other 30%.
    Went to angio cath. Results were 95% blockage of the lower lad, two others were 20%.

    To me it was benifical, I wass told BMI and pulse was very important to the out come my BMI was 20, pulse below 60.

    Hope this helps!

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