Clinical investigations from the RACP

Coronary artery disease: what’s new in diagnostic imaging?

Mark R Adams



There are many imaging techniques available for investigating coronary artery disease (CAD). This area is rapidly changing, and some techniques such as cardiac CT and MRI show great promise for the future. Here is a summary of some of the recent advances in this area and a suggested approach to the diagnosis of CAD.

Key Points

  • Over the past decade there have been great advances in the methods available for imaging the coronary arteries.
  • Cardiac multidetector CT is a valuable diagnostic tool in assessing patients at intermediate risk of coronary artery disease in whom diagnosis is not certain and when a noninvasive imaging technique is desirable.
  • The potential of cardiac MRI appears to be great with the real possibility of imaging not only the coronary artery lumen but also the coronary wall and plaque composition, thus potentially detecting patients at high risk who have no angiographic obstruction.
  • Cardiac sestamibi scanning with single-photon emission CT has improved with both better analysis systems and better stress and pharmacological protocols; perfusion data can be important in clinical decision making regarding intervention or risk prediction.
  • The ability of echocardiography to provide data on the function of valves and cardiac chambers has continued to improve with better hardware and development of techniques such as Doppler tissue imaging and the use of echo contrast media.
  • Most imaging tests are operator dependent, with performance requiring a high level of care and interpretation of results a high level of experience.