Does Ultrafast CT Screening Make Sense?

Stephen Barrett, M.D.

Question

Does it make sense for apparently healthy individuals to undergo ultrafast CT screening? I have heard that the "calcium score" can predict the likelihood of having a heart attack.

Answer

Ultrafast CT scanning—also called electron beam computed tomography (EBCT)—has predictive value but has not been proven cost-effective as a screening tool. The test combines electrocardiography with CT scanning so that the heart is imaged only during a particular moment within each cycle of the heartbeat. The resultant images show whether the coronary arteries contain calcium deposits that mark the presence of atherosclerosis [1]. Further testing—usually angiography—might then be performed to pinpoint the extent of disease.

If an ultrafast CT scan is negative, the individual has a low (but not zero) probability of having coronary artery disease. However, the test is expensive, not covered by insurance, and produces many false-positive tests that can lead to further unnecessary expense. For this reason, the American Heart Association does not recommend routine use in people without heart-related symptoms unless standard cardiac risk assessment is considered insufficient. Nor is it considered useful to measure coronary calcium in patients who have already had a heart attack or undergone coronary bypass surgery or coronary angioplasty. EBCT may be appropriate for individuals who are anxious to know with a high degree of certainty the state of their coronary arteries and who are willing to undergo considerable expense and possibly an unnecessary cardiac catheterization to get that information [2].

References

  1. Budoff MJ and others. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: A multicenter study. Circulation 93:989-904, 1996.
  2. O'Rourke RA and others. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 102:126-140, 2000.

This article was posted on March 21, 2002.

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