2008 Charles T. Dotter Memorial Lecture—More Surprises From the Healthy Donut
In 1990, magnetic resonance imaging (MRI) techniques for imaging the cardiovascular system were ascendant, generating considerable enthusiasm throughout the imaging community. Simultaneously, computed tomography (CT) was considered to play a minimal role in cardiovascular imaging. However, the introduction of spiral CT and subsequent birth of CT angiography (CTA) in 1991 transformed the field by offering greater spatial detail, more reliable image quality, and a less complex workflow than MRI.
In 1998, multidetector-row CT (MDCT) revolutionized CTA by allowing high spatial resolution imaging of large vascular territories, including “whole-body” three-dimensional angiograms in less than 20 seconds. The volumetric acquisitions of CTA allowed the analysis of the arterial wall, juxta-arterial structures, and the arterial lumen, while revealing limitations of intra-arterial angiography, the previously undisputed standard for vascular imaging. MDCT also provided key breakthroughs for improving the temporal resolution of CT, enabling cardiac and coronary CTA to be performed on widely available scanning platforms.
Throughout the current decade, CT advances have followed a near exponential trajectory, and the question “Can we reliably perform coronary CTA?” has been replaced by “What impact does management based on CT findings have on patient outcomes?” In just 2 years, an unprecedented diversity in novel CT technology has emerged, including multiple x-ray sources, wide-area detectors, and energy-discriminating detectors that promise extraordinary advances in the assessment of tissue composition, fine detail visualization, tissue perfusion, functional characterization, artifact suppression, and radiation dose minimization. Together, we will explore the past, present, and future of CT in the diagnosis and characterization of cardiovascular health and disease.