Clinical value of electron-beam computed tomography in the diagnosis and prognosis of coronary artery disease

Electron-beam computed tomography (EBCT) is a relatively new imaging modality that provides transaxial cardiac images with excellent spatial and temporal resolution. At present EBCT is used primarily to detect and quantify the extent of coronary calcification. In autopsy studies, increasing areas of classification are associated with the increasing likelihood of more advanced atherosclerosis, but the relationship is not linear, with large confidence limits, and EBCT may underestimate the total plaque burden. Compared with angiography, EBCT has a high sensitivity to detect coronary classification and a high negative predictive value to rule out a significant stenosis. But it may miss atherosclerotic plaque, including unstable plaque. Recent studies have aimed at improving the characterization of individual plaques by EBCT. Despite validation against autopsy and angiography, the clinical utility of EBCT still is not well defined. Additional data on reproducibility and better consensus on criteria for abnormality for coronary calcification are advised.