Imagerie non invasive des artères coronaires : TDM et IRM

The advent of helical multidetector CT has significantly modified several traditional clinical approaches to cardiovascular diagnosis. The current availability of rapid image acquisition has provided the basis for investigating direct imaging in real time of cardiac structures using CT. Application of thin-section submillimetric image acquisitions to three-dimensional (3D) reconstruction algorithms produces 3D data sets from which images of the coronary arteries may be obtained in any anatomic plane. The advantage of the submillimetric isotropic spatial resolution is partly offset by reduced temporal resolution as well as reduced contrast resolution compared to MRI. This lack in contrast sensitivity prevents accurate perfusion imaging and restricts the clinical use to coronary artery imaging. Moreover, the large amount of iodinated contrast medium injected has potential nephrotoxic effects, which can be deleterious if coronary artery angiography must to be performed. On the other hand, MRI has less spatial resolution, and acquisitions must be performed in the plane of each coronary artery because of reduced volume coverage. Both techniques play a role in the non-invasive assessment of coronary artery disease, by providing complementary information already useful in a growing number of clinical situations.