Stephan Achenbach, MD

Plaque rupture is the main cause of acute coronary syndromes, which are associated with high mortality and morbidity. The prevalence of plaque rupture in acute coronary syndrome is more than 70%.1 Rupture-prone plaques are characterized by a large core of extracellular lipid with a thin fibrous cap (Figure 1). Inflammation, particularly in the plaque shoulder, causes the fibrous cap to thin and results in disruption of the atherosclerotic plaque.

Acute coronary syndromes, especially acute myocardial infarction and sudden cardiac death, are most often caused by the rupture or erosion of coronary atherosclerotic plaques. The plaque itself does not have to be associated with lumen narrowing.

I have been performing CT angiography of the coronary arteries since 1993, mainly at the University of Erlangen-Nuremberg. Collaboration with radiologists has been good from the start. I know of several other hospitals in Germany where cardiac CTA works similarly well, but I also know of many where it does not. Why the difference?

The first announcements came at the 2003 RSNA meeting, informing the radiology community that 64-slice CT would soon be available for clinical practice. Initial site installations by Siemens Medical Solutions and GE Healthcare began shortly after, in late spring and early summer of 2004. The introduction of this new technology came as a surprise to many, since 16-slice CT had been widely available only since 2002.

The first announcements came at RSNA 2003, informing the radiology community that 64-slice CT would soon be available for clinical practice. Initial site installations by Siemens Medical Solutions and GE Healthcare began shortly after, in late spring and early summer of 2004. The introduction of this new technology came as a surprise to many, since 16-slice CT had been widely available only since 2002.