New scanner improves heart disease detection

A new noninvasive technology is revolutionizing the way doctors treat patients suspected of having coronary disease.

While a traditional catheterization can take from 30 to 45 minutes and leave patients sore for a few days, a LightSpeed VCT scan lasts only 15 minutes with no recovery period.

The scanner rapidly creates 64 credit-card-thin images that form a three-dimensional view of the heart which the doctor can analyze on a computer. It also can diagnose other diseases such as stroke and cancer.

“It was over before I knew it,” said Albert Cuccinello of Edison, N.J., a 46-year-old contractor who chose scanning over heart catheterization because it has fewer complications.

An invasive procedure, catheterization involves threading a thin tube from the groin area up into the heart’s arteries, where a contrast dye is released to increase the visual detail of the X-rays.

With the new technology, patients hold their breath only five seconds at a time. In older-generation machines, such as the 16-CT, patients have to hold their breath 20 to 30 seconds. “The images are noticeably sharper and more accurate,” said Lawrence Tanenbaum, section chief of CT and MRI for Edison Imaging Associates and JFK Medical Center, both in Edison, where Cuccinello was scanned.

“We have no reason to suspect that the accuracy won’t be as good or even better than the 16-slice, which was able to detect disease 98 percent of the time,” Tanenbaum said.

Considered the next generation of CT equipment, the LightSpeed is manufactured by GE Healthcare, a unit of General Electric. Siemens, Toshiba and Philips also manufacture similar devices.

“This added technology will dramatically alter the way we currently treat patients with suspected coronary disease and chest pain,” said cardiologist Joao Lima, associate professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart Institute. The facility recently installed Toshiba’s 64-slice CT machine.

According to Lima, because the technology is fast, doctors are able to quickly sort out who is and isn’t at high risk of having a heart attack. Johns Hopkins is leading a multicenter clinical trial to compare the clinical effectiveness of cardiac catheterization to 64-slice CT imaging.

There are some similarities between catheterization and the test Cuccinello had. He was injected – through an intravenous line attached to his arm – with a contrast dye to increase the visual detail of the pictures. There is the potential for an allergic reaction to the dye in some patients, and individuals with compromised kidney function, such as those with diabetes or kidney disease, may not be eligible for the CT test.

To produce the angiogram, or X-ray images, computer-driver machinery passes X-rays through the body, producing digitized signals that are detected and reconstructed. Each X-ray measurement lasts just a fraction of a second and represents a “slice” of an organ or tissue, in this case the heart. The greater the number of detectors – the new device has a total of 64 – the better the resolution of the picture, because the computer uses these slices to reconstruct the 3-D images.

Many cardiologists are welcoming the technology, but believe it will take some time before it’s the diagnostic treatment of choice for heart patients. The machinery and software are expensive. The General Electric scanner costs between $1.2 and $2 million, according to company officials.

But a scan is cheaper (about $700 a test) than cardiac catheterization, which can cost thousands of dollars.

While Medicare reimburses for the procedure, some private insurers do not yet cover it.

Meanwhile, Cuccinello, who was told his heart is “entirely normal,” said he could not have been more pleased with his test results. “I would recommend it to anyone who thinks they might need a catheterization,” he said.