Coronary CT Angiography (Cardiac CT)

ECG-gated coronary CT angiography at AGEL Ostrava-Vítkovice on the Philips IQon Spectral CT for non-invasive assessment of coronary artery stenosis, plaque burden, and coronary anatomy. Spectral plaque characterisation and calcium scoring available.

Coronary CT angiography (CCTA) at AGEL Ostrava-Vítkovice provides non-invasive visualisation of the coronary arteries using ECG-gated contrast-enhanced imaging on the Philips IQon Spectral CT. The examination enables detailed assessment of the coronary lumen, plaque burden, and vessel anatomy without cardiac catheterisation, and the IQon's spectral capabilities extend the diagnostic information available compared to conventional CCTA. The coronary arteries — left main, left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) — supply the myocardium with oxygenated blood. Atherosclerotic plaque buildup causes stenosis (narrowing), which can produce exertional angina or, following plaque rupture, acute myocardial infarction. CCTA is recommended by the European Society of Cardiology (ESC) as the first-line non-invasive investigation for stable chest pain in patients with low-to-intermediate pre-test probability of obstructive coronary artery disease. A normal CCTA has a very high negative predictive value, effectively ruling out significant coronary obstruction and sparing patients from invasive catheter angiography and its associated procedural risk. The Philips IQon adds spectral plaque analysis to standard CCTA: the dual-layer detector captures iodine spectral information in the coronary lumen and can differentiate plaque components — calcified, non-calcified (lipid-rich versus fibrous), and mixed — with greater precision than conventional CT. Non-calcified and mixed plaques are clinically more significant for rupture risk and acute event prediction than calcified plaques. The ability to retrospectively characterise plaque without additional radiation exposure improves cardiovascular risk stratification in the same scan used for stenosis grading. Calcium scoring is also available using the IQon — a dedicated low-dose ECG-gated scan without contrast that quantifies the total coronary arterial calcium burden as an Agatston score. Coronary calcium scoring is one of the most powerful independent predictors of future cardiovascular events and is used in intermediate-risk patients to reclassify risk and guide preventive treatment decisions. Given the spectral CT architecture, calcium scoring protocols at AGEL Ostrava-Vítkovice benefit from the same iMR dose reduction of 60–80%. ECG-gating synchronises CT acquisition with the cardiac cycle to freeze coronary motion and produce sharp images of these rapidly moving vessels. In most patients, heart rate optimisation with beta-blocker medication (taken orally before the examination, or administered intravenously if required) reduces heart rate and improves image quality; the CT team discusses preparation with each patient at booking. Intravenous contrast is administered via a high-flow cannula. Scan time for coronary CTA is typically 5–10 seconds. AGEL Ostrava-Vítkovice is a full-service hospital with a cardiology department and vascular centre, providing patients with the clinical context to act immediately on CCTA findings if required. The Radiology Department is led by prim. MUDr. Jitka Návratová; coronary CTA is performed by the CT team under prim. MUDr. Jaroslav Krátký. Czech insurance covered; self-pay and international patients book via radiology reception.