Perhaps the ischaemia (excuse the English spelling) and ECG
changes were related to your previous condition caused by
the diseased vessel. You must have had some sort of problem
previously for them to investigate and find a stenosis in a
coronary artery. Did the new tests show evidence of an old MI
(myocardial infarct - "heart attack") ?
In Medical Imaging, we often refer to certain tests as the
"gold standard" for imaging a certain type of pathology. We use
this term when one test demonstrates a suspected pathology
better than others do, to a higher degree of sensitivity
and/or specificity. For demonstrating intraluminal stenoses,
coronary angiography remains the gold standard, and you can take
some comfort in your good news - congratulations ! Angiography
does only demonstrate the inner filling of an artery and it
is possible that a subtle amount of smooth thrombus could line
the wall of the vessel, or that someone could even have an
aneursym filled with clot which may be missed. As an angiogram
shows only the lumen of the vessel filled with contrast, it
does not show extraluminal structures and problems, unless
the inner arterial wall is involved.
To show ischaemia of the heart muscle, I understand that the gold
standard is an FDG Positron Emission Tomography (PET) scan. It
shows subtle perfusion of isotope to areas which still metabolize
glucose and hence demonstrate cardiac viability, even in cases
where other tests result in "dead" heart muscle. It is being
increasingly used as a test to decide whether to do a "cabbage"
(CABG = Coronary Artery Bypass Graft) in those patients with
marginal results. PET scanners are expensive though, not just
for the scanner, but for the associated cyclotron needed to
produce the isotopes that have short half lives.
With regard to IMAT's cardiac CT scanners, I still haven't had
time to do the DD, but in principle, a new technology may or
may not become the gold standard for assessing new pathologies.
MRI for example now leads the field in brain and spine imaging,
but the MRI "Angiography" techniques have still not gotten
anywhere near Digital Subtraction Angiography in terms of
spatial resolution and confidence in diagnosis. The cardiac CT
may have applications for certain screening or follow ups, but
until I find out more, I won't hazard a guess as to its diagnostic
accuracy.
Techniques like the CT scanner will never completely replace
invasive procedures like Angiography, purely for the reason that
intravascular therapy is becoming increasingly popular and
effective. There will always be a need to access the vascular
system from within and conduct therapies. My question to you JimTK
is, would you rather have a 2mm hole in the groin and be up walking
the next day after angioplasty for a fraction of the cost, or
would you rather have had your chest split open for bypass, and
end up in ICU with a several week recovery time ? Can I assume
that you are happy with the angioplasty results ?
It would be good if you could be followed up with less
invasive techniques. Of course angiography has its inherent
risks and is generally more expensive than say a thallium
scan.
I'm increasingly interested in this company, and will
endeavour to find out more, both from the investment point
of view, and via Medical Imaging journals. Ultrafast CT
sounds intriguing. I'll let you know what I find out.
In the immortal words of Arnie..... I'll be back !
Regards,
Durro |
