The rapid rise of coronary CT angiography from a research application to a robust, widely embraced clinical tool has very few parallels in medicine. Currently, a convergence of factors has the potential to make coronary CT angiography a pivotal cornerstone in cardiovascular disease management.

In a review article in the November issue of Radiology, (RSNA.org/radiology), Gorka Bastarrika, M.D., Ph.D., of the Medical University of South Carolina in Charleston, and colleagues, review each of these factors as they relate to the current and future role of coronary CT angiography. Specifically, authors discuss:

A 70-year old woman with continuous systolic murmur and anterior wall motion abnormality at stress nuclear myocardial perfusion imaging. Contrast-enhanced retrospectively ECG-gated coronary CT angiogram displayed as 3D volume render-ing from a left anterior oblique perspective shows the extent of fistulas of the left coronary system and reveals anomalous origin of the right coronary artery (arrowhead) from the left coronary artery cusp.

• The scope and importance of cardiovascular disease

• Rapidly evolving technology

• Widening use of coronary CT angiography for established indications

• Emerging applications

• Fundamental changes in clinical cardiovascular disease management

• Increased emphasis on cost-effectiveness in healthcare

"Current technical limitations, especially the association of coronary CT angiography with relatively high levels of radiation, will be increasingly addressed by ongoing refinements in technology," the authors conclude. "Along with an increasing evidence base, guidelines for appropriate indication are in place and are evolving to ensure appropriate use, curb over-utilization, and ensure cost-effectiveness."

This article meets the criteria for 1.0 AMA PRA Category 1 Credit™.

Thoracic Manifestations of Primary Humoral Immunodeficiency: A Comprehensive Review

Pulmonary abnormalities are present in as many as 60 percent of patients with primary humoral immunodeficiency and chronic changes and recurrent infections in the respiratory tract are the main causes of morbidity and mortality among those patients.

Bronchiectasis and bronchial wall thickening in a 17-year-old patient with X-linked agam-maglobulinemia. CT image shows the dif-fuse distribution of abnormalities (arrows).

(RadioGraphics 2009;29:1909-1920) © RSNA, 2009. All rights reserved. Printed with permission.

In a review article in the November-December issue of RadioGraphics (RSNA.org/radiographics), Guillaume Bierry, M.D., Ph.D., of the University Hospital of Strasbourg in France, and colleagues describe the thoracic abnormalities most often observed at imaging in patients with various primary humoral immunodeficiencies, emphasizing key findings to narrowing the differential diagnosis and determining the prognosis. Authors detail the manifestations of:

• Noninfectious airway disorders

• Infections

• Chronic lung disease

• Chronic inflammatory conditions

• Benign lymphoproliferative disorders

• Malignancies

"Imaging plays a crucial role in the management of patients with primary humoral immunodeficiencies by allowing the detection and characterization of thoracic abnormalities," the authors conclude. "Thoracic CT should be included in the imaging evaluation of patients in whom the presence of a primary humoral immunodeficiency is suspected."