Cardiac CT in women: clinical application and considerations

Abstract

Cardiac computed tomography (CT) has special considerations and applications in women for the evaluation of coronary heart disease (CHD). Unique aspects of cardiovascular disease (CVD) in women include atypical symptoms and a later presentation of CHD. Disparities exist in mortality trends of CVD between men and women along with a lack of patient awareness of CVD as a significant cause of mortality for women. Differences have also become evident among plaque characteristics between the 2 sexes, with a relative increased prevalence of noncalcified plaque in women. Traditional risk prediction models, such as the Framingham Risk Score (FRS), have limitations in this population. Coronary calcium scanning contributes significantly to the accuracy of CHD detection on top of traditional CV risk factors in asymptomatic women. Coronary CT angiography has proven accurate for the diagnosis of significant CHD as well as cost effective in the evaluation of symptomatic women. The safety issue of radiation exposure with cardiac CT warrants special consideration for women. Concern for radiation-related cancer risks and organ-specific dose delivered to the breast is being addressed by radiation-reducing techniques. Future technologic advances in CT may allow for simultaneous screening for CHD and other disease processes, such as osteoporosis, breast cancer, and visceral adiposity in one routine test.