Tuesday, February 29, 2000
Heart tests become easier
New generation of scanner gives detailed picture
BY TIM BONFIELD
The Cincinnati Enquirer
In a new type of picture, potentially deadly heart disease looks like a sharp white stick stabbing through soft gray heart tissue.
The white stick is a coronary artery laced with high amounts of calcium — an early sign of blockage that, left untreated, could lead to a heart attack.
Until now, dangerous blockages were detected after patients were wired to a treadmill machine for a cardiac stress test or by doing an angiogram, which involves snaking a thin probe from the groin through major blood vessels to the heart.
Now, small numbers of Tristate patients are getting a new type of cardiac scoring test that doesn't require an invasive procedure and takes as little as 30 seconds to complete. The test is one of several new uses for what doctors are calling “fast” CT scanners.
One of the first fast CT scanners in town was installed in Kennedy Heights at ProScan International, a year-old medical imaging company launched by Dr. Stephen Pomeranz, formerly a top radiologist at Christ Hospital. About four months ago, ProScan became the first in town to offer cardiac scoring tests.
“This is safer than a groin stick, where there's a chance that the catheter can shear off a piece of plaque and trigger a stroke,” Dr. Pomeranz said. “This type of scanning eventually will replace 95 percent of the diagnostic catheterizations (angiograms) performed today.”
Beyond providing a new, quick test for heart disease, the improved CT scanners can:
• Detect small blood clots in the lungs and signs of lung cancer at far earlier stages than traditional chest X-rays.
• Check colons and throats for signs of disease without uncomfortable internal probes.
• Speed up and improve the head scans, 3-D bone scans and other tests already done on traditional CT scanners.
“This is a very good screening tool for coronary disease,” said Dr. Bruce Corser, an internist who has sent patients to Dr. Pomeranz for the cardiac scoring test. “Other places in the country have been doing this for some time, but this is the first scanner (to offer cardiac scoring) in this area.”
The new device is called a multidetector, or multislice, helical CT scanner. The model purchased by Dr. Pomeranz was made by Picker International, a unit of Cleveland-based Marconi Medical Systems. Other leading CT scanner makers, including General Electric, Siemens, Toshiba and Philips have been making versions of fast CT scanners.
“I think you'll see some of the hospitals start buying these devices,” Dr. Corser said.
Helical CT (computed tomography) scanners have been around for about a decade. Here's how they work:
A patient lying on a moving table passes under a spinning ring equipped with an X-ray emitter. The ring takes pictures as if the body had been sliced like a spiral-cut ham. A radiologist can spot disease just by looking at a single slice, or by using a computer to assemble multiple slices into a 3-D image.
The newest helical scanners now come with two, four, even eight spinning rings, which means they can take thinner slices than ever before, Dr. Pomeranz said. The thinner the slice, the easier to detect small signs of disease.
The newest scanners also are fast enough to take a picture of a heart between beats, much like a high-speed photograph that freezes an athlete in midleap.
While some fast CT scanners date to the early 1990s, cardiac scoring tests hit the market in 1997. Before the fast scanners came along, images that could be affected by moving parts — such as a beating heart — came out too blurry to spot problems, Dr. Pomeranz said.
Cardiac scoring can spot trouble before a patient feels symptoms, such as chest pain or a full-blown heart attack. Early detection could lead to early treatment, which in turn could save lives, Dr. Pomeranz said.
Whether cardiac scoring will become a widespread or common test for heart disease remains a matter of debate, said Dr. Raymond Rost Jr., medical director of radiology at the Christ Hospital.
Cardiac scoring with a CT scanner can spot “false positives,” such as elevated calcium levels that do not cause disease. The test also can miss blockages caused by “soft” plaque that does not come with high calcium levels, Dr. Rost said.
Beyond heart disease, the fast scanners can be a useful tool for lung cancer — the nation's leading cancer killer.
Mammograms for breast cancer, blood tests for prostate cancer and Pap smears for cervical cancer all help spot disease before a patient feels sick.
However, there is no cheap-yet-effective screening test for lung cancer. Chest X-rays can detect tumors, but too often not until the cancer has grown to an advanced, hard-to-treat stage.
Dr. Pomeranz contends that the fast CT scanner can serve as a screening tool for smokers, asbestos workers and others with high risk of developing lung cancer. Others aren't so sure.
“There's no question that a fast CT scan can pick up lung cancer at much earlier stages than a chest X-ray. If I were talking to a guy who had been smoking for 30 years and wanted to know his status, I would tell him that this is the best way out there to screen for lung cancer,” Dr. Corser said.
“But whether that would be a good screening tool (for the general population) is not really clear,” Dr. Corser said.
First, the technology is so new that researchers do not know whether the early detection ability of the CT scanner would actually reduce deaths from lung cancer.
Second, the CT testing may not be cheap enough. While the cardiac scoring test can be done for less than $200, a full chest scan from a fast CT scanner costs about $400. That's far higher than the $65 fee several local testing centers charge for a mammogram.
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