New Orleans, LA - The debate rages on over the pros and cons of electron-beam computed tomography (EBCT) and multislice computed tomography (MDCT). Drs Matthew Budoff (Harbor-UCLA Medical Center, Los Angeles, CA) and Michael Poon (Cabrini Medical Center, NY) faced off yesterday afternoon at the American College of Cardiology 2004 Scientific Sessions, debating the merits of these options for imaging coronary arteries.

Drs Matthew Budoff and Michael Poon

Budoff argued in favor of EBCT, pointing out the convenience of this option. "I'm a clinical cardiologist and I am looking for clinical practicality. If you want something that is easy to do and easy to interpret, EBCT is the way to go." He asked attendees, "As a cardiologist, do you want to prescreen every patient for rhythms? Do you want to introduce beta blockers and wait an hour?"

Budoff argued that EBCT offers many advantages over MDCT, including higher temporal resolution, higher success rates, lower radiation, and better validation and standardization of calcium scoring.

He said that 12% to 25% of multislice cases are nondiagnostic. And he added that multiple reconstructions are required just to see the coronary arteries. He concluded, "MDCT is not practical for routine cardiac use. EBCT is easy with a 95% success rate."

Poon disagreed with Budoff's conclusion and argued in favor of MDCT. "Comparing multislice to EBCT is like comparing the Airbus to the Concorde," he said, noting that the Concorde has been relegated to the museum and is of little use today. Poon argued that multislice is in fact easier to work with and offers many advantages, including higher spatial resolution, unmatched specificity, and versatility.

Poon argued that MDCT is gaining ground with regard to temporal resolution, and this obstacle is less of an issue today due to beta blockers and calcium channel blockers, which can be introduced before scanning. He also argued that MDCT does not result in much more radiation exposure than EBCT.

He concluded that while EBCT can be done quickly, it provides about half the amount of information that multislice can. "With MDCT, patients are more gratified. They are provided beautiful images and a more complete picture."

At the end of the session, an informal vote by a show of hands was taken. Multislice won by a strong majority. But some clinicians attending the event pointed out the strong contingent of Siemens employees present who voted in favor of their product. Budoff joked after the session, "I was roasted by the Siemens people. They shouldn't be allowed to vote!"