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The Role of Cardiac Computed Tomography in Heart Failure. Curr Heart Fail Rep 2022; 19:213-222. [PMID: 35588344 DOI: 10.1007/s11897-022-00553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Cardiac computed tomography (CT) is becoming a more widely applied tool in the diagnosis and management of a variety of cardiovascular conditions, including heart failure. The aim of this narrative review is to examine the role of cardiac CT in patients with heart failure. RECENT FINDINGS Coronary computed tomographic angiography has robust diagnostic accuracy for ruling out coronary artery disease. These data are reflected in updated guidelines from major cardiology organizations. New roles for cardiac CT in myocardial imaging, perfusion scanning, and periprocedural planning, execution, and monitoring are being implemented. Cardiac CT is useful in ruling out coronary artery disease its diagnostic accuracy, accessibility, and safety. It is also intricately linked to invasive cardiac procedures that patients with heart failure routinely undergo.
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Zhang W, Ba Z, Wang Z, Lv H, Zhao J, Zhang Y, Zhang F, Song L. Diagnostic performance of low-radiation-dose and low-contrast-dose (double low-dose) coronary CT angiography for coronary artery stenosis. Medicine (Baltimore) 2018; 97:e11798. [PMID: 30142766 PMCID: PMC6113019 DOI: 10.1097/md.0000000000011798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic accuracy of low-radiation-dose and low-contrast-dose (double low-dose) coronary computed tomography angiography (CTA) for coronary artery stenosis in patients with suspected coronary artery disease (CAD).Totally 88 patients with suspected CAD were divided in the routine and double low-dose groups. Subjective image quality (IQ) was scored and diagnostic performance for detecting ≥50% stenosis was determined with the invasive coronary angiography. IQ and diagnostic performance were analyzed and compared between the 2 groups.There was no significant difference in the IQ of coronary artery between the routine and double low-dose groups, with good inter-observer agreement for the IQ. There were no significant differences in the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy on the per-patient, per-vessel, or per-segment level between the routine and double low-dose groups. The contrast medium injection volume in the double low-dose group was reduced by 37.1% compared with the routine-dose group. The effective dose in the double low dose was reduced by 44.5% compared with the routine-dose group.Double low-dose coronary CTA with IR can acquire satisfactory IQ and have high diagnostic sensitivity, specificity, and accuracy for the detection of coronary artery stenosis.
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Affiliation(s)
- Wei Zhang
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Zhaogui Ba
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Zhenqiang Wang
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Huaying Lv
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Jun Zhao
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Yonghua Zhang
- Department of Radiology, People's Hospital of Yutian County, Yutian, Hebei, China
| | - Feixue Zhang
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Lei Song
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
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Age-related differences in image quality of prospectively ECG-triggered axial and helical scans for coronary CT angiography. Radiol Phys Technol 2016; 9:214-20. [PMID: 26984733 DOI: 10.1007/s12194-016-0351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/27/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
We investigated the underlying reasons for the occurrence of misalignment artifacts in prospectively ECG-triggered axial coronary CT angiography scans. In this study we analyzed 56 consecutive patients scanned in axial mode and 66 consecutive patients scanned in helical mode. Predictors for the occurrence of misalignment artifacts were evaluated by multivariable logistic regression analysis for those patients scanned in the axial mode; advanced age was identified as the sole independent predictor (odds ratio: 1.088; 95 % CI: 1.012-1.170; p = 0.0228). In a comparison with the patients scanned in the helical mode, the image quality score for patients aged 65 years or older was significantly higher in helical mode than in axial mode (2.6 ± 0.5 and 2.4 ± 0.7, respectively; p = 0.0313). Misalignment artifacts in the image are more common in the elderly than in younger. Helical mode should be preferred in this older patient population to allow for good diagnostic image quality.
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Litmanovich DE, Tack DM, Shahrzad M, Bankier AA. Dose reduction in cardiothoracic CT: review of currently available methods. Radiographics 2015; 34:1469-89. [PMID: 25310412 DOI: 10.1148/rg.346140084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiation exposure from computed tomography (CT) has received much attention lately in the medical literature and the media, given the relatively high radiation dose that characterizes a CT examination. Although there are a variety of possible strategies for reducing radiation exposure from CT in an individual patient, optimal CT image acquisition requires that the radiologist understand new scanner technology and how to implement the most effective means of dose reduction while maintaining image quality. The authors describe a practical approach to dose reduction in cardiothoracic radiology, discussing CT radiation dose metrics (eg, CT dose index, dose-length product, effective diameter, and size-specific dose estimate) as well as CT scanner parameters that directly or indirectly influence radiation dose (eg, scan length, x-ray tube output, tube current modulation, pitch, image reconstruction techniques [including iterative reconstruction], and noise reduction). These variables are discussed in terms of their relative importance to image quality and the implications of parametric changes for image quality and diagnostic content, and practical recommendations are made for their immediate implementation in the clinical setting. Taken together, the principles of physics and key parameters involved in reducing radiation dose while maintaining image quality can serve as a "survival guide" for a diagnostic radiology practice.
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Affiliation(s)
- Diana E Litmanovich
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Shapiro 4, Boston, MA 02215 (D.E.L., M.S., A.A.B.); and Department of Radiology, Epicura Hospital, Baudour, Belgium (D.M.T.)
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Staab W, Goth S, Sohns C, Sohns JM, Steinmetz M, Buchwald CU, Schuster A, Kowallick JT, Fasshauer M, Lotz J. Comparison of end-diastolic versus end-systolic cardiac-computed tomography reconstruction interval in patient's prior to pulmonary vein isolation. SPRINGERPLUS 2014; 3:218. [PMID: 25279273 PMCID: PMC4178958 DOI: 10.1186/2193-1801-3-218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/23/2014] [Indexed: 02/06/2023]
Abstract
Purpose Aim of the study was to investigate diagnostic accuracy of cardiac computed tomography angiography (CCTA) between left ventricular end-systolic (LVES) and left ventricular end-diastolic (LVED) cardiac phase for thrombus detection in patient’s prior to pulmonary vein isolation (PVI). Materials and methods 182 consecutive Patients with drug refractory AF scheduled for PVI (62.6% male, mean age 64.1 ± 10.2 years) underwent routine pre-procedural evaluation including transesophageal echocardiography (TEE) and CCTA for evaluation of left atrial (LA)/left atrial appendage (LAA) anatomy and thrombus formation. Qualitative and quantitative analysis (using aorta ascendens (AA)/LAA ratio) was performed. Measurements of the LA/LAA in LVES and LVED cardiac phase were obtained. Results End-systolic volumes (LA/LAA) measured in 30 patients without filling defects as control group and all 14 with filling defects of 182 patients were significantly larger (p < 0.01) than in end-diastolic phase. Qualitative analysis was inferior to quantitative analysis using LA/LAA ratio (<0.5; accuracy: 100%, 88%,100%, 99% vs 100%). 5 out of 182 patients (2.7%) showed thrombus formation of the LAA in CCTA confirmed by TEE and quantitative analysis. Intra/-interobserver variability was lower in end-systolic vs end-diastolic reconstruction interval. Conclusion For evaluating CCTA datasets in patients prior PVI, the LVES reconstruction interval is recommended due to significantly larger LA/LAA volumes and lower intra/- interobserver variability’s.
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Affiliation(s)
- Wieland Staab
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Sabrina Goth
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Christian Sohns
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Jan Martin Sohns
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Michael Steinmetz
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Christina Unterberg Buchwald
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Johannes Tammo Kowallick
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Martin Fasshauer
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; DZHK, Göttingen, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, Georg-August-University, Robert-Koch-Str. 40, 37075 Goettingen, Germany ; DZHK, Göttingen, Germany
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Iterative Reconstruction to Preserve Image Quality and Diagnostic Accuracy at Reduced Radiation Dose in Coronary CT Angiography. JACC Cardiovasc Imaging 2013; 6:1239-49. [DOI: 10.1016/j.jcmg.2013.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 08/02/2013] [Accepted: 08/09/2013] [Indexed: 11/19/2022]
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Hou Y, Ma Y, Fan W, Wang Y, Yu M, Vembar M, Guo Q. Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease. Eur Radiol 2013; 24:3-11. [PMID: 23887663 DOI: 10.1007/s00330-013-2969-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the accuracy of low-dose coronary CTA with iterative reconstruction (IR) in the diagnosis of coronary artery disease (CAD) in patients with suspected CAD. METHODS Ninety-six patients with suspected CAD underwent low-dose prospective electrocardiogram-gated coronary CTA, with images reconstructed using IR. Image quality (IQ) of coronary segments were graded on a 4-point scale (4, excellent; 1, non-diagnostic). With invasive coronary angiography (ICA) considered the "gold standard", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of coronary CTA were calculated on segment-, vessel- and patient-based levels. The patient data were divided into two groups (Agatston scores of ≥ 400 and <400). The differences in diagnostic performance between the two groups were tested. RESULTS Diagnostic image quality was found in 98.1 % (1,232/1,256) of segments. The sensitivity, specificity, PPV, NPV and accuracy were 90.8 %, 95.3 %, 81.8 %, 97.8 % and 94.3 % (segment-based) and 97.2 %, 83.3 %, 94.6 %, 90.9 % and 93.8 % (patient-based). Significant differences between the two groups were seen in specificity, PPV and accuracy (92.1 % vs. 97.9 %, 76.0 % vs. 86.7 %, 91.7 % vs. 96.6 %, P < 0.05; segment-based). The average effective dose was 1.30 ± 0.15 mSv. CONCLUSION Low-dose prospective coronary CTA with IR can acquire satisfactory image quality and show high diagnostic accuracy in patients with suspected CAD; however, blooming continues to pose a challenge in severely calcified segments. KEY POINTS • Coronary artery disease (CAD) is increasingly investigated using coronary CTA. • The iterative reconstruction (IR) algorithm is promising in decreasing radiation doses. • Low-dose prospective coronary CTA with IR can acquire satisfactory image quality. • Low-dose prospective coronary CTA with IR can show high diagnostic accuracy.
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Affiliation(s)
- Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China,
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Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction. Eur Radiol 2013; 23:2927-33. [PMID: 23807568 DOI: 10.1007/s00330-013-2920-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of sub-milliSievert (mSv) coronary CT angiography (cCTA) using prospectively ECG-triggered high-pitch spiral CT acquisition combined with iterative image reconstruction. METHODS Forty consecutive patients (52.9 ± 8.7 years; 30 men) underwent dual-source cCTA using prospectively ECG-triggered high-pitch spiral acquisition. The tube current-time product was set to 50 % of standard-of-care CT examinations. Images were reconstructed with sinogram-affirmed iterative reconstruction. Image quality was scored and diagnostic performance for detection of ≥50 % stenosis was determined with catheter coronary angiography (CCA) as the reference standard. RESULTS CT was successfully performed in all 40 patients. Of the 601 assessable coronary segments, 543 (90.3 %) had diagnostic image quality. Per-patient sensitivity for detection of ≥50 % stenosis was 95.7 % [95 % confidence interval (CI), 76.0-99.8 %] and specificity was 94.1 % (95 % CI, 69.2-99.7 %). Per-vessel sensitivity was 89.5 % (95 % CI, 77.8-95.6 %) with 93.2 % specificity (95 % CI, 86.0-97.0 %). The area under the receiver-operating characteristic curve on per-patient and per-vessel levels was 0.949 and 0.913. Mean effective dose was 0.58 ± 0.17 mSv. Mean size-specific dose estimate was 3.14 ± 1.15 mGy. CONCLUSIONS High-pitch prospectively ECG-triggered cCTA combined with iterative image reconstruction provides high diagnostic accuracy with a radiation dose below 1 mSv for detection of coronary artery stenosis. KEY POINTS • Cardiac CT with sub-milliSievert radiation dose is feasible in many patients • High-pitch spiral CT acquisition with iterative reconstruction detects coronary stenosis accurately. • Iterative reconstruction increases who can benefit from low-radiation cardiac CT.
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Examination of the optimal temporal resolution required for computed tomography coronary angiography. Radiol Phys Technol 2013; 6:453-60. [DOI: 10.1007/s12194-013-0218-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Menke J, Unterberg-Buchwald C, Staab W, Sohns JM, Seif Amir Hosseini A, Schwarz A. Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image quality, and radiation dose. Am Heart J 2013; 165:154-63.e3. [PMID: 23351817 DOI: 10.1016/j.ahj.2012.10.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND In coronary computed tomography (CT) angiography (CTA) prospective electrocardiography triggering requires less radiation dose than retrospective electrocardiography gating but provides less cardiac phases for interpretation. This meta-analysis presents a concise and comprehensive head-to-head comparison of image quality, diagnostic accuracy, and radiation dose of prospectively triggered coronary CTA vs retrospectively gated CTA in patients with suspected or known coronary artery disease (CAD). METHODS In patients with CAD and without tachyarrhythmia, eligible studies (selected from 4 databases) compared prospectively triggered vs retrospectively gated CTA (performed with ≥64-slice CT or dual-source CT) in 2 groups having approximately similar patient characteristics, scored CTA image quality, and/or assessed how accurately CTA diagnoses ≥50% coronary stenoses compared with catheter angiography and reported the radiation dose. The data were meta-analyzed by random-effects models, with CIs provided in the text. RESULTS Among 3,330 patients from 20 included studies, 91.3% of CTAs (segments: 97.8%) had diagnostic quality with prospective triggering and 93.3% of CTAs (segments: 98.4%) with retrospective gating (P > .05). Among 664 patients from 5 studies, the pooled sensitivity/specificity of diagnostic CTAs was 98.7%/91.3% (segment level: 91.3%/97.7%) with prospective triggering and 96.9%/95.8% (segment level: 93.1%/97.6%) with retrospective gating (P > .05). The pooled effective dose was 3.5 mSv with prospective triggering and thus, by a factor of 3.5, lower than the pooled effective dose of retrospective gating, which was 12.3 mSv (P < .01). CONCLUSIONS In patients with CAD and without tachyarrhythmia, prospectively triggered coronary CTA provides image quality and diagnostic accuracy comparable with retrospectively gated CTA, but at a much lower radiation dose.
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Affiliation(s)
- Jan Menke
- Department of Diagnostic Radiology, University Hospital, Goettingen, Germany.
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Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison with Catheter Coronary Angiography. ACTA ACUST UNITED AC 2012; 27:213-9. [DOI: 10.1016/s1001-9294(13)60004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Neefjes LA, Rossi A, Genders TSS, Nieman K, Papadopoulou SL, Dharampal AS, Schultz CJ, Weustink AC, Dijkshoorn ML, Ten Kate GJR, Dedic A, van Straten M, Cademartiri F, Hunink MGM, Krestin GP, de Feyter PJ, Mollet NR. Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols. Eur Radiol 2012; 23:614-22. [PMID: 23052644 DOI: 10.1007/s00330-012-2663-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/11/2012] [Accepted: 06/29/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction. METHODS We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients. RESULTS In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P = 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P > 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv, P < 0.001). In group B (228 patients, 132 men, mean heart rate 75 ± 11 bpm), per-segment sensitivity, specificity, PPV and NPV were comparable (94 %, 95 %, 67 %, 99 % vs. 92 %, 95 %, 66 %, 99 %, P > 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv, P < 0.001). Diagnostic performance was comparable in both groups. CONCLUSION Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose.
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Affiliation(s)
- Lisan A Neefjes
- Department of Cardiology, Erasmus Medical Center, Room Hs 207, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Li M, Sun G. Low-Dose Scan Protocols in Dual-Source CT Coronary Angiography. Radiology 2012; 263:937-8; author reply 938. [DOI: 10.1148/radiol.12112369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Srichai MB, Lim RP, Donnino R, Mannelli L, Hiralal R, Avery R, Ho C, Babb JS, Jacobs JE. Low-dose, prospective triggered high-pitch spiral coronary computed tomography angiography: comparison with retrospective spiral technique. Acad Radiol 2012; 19:554-61. [PMID: 22366557 DOI: 10.1016/j.acra.2012.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Cardiac computed tomographic angiography algorithms emphasize radiation reduction while maintaining diagnostic image quality (IQ). The aim of this study was to evaluate IQ and interreader variability using prospective electrocardiographically triggered high-pitch spiral cardiac computed tomographic angiography (FLASH-CT) compared to retrospective electrocardiographic gating (RETRO-CT) for coronary artery disease evaluation in a patient population including overweight and obese individuals. MATERIALS AND METHODS Seventy patients (24 women; mean age, 60 years) matched for gender, age, body mass index (27.4 ± 5.5 kg/m(2)), and calcium score (184 ± 328) underwent cardiac computed tomographic angiography, 35 with FLASH-CT (Definition Flash) and 35 with RETRO-CT (Somatom Definition). Images were reconstructed using standard protocols and least motion phase for RETRO-CT acquisitions. Two independent, blinded readers evaluated the coronary arteries using an 18-segment model, grading IQ on a 5-point, Likert-type scale and coronary stenosis on a 5-point semiquantitative and binary scale. RESULTS Effective radiation dose (1.50 vs 17.3 mSv, P < .0001) and mean heart rate (58 vs 62 beats/min, P < .05) were significantly lower for FLASH-CT compared to RETRO-CT. Seven hundred forty segments (> 1.5 mm) were evaluated. There was no significant difference between FLASH-CT and RETRO-CT scans in overall per-segment IQ (3.11 ± 0.75 vs 3.10 ± 0.82, P = .94). FLASH-CT had noninferior IQ relative to RETRO-CT (95% confidence interval, -0.25 to 0.26). There was no significant difference in interreader variability in diagnosis between FLASH-CT and RETRO-CT for all coronary segments (77.5% vs 78.2%, P = .83). CONCLUSIONS FLASH-CT is an acceptable coronary computed tomographic angiographic method for reducing radiation dose without compromising IQ for a patient population including overweight and obese individuals.
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May MS, Deak P, Kuettner A, Lell MM, Wuest W, Scharf M, Keller AK, Häberle L, Achenbach S, Seltmann M, Uder M, Kalender WA. Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch. Eur Radiol 2011; 22:569-78. [PMID: 21984448 DOI: 10.1007/s00330-011-2300-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine. METHODS Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation. RESULTS Estimates for mean relative ED was 7.1 ± 2.1 mSv/100 mAs for TCM and 12.5 ± 5.3 mSv/100 mAs for CTC (P < 0.001). Relative dose reduction at low HR (≤60 bpm) was highest (49 ± 5%) compared to intermediate (60-70 bpm, 33 ± 12%) and high HR (>70 bpm, 29 ± 12%). However lowest ED is achieved at high HR (5.2 ± 1.5 mSv/100 mAs), compared with intermediate (6.7 ± 1.6 mSv/100 mAs) and low (8.3 ± 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied. CONCLUSIONS Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM. KEY POINTS • Monte Carlo simulations allow for individual radiation dose calculations. • ECG-triggered tube current modulation (TCM) can effectively reduce radiation dose. • Slow and regular heart rates allow for highest dose reductions by TCM. • Adaptive pitch accounts for lowest radiation dose at high heart rates. • Women receive higher effective dose than men undergoing spiral coronary CT-angiography.
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Affiliation(s)
- Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
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