Noninvasive visualization of the coronary arteries with multi-slice computed tomography; influence of heart rate on diagnostic accuracy

The influence of novel CT reconstruction technique and ECG-gated technique on image quality and patient dose of cardiac computed tomography

The aim of the present study was to compare image quality and patient dose in cardiac computed tomography angiography (CTA) in terms of volume computed tomography dose index (CTDI vol), dose length product (DLP) and effective dose, when changing from filtered back projection (FBP) to adaptive iterative dose reduction (AIDR) reconstruction techniques. Further aim was to implement prospective electrocardiogram (ECG) gating for patient dose reduction. The study was performed with Aquilion ONE 320-row CT of Toshiba Medical Systems. Analysis of cardiac CT protocols was performed before and after integration of the new software. The AIDR technique showed more than 50 % reduction in CTDIvol values and 57 % in effective dose. The subjective evaluation of clinical images confirmed the adequate image quality acquired by the AIDR technique. The preliminary results indicated significant dose reduction when using prospective ECG gating by keeping the adequate diagnostic quality of clinical images.

The prevalence and clinical importance of incidentally detected noncoronary cardiovascular findings with coronary multidetector CT angiography

OBJECTIVE

The purpose of this study was to determine the prevalence and clinical importance of incidental findings of noncoronary cardiac structures and mediastinal great vessels in patients who underwent coronary computed tomography angiography (CCTA).

METHODS

The study included 2,096 consecutive patients (1,472 men and 624 women, with a mean age of 55 years). Cardiovascular findings were categorized into three groups according to the clinical importance: group 1 included findings necessitating immediate treatment or intervention; group 2 included findings requiring clinical awareness, follow-up, or further clinical and/or radiological investigations; and group 3 included findings not requiring any follow-up or further tests. We also evaluated whether there was any previous diagnosis of cardiovascular findings.

RESULTS

A total of 174 abnormalities (8.3 %) were detected in 170 patients. Of these abnormalities, 21 findings (12 %) were considered as group 1, 121 (69.5 %) as group 2, and 32 (18.5 %) as group 3. The majority of cardiovascular findings (140 of 174, 80.5 %) were unknown by the reporter during the interpretation of CCTA examinations and regarded as incidental findings.

CONCLUSION

Noncoronary incidental cardiovascular findings in patients who underwent CCTA are common. It is important to be aware of these findings necessitating immediate treatment or intervention, and follow-up or further investigations, and careful attention must be paid to all the structures included in the images.

Congenitally corrected transposition of the great arteries: MDCT angiography findings and interpretation of complex coronary anatomy

A 56-year-old male patient was admitted to our hospital because of dyspne and chest pain. A chest radiograph showed mild cardiomegaly. Echocardiography revealed unusual chamber in the heart. The chamber beneath the left atrium was morphologically right ventricle. To evaluate the precise complex anatomy of this abnormality, multidetector computed tomography (MDCT) angiography was performed. MDCT clearly revealed complex intracardiac and vascular anatomy, including typical imaging findings of a patient with congenitally corrected transposition of the great arteries (CCTGA). We described both imaging findings of MDCT angiography and interpretation of complex vascular anatomy in a patient with CCTGA.