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The effect of scan and patient parameters on the diagnostic performance of AI for detecting coronary stenosis on coronary CT angiography. Clin Imaging 2022; 84:149-158. [DOI: 10.1016/j.clinimag.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022]
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Schmidt B, Flohr T. Principles and applications of dual source CT. Phys Med 2020; 79:36-46. [PMID: 33115699 DOI: 10.1016/j.ejmp.2020.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 01/03/2023] Open
Abstract
This article describes the technical principles and clinical applications of dual source CT. A dual source CT (DSCT) is a CT system with two x-ray tubes and two detectors at an angle of approximately 90°. Both measurement systems acquire CT scan data simultaneously at the same anatomical level of the patient (same z-position). DSCT provides temporal resolution of approximately a quarter of the gantry rotation time for cardiac, cardio-thoracic and pediatric imaging. Successful imaging of the heart and the coronary arteries at high and variable heart rates has been demonstrated. DSCT systems can be operated at twice the spiral pitch of single source CT systems (up to pitch 3.2). The resulting high table speed is beneficial for pediatric applications and fast CT angiographic scans, e. g. of the aorta or the extremities. Operating both X-ray tubes at different tube potential (kV) enables the acquisition of dual energy data and the corresponding applications such as monoenergetic imaging and computation of material maps. Spectral separation can be improved by different filtration of the X-ray beams of both X-ray tubes. As a downside, DSCT systems have to cope with some challenges, among them the limited size of the second measurement system, and cross-scattered radiation.
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Affiliation(s)
- Bernhard Schmidt
- Siemens Healthcare GmbH, Computed Tomography, Siemensstr. 3, 91301 Forchheim, Germany.
| | - Thomas Flohr
- Siemens Healthcare GmbH, Computed Tomography, Siemensstr. 3, 91301 Forchheim, Germany
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Assessment of Cardiac Lead Perforation: Comparison Among Chest Radiography, Transthoracic Echocardiography and Electrocardiography-gated Contrast-enhanced Cardiac CT. Eur Radiol 2018; 29:963-974. [DOI: 10.1007/s00330-018-5633-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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Matveeva A, Schmitt RR, Edtinger K, Wagner M, Kerber S, Deneke T, Uder M, Barth S. Coronary CT angiography in patients with atrial fibrillation: Standard-dose and low-dose imaging with a high-resolution whole-heart CT scanner. Eur Radiol 2018; 28:3432-3440. [PMID: 29426987 DOI: 10.1007/s00330-017-5282-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare image quality, observer confidence, radiation exposure in the standard-dose (SD-CCTA) and low-dose (LD-CCTA) protocols of coronary CT angiography (CCTA) in patients with atrial fibrillation (AF). MATERIAL AND METHODS CCTA was performed in 303 patients using a CT scanner with 16-cm coverage (111 scans during sinus rhythm (SR); 192 during AF). LD-CCTA was used in 218 patients; SD-CCTA in 85 patients suspected of having coronary artery disease (CAD). Image quality and observer confidence were evaluated on 5-point scales. Radiation doses were recorded. RESULTS Image quality was superior in the SD-CCTA compared to the LD-CCTA (SR 1.45±0.40; AF 1.72±0.46; vs. SR 1.83±0.48; AF 1.92±0.50; p < 0.001). Observers were more confident with SD-CCTA than with LD-CCTA (SR 1.38±0.33; AF 1.61±0.43; vs. SR 1.70±0.45; AF 1.82±0.50; p < 0.001). Radiation doses in AF were significantly higher than in the SR (LD-CCTA, 1.68±0.71 mSv; SD-CCTA, 3.72±1.95 mSv; vs. LD-CCTA, 1.3 ±0.52 mSv; SD-CCTA, 2.67±1.47 mSv; p < 0.001). CONCLUSION Using a low-dose protocol in AF, radiation exposure can be decreased by 50 % at the expense of 20 % impaired image quality. A low-dose CCTA protocol can be considered in young patients, whereas the standard-dose protocol is recommended for older patients and those suspected of having CAD. KEY POINTS • Whole-heart CT allows visualization of the coronary arteries in atrial fibrillation. • Low-dose CT decreases radiation exposure by 50%, image quality by 20%. • Standard-dose CT seems advantageous when concomitant coronary artery disease is suspected.
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Affiliation(s)
- Anna Matveeva
- Department of Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany.
| | - Rainer R Schmitt
- Department of Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
| | - Karoline Edtinger
- Department of Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
| | - Matthias Wagner
- Department of Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany
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Hedgire SS, Baliyan V, Ghoshhajra BB, Kalra MK. Recent advances in cardiac computed tomography dose reduction strategies: a review of scientific evidence and technical developments. J Med Imaging (Bellingham) 2017; 4:031211. [PMID: 28894760 DOI: 10.1117/1.jmi.4.3.031211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac imagers worldwide are bracing for increased utilization of cardiac computed tomography (CT) in clinical practice. This expanding opportunity brings along a responsibility to produce diagnostic quality images with optimized radiation dose. The following review aims to address the dose reduction strategies in cardiac CT in light of recent scientific evidence and technical developments.
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Affiliation(s)
- Sandeep S Hedgire
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Vinit Baliyan
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Brian B Ghoshhajra
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Mannudeep K Kalra
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
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Image Quality and Radiation Exposure Comparison of a Double High-Pitch Acquisition for Coronary Computed Tomography Angiography Versus Standard Retrospective Spiral Acquisition in Patients With Atrial Fibrillation. J Comput Assist Tomogr 2017; 42:45-53. [PMID: 28448411 DOI: 10.1097/rct.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare image quality and radiation dose of coronary computed tomography (CT) angiography performed with dual-source CT scanner using 2 different protocols in patients with atrial fibrillation. METHODS Forty-seven patients with AF underwent 2 different acquisition protocols: double high-pitch (DHP) spiral acquisition and retrospective spiral acquisition. The image quality was ranked according to a qualitative score by 2 experts: 1, no evident motion; 2, minimal motion not influencing coronary artery luminal evaluation; and 3, motion with impaired luminal evaluation. A third expert solved any disagreement. RESULTS A total of 732 segments were evaluated. The DHP group (24 patients, 374 segments) showed more segments classified as score 1 than the retrospective spiral acquisition group (71.3% vs 37.4%). Image quality evaluation agreement was high between observers (κ = 0.8). There was significantly lower radiation exposure for the DHP group (3.65 [1.29] vs 23.57 [10.32] mSv). CONCLUSIONS In this original direct comparison, a DHP spiral protocol for coronary CT angiography acquisition in patients with atrial fibrillation resulted in lower radiation exposure and superior image quality compared with conventional spiral retrospective acquisition.
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Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT. Clin Res Cardiol 2017; 106:485-492. [PMID: 28168514 DOI: 10.1007/s00392-017-1077-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. METHODS Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA. RESULTS SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts. CONCLUSION SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
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The Effect of Heart Rate on Exposure Window and Best Phase for Stress Perfusion Computed Tomography. J Comput Assist Tomogr 2017; 41:242-248. [DOI: 10.1097/rct.0000000000000514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee YH, Chan WP, Swensen SJ. Whole-Systems Approach to Patient Safety: Can We Do More? J Am Coll Radiol 2016; 13:1501-1504. [PMID: 27727013 DOI: 10.1016/j.jacr.2016.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Yuan-Hao Lee
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, Taipei Medical University, Taipei, Taiwan.
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Vadvala HV, Sayegh K, Moy M, Staziaki PV, Ghoshhajra BB. Salvage of diagnostic quality of image acquired by low-radiation-dose prospectively ECG-triggered coronary CTA during ventricular trigeminy: A case report of a novel image processing method. HeartRhythm Case Rep 2016; 2:20-23. [PMID: 28491624 PMCID: PMC5412625 DOI: 10.1016/j.hrcr.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | - Brian B. Ghoshhajra
- Address reprint requests and correspondence: Brian B. Ghoshhajra, Assistant Professor of Radiology, Harvard Medical School, Service Chief, Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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Scheske JA, Chung JH, Abbara S, Ghoshhajra BB. Computed Tomography Angiography of the Thoracic Aorta. Radiol Clin North Am 2016; 54:13-33. [DOI: 10.1016/j.rcl.2015.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Chaikriangkrai K, Choi SY, Nabi F, Chang SM. Important advances in technology and unique applications to cardiovascular computed tomography. Methodist Debakey Cardiovasc J 2015; 10:152-8. [PMID: 25574342 DOI: 10.14797/mdcj-10-3-152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
For the past decade, multidetector cardiac computed tomography and its main application, coronary computed tomography angiography, have been established as a noninvasive technique for anatomical assessment of coronary arteries. This new era of coronary artery evaluation by coronary computed tomography angiography has arisen from the rapid advancement in computed tomography technology, which has led to massive diagnostic and prognostic clinical studies in various patient populations. This article gives a brief overview of current multidetector cardiac computed tomography systems, developing cardiac computed tomography technologies in both hardware and software fields, innovative radiation exposure reduction measures, multidetector cardiac computed tomography functional studies, and their newer clinical applications beyond coronary computed tomography angiography.
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Affiliation(s)
| | - Su Yeon Choi
- Seoul National University Hospital, Seoul, South Korea
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Celeng C, Vadvala H, Puchner S, Pursnani A, Sharma U, Kovacs A, Maurovich-Horvat P, Hoffmann U, Ghoshhajra B. Defining the optimal systolic phase targets using absolute delay time for reconstructions in dual-source coronary CT angiography. Int J Cardiovasc Imaging 2015; 32:91-100. [PMID: 26335369 DOI: 10.1007/s10554-015-0755-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
To define the optimal systolic phase for dual-source computed tomography angiography using an absolute reconstruction delay time after the R-R interval based on the coronary artery motion, we analyzed images reconstructed between 200 and 420 miliseconds (ms) after the R wave at 20 ms increments in 21 patients. Based on the American Heart Association coronary segmentation guidelines, the origin of six coronary artery landmarks (RCA, AM1, PDA, LM, OM1, and D2) were selected to calculate the coronary artery motion velocity. The velocity of the given landmark was defined as the quotient of the route and the length of the time interval. The x, y and z-coordinates of the selected landmark were recorded, and were used for the calculation of the 3D route of coronary artery motion by using a specific equation. Differences in velocities were assessed by analysis of variance for repeated measures; Bonferroni post hoc tests were used for multiple pair wise comparisons. 1488 landmarks were measured (6 locations at 12 systolic time points) in 21 patients and were analyzed. The mean values of the minimum velocities were calculated separately for each heart rate group (i.e. <65; 65-80; and >80 bpm). The mean lowest coronary artery velocities in each segment occurred in the middle period of each time interval of the acquired systolic phase i.e. 280-340 ms. No differences were found in the minimal coronary artery velocities between the three HR groups, with the exception of the AM1 branch (p = 0.00495) between <65 and >80 bpm (p = 0.03), and at HRs of 65-80 versus >80 bpm (p = 0.006). During an absolute delay of 200-420 ms after the R-wave, the ideal reconstruction interval varies significantly among coronary artery segments. Decreased velocities occur between 280 to 340 ms. Therefore a narrow range of systolic intervals, rather than a single phase, should be acquired.
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Affiliation(s)
- Csilla Celeng
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. .,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Harshna Vadvala
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Stefan Puchner
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Amit Pursnani
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Umesh Sharma
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Attila Kovacs
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Pâl Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Udo Hoffmann
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Yang L, Xu L, Schoepf UJ, Wichmann JL, Fox MA, Yan J, Fan Z, Zhang Z. Prospectively ECG-Triggered Sequential Dual-Source Coronary CT Angiography in Patients with Atrial Fibrillation: Influence of Heart Rate on Image Quality and Evaluation of Diagnostic Accuracy. PLoS One 2015. [PMID: 26221952 PMCID: PMC4519310 DOI: 10.1371/journal.pone.0134194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the effects of mean heart rate (HR) and heart rate variation (HRV) on image quality and diagnostic accuracy of prospectively ECG-triggered sequential dual-source coronary CT angiography (CCTA) in patients with atrial fibrillation (AF). Methods Eighty-five patients (49 women, 36 men; mean age 62.1±9.5 years) with persistent AF underwent prospectively ECG-triggered sequential second-generation dual-source CCTA. Tube current and voltage were adjusted according to body mass index (BMI) and iterative reconstruction was used. Image quality of coronary segments (four-point scale) and presence of significant stenosis (>50%) were evaluated. Diagnostic accuracy was analyzed in 30 of the 85 patients who underwent additional invasive coronary angiography (ICA). Results Only 8 of 1102 (0.7%) segments demonstrated poor image quality. No significant impact on image quality was found for mean HR (94.9±21.8 bpm; r=0.034, p=0.758; F=0.413, p=0.663) or HRV (67.5±22.8 bpm; r=0.097, p=0.377; F=0.111, p=0.895). On per-segment analysis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 89.7% (26/29), 99.4% (355/357), 92.9% (26/28), and 99.2% (355/358), respectively, with excellent correlation (kappa=0.91) with ICA. Mean effective dose was 3.3±1.0 mSv. Conclusions Prospectively ECG-triggered sequential dual-source CCTA provides diagnostic image quality and good diagnostic accuracy for detection of coronary stenosis in AF patients without significant influence by HR or HRV.
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Affiliation(s)
- Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- * E-mail:
| | - U. Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America
| | - Julian L. Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America
| | - Mary A. Fox
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jing Yan
- Siemens Healthcare China, 278 Zhouzhu Road, Shanghai, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhaoqi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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State-of-the-Art Updates on Cardiac Computed Tomographic Angiography for Assessing Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:398. [PMID: 26092612 DOI: 10.1007/s11936-015-0398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OPINION STATEMENT Cardiac computed tomographic angiography (CCTA) is a noninvasive imaging modality that is increasingly useful for the evaluation of coronary artery disease (CAD). Over the past decade, CCTA has consistently demonstrated an excellent sensitivity for the detection and exclusion of coronary atherosclerosis in patients with stable or acute chest pain symptoms. Large prospective registries have repeatedly demonstrated the prognostic significance of the presence, extent, or absence of CAD by CCTA. In response to initial concerns, technical advances have permitted a dramatic reduction in patient radiation exposure with preserved image quality. For many patients, the radiation dose of CCTA is less than half of that with conventional myocardial perfusion imaging while providing significantly more anatomic information. Furthermore, CCTA's excellent spatial resolution is increasingly being used for noninvasive assessment of coronary plaque, including the detection of higher-risk vulnerable plaque and association between plaque characteristics and ischemia. Finally, new promising techniques that incorporate physiology with anatomy, such as CT-based fractional flow reserve (FFR-CT) and CT perfusion (CTP), are allowing for the noninvasive hemodynamic assessment of coronary stenoses and improvements in the specificity of CCTA findings. Such advances augur a coming transition when CCTA will be a first-line test for the detection, exclusion, and even management of CAD in many patients.
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Low Radiation Coronary CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Groarke JD, Waller AH, Vita TS, Michaud GF, Di Carli MF, Blankstein R, Kwong RY, Steigner M. Feasibility study of electrocardiographic and respiratory gated, gadolinium enhanced magnetic resonance angiography of pulmonary veins and the impact of heart rate and rhythm on study quality. J Cardiovasc Magn Reson 2014; 16:43. [PMID: 24947763 PMCID: PMC4078012 DOI: 10.1186/1532-429x-16-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 05/23/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We aimed to assess the feasibility of 3 dimensional (3D) respiratory and ECG gated, gadolinium enhanced magnetic resonance angiography (MRA) on a 3 Tesla (3 T) scanner for imaging pulmonary veins (PV) and left atrium (LA). The impact of heart rate (HR) and rhythm irregularity associated with atrial fibrillation (AF) on image and segmentation qualities were also assessed. METHODS 101 consecutive patients underwent respiratory and ECG gated (ventricular end systolic window) MRA for pre AF ablation imaging. Image quality (assessed by PV delineation) was scored as 1 = not visualized, 2 = poor, 3 = good and 4 = excellent. Segmentation quality was scored on a similar 4 point scale. Signal to noise ratios (SNRs) were calculated for the LA, LA appendage (LAA), and PV. Contrast to noise ratios (CNRs) were calculated between myocardium and LA, LAA and PV, respectively. Associations between HR/rhythm and quality metrics were assessed. RESULTS 35 of 101 (34.7%) patients were in AF at time of MRA. 100 (99%) patients had diagnostic studies, and 91 (90.1%) were of good or excellent quality. Overall, mean ± standard deviation (SD) image quality score was 3.40 ± 0.69. Inter observer agreement for image quality scores was substantial, (kappa = 0.68; 95% confidence interval (CI): 0.46, 0.90). Neither HR adjusting for rhythm [odds ratio (OR) = 1.03, 95% CI = 0.98,1.09; p = 0.22] nor rhythm adjusting for HR [OR = 1.25, 95% CI = 0.20, 7.69; p = 0.81] demonstrated association with image quality. Similarly, SNRs and CNRs were largely independent of HR after adjusting for rhythm. Segmentation quality scores were good or excellent for 77.3% of patients: mean ± SD score = 2.91 ± 0.63, and scores did not significantly differ by baseline rhythm (p = 0.78). CONCLUSIONS 3D respiratory and ECG gated, gadolinium enhanced MRA of the PVs and LA on a 3 T system is feasible during ventricular end systole, achieving high image quality and high quality image segmentation when imported into electroanatomic mapping systems. Quality is independent of HR and heart rhythm for this free breathing, radiation free, alternative strategy to current MRA or CT based approaches, for pre AF ablation imaging of PVs and LA.
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Affiliation(s)
- John D Groarke
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfonso H Waller
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomas S Vita
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory F Michaud
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Steigner
- Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Lidocaine bolus may facilitate computed tomographic coronary angiography in patients with frequent premature ventricular contractions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:199-204. [PMID: 24570719 PMCID: PMC3915980 DOI: 10.5114/pwki.2013.37496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/16/2013] [Accepted: 06/12/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Heart rate irregularities are the major limitations of computed tomographic coronary angiography (CTCA) due to severe motion artifacts. Aim To evaluate the safety and efficacy of a lidocaine intravenous bolus in preserving good image quality by the transient suppression of premature ventricular contractions (PVC) during the CTCA scan. Material and methods The study group comprised 67 consecutive patients with sinus rhythm and numerous PVC scheduled for CTCA. Intravenous boluses of 25–50 mg lidocaine were given after calcium score assessment and immediately before CTCA. The control group comprised 67 patients with sinus rhythm without PVC matched according to the body mass index (BMI), age, sex, and calcium score. All coronary vessel segments were assessed for image quality and presence of significant stenosis. Results As compared with calcium score assessment, after administration of lidocaine and during the CTCA scan PVC were completely suppressed in 22 (40%), reduced in 10 (18%), unchanged in 18 (32%), and intensified in 5 (10%) patients. Overall, there were 32 (58%) patients with sinus rhythm during CTCA as compared with only 11 (20%) patients free from PVC during calcium score assessment (p < 0.001). Image quality in 871 coronary segments including both the study group and control patients was worse in patients with PVC (p < 0.0001). However, there was no statistically significant difference in the number of patients with at least one segment of non-diagnostic quality (6% vs. 12%, p = 0.36; respectively). Conclusions Single lidocaine bolus given prior to CTCA is safe, may temporarily eliminate or reduce the intensity of arrhythmia, and hence results in improved quality of CTCA in patients with numerous PVC.
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Radiation dose reduction in pediatric cardiac computed tomography: experience from a tertiary medical center. Pediatr Cardiol 2014; 35:171-9. [PMID: 23872908 DOI: 10.1007/s00246-013-0758-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Cardiac CT angiography (cCTA) has become an established method for the assessment of congenital heart disease. However, the potential harmful effects of ionizing radiation must be considered, particularly in younger, more radiosensitive patients. In this study, we sought to assess the temporal change in radiation doses from pediatric cCTA during an 8-year period at a tertiary medical center. This retrospective study included all patients ≤18 years old who were referred to electrocardiography (ECG)-gated cCTA for the assessment of congenital heart disease or inflammatory disease (Kawasaki disease) from November 2004 to September 2012. During the study period, 95 patients were scanned using 3 different scanner models-64-slice multidetector CT (64-MDCT) and first- (64-DSCT) and second-generation (128-DSCT) dual-source CT-and 3 scan protocols-retrospective ECG-gated helical scanning (RG), prospective ECG-triggered axial scanning (PT), or prospective ECG-triggered high-pitch helical scanning (HPH). Effective dose (ED) was calculated with the dose length product method with a conversion factor (k) adjusted for age. ED was then compared among scan protocols. Image quality was extracted from clinical cCTA reports when available. Overall, 94 % of scans were diagnostic (80 % for 64-slice MDCT, 93 % for 64-slice DSCT, and 97 % for 128-slice DSCT).With 128-DSCT, median ED (1.0 [range 0.6-2.0] mSv) decreased by 85.8 % and 66.8 % compared with 64-MDCT (6.8 [range 2.9-13.6] mSv) and 64-DSCT (2.9 [range 0.9-4.1] mSv), respectively. With HPH, median ED (0.9 [range 0.6-1.8] mSv) decreased by 59.4 % and 85.4 % compared with PT (2.2 [range 0.9-3.4] mSv) and RG (6.1 [range 2.5-10.6] mSv). cCTA can now be obtained at very low radiation doses in pediatric patients using the latest dual-source CT technology in combination with prospective ECG-triggered HPH acquisition.
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Technical note: Electrocardiogram electrode repositioning for 320-row coronary CT angiography in patients with regular and recurrent premature ventricular contractions. J Cardiovasc Comput Tomogr 2014; 8:13-8. [DOI: 10.1016/j.jcct.2013.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/15/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
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Engel LC, Lee AM, Seifarth H, Sidhu MS, Brady TJ, Hoffmann U, Ghoshhajra BB. Weekly dose reports: the effects of a continuous quality improvement initiative on coronary computed tomography angiography radiation doses at a tertiary medical center. Acad Radiol 2013; 20:1015-23. [PMID: 23830607 DOI: 10.1016/j.acra.2013.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/14/2013] [Accepted: 04/30/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service. MATERIALS AND METHODS This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April-September 2011) and 150 patients after the initiation (postintervention period: September 2011-February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012-January 2013). Patient characteristics and effective radiation were recorded and compared. RESULTS Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7-5.7] and in the late control group (3.3 mSv [2.0-5.3] versus the preintervention period (4.1 mSv [2.1-6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control). CONCLUSION Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.
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Affiliation(s)
- Leif-Christopher Engel
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St., Suite 400, Boston, MA 02114, USA
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Prospectively ECG-triggered sequential dual-source coronary CT angiography in patients with atrial fibrillation: comparison with retrospectively ECG-gated helical CT. Eur Radiol 2013; 23:1822-8. [DOI: 10.1007/s00330-013-2793-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/29/2012] [Accepted: 01/08/2013] [Indexed: 11/25/2022]
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Lee AM, Beaudoin J, Thai WE, Wai B, Hui GC, Sidhu MS, Engel LC, Abbara S, Hoffmann U, Ghoshhajra BB. Feasibility of aortic valve assessment with low dose prospectively triggered adaptive systolic (PTAS) cardiac computed tomography angiography. BMC Res Notes 2013; 6:158. [PMID: 23602055 PMCID: PMC3640955 DOI: 10.1186/1756-0500-6-158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac computed tomography angiography (CTA) is feasible for aortic valve evaluation, but retrospective gated protocols required high radiation doses for aortic valve assessment. A prospectively triggered adaptive systolic (PTAS) cardiac CT protocol was recently described in arrhythmia using second-generation dual-source CT. In this study, we sought to evaluate the feasibility of PTAS CTA to assess the aortic valve at a low radiation dose. FINDINGS A retrospective cohort of 29 consecutive patients whom underwent PTAS protocols for clinical indications other than aortic valve assessment and whom also received echocardiography within 2 months of CT, was identified. Images were reviewed for aortic valve morphology (tricuspid/bicuspid/prosthetic) and stenosis (AS) by experienced blinded readers. Accuracy versus echocardiography and radiation doses were assessed. CONCLUSIONS PTAS CTA protocols using second-generation dual-source CT for aortic valve evaluation are feasible at low doses. This protocol should be investigated further in larger cohorts.
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Lee AM, Beaudoin J, Engel LC, Sidhu MS, Abbara S, Brady TJ, Hoffmann U, Ghoshhajra BB. Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study. Int J Cardiovasc Imaging 2013; 29:1361-70. [DOI: 10.1007/s10554-013-0208-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/15/2013] [Indexed: 11/30/2022]
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Srichai MB, Barreto M, Lim RP, Donnino R, Babb JS, Jacobs JE. Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. J Cardiovasc Comput Tomogr 2013; 7:102-9. [PMID: 23545461 DOI: 10.1016/j.jcct.2013.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obtaining diagnostic coronary CT angiography with low radiation exposure in patients with irregular heart rhythms such as atrial fibrillation (AF) remains challenging. OBJECTIVE We evaluated image quality and inter-reader variability with the use of prospective electrocardiographic (ECG)-triggered sequential dual-source acquisition at end systole for coronary artery disease (CAD) evaluation in patients with AF. METHODS Thirty consecutive patients with AF who underwent prospective ECG-triggered sequential dual-source acquisition were evaluated. Images were reconstructed every 50 milliseconds from 250 to 400 milliseconds after the R wave. Two independent, blinded readers evaluated the coronaries for image quality on a 5-point scale (worst to best) and stenosis on 5-point semiquantitative (none to severe) and binary scales (>50% or <50%). Diagnostic image quality was graded for each reconstruction. RESULTS Eleven patients (37%) had significant (≥50% stenosis) CAD. Average heart rate was 82 ± 20 beats/min and variability range was 71 ± 22 beats/min. Mean effective radiation dose was 6.5 ± 2.4 mSv. Diagnostic image quality was noted in 97.9% of 304 coronary segments with median image quality of 3.0. The 300-millisecond reconstruction phase provided the highest image quality; 70% of patients showed diagnostic image quality. Combination of all phases (250-400 milliseconds) performed significantly better than single or other phase combinations (P < 0.0005 for all comparisons). Inter-reader variability for stenosis detection was excellent, with 98.4% concordance by using a binary scale (50% stenosis cutoff). CONCLUSIONS Prospective ECG-triggered sequential dual-source CT acquisition with the use of end-systolic acquisition provides diagnostic image quality with potentially low radiation doses for evaluation of CAD in patients with AF. Use of multiple end-systolic phases over a 150-millisecond window improves diagnostic image quality.
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Affiliation(s)
- Monvadi B Srichai
- Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA.
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Coronary CT angiography: Comparison of a novel iterative reconstruction with filtered back projection for reconstruction of low-dose CT—Initial experience. Eur J Radiol 2013. [DOI: 10.1016/j.ejrad.2012.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lin L, Wang YN, Kong LY, Jin ZY, Lu GM, Zhang ZQ, Cao J, Li S, Song L, Wang ZW, Zhou K, Wang M. 128-slice Dual-source Computed Tomography Coronary Angiography in Patients with Atrial Fibrillation: Image Quality and Radiation Dose of Prospectively Electrocardiogram-triggered Sequential Scan Compared with Retrospectively Electrocardiogram-gated Spiral Scan. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2013; 27:195-200. [PMID: 23294583 DOI: 10.1016/s1001-9294(13)60001-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Objective To evaluate the image quality (IQ) and radiation dose of 128-slice dual-source computed tomography (DSCT) coronary angiography using prospectively electrocardiogram (ECG)-triggered sequential scan mode compared with ECG-gated spiral scan mode in a population with atrial fibrillation. Methods Thirty-two patients with suspected coronary artery disease and permanent atrial fibrillation referred for a second-generation 128-slice DSCT coronary angiography were included in the prospective study. Of them, 17 patients (sequential group) were randomly selected to use a prospectively ECG-triggered sequential scan, while the other 15 patients (spiral group) used a retrospectively ECG-gated spiral scan. The IQ was assessed by two readers independently, using a four-point grading scale from excel-lent (grade 1) to non-assessable (grade 4), based on the American Heart Association 15-segment model. IQ of each segment and effective dose of each patient were compared between the two groups. Results The mean heart rate (HR) of the sequential group was 96±27 beats per minute (bpm) with a variation range of 73±25 bpm, while the mean HR of the spiral group was 86±22 bpm with a variationrange of 65±24 bpm. Both of the mean HR (t=1.91, P=0.243) and HR variation range (t=0.950, P=0.350) had no significant difference between the two groups. In per-segment analysis, IQ of the sequential group vs. spiral group was rated as excellent (grade 1) in 190/244 (78%) vs. 177/217 (82%) by reader1 and 197/245 (80%) vs. 174/214 (81%) by reader2, as non-assessable (grade 4) in 4/244 (2%) vs. 2/217 (1%) by reader1 and 6/245 (2%) vs. 4/214 (2%) by reader2. Overall averaged IQ per-patient in the sequential and spiral group showed equally good (1.27±0.19 vs. 1.25±0.22, Z=-0.834, P=0.404). The effective radiation dose of the sequential group reduced significantly compared with the spiral group (4.88±1.77 mSv vs. 10.20±3.64 mSv; t=-5.372, P=0.000). Conclusion Compared with retrospectively ECG-gated spiral scan, prospectively ECG-triggered sequential DSCT coronary angiography provides similarly diagnostically valuable images in patients with atrial fibrillation and significantly reduces radiation dose.
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Affiliation(s)
- Lu Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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