1
|
Preuß D, Garcia G, Laule M, Dewey M, Rief M. Myocardial CT perfusion imaging for the detection of obstructive coronary artery disease: multisegment reconstruction does not improve diagnostic performance. Eur Radiol Exp 2022; 6:5. [PMID: 35099638 PMCID: PMC8804122 DOI: 10.1186/s41747-021-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/02/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Multisegment reconstruction (MSR) was introduced to shorten the temporal reconstruction window of computed tomography (CT) and thereby reduce motion artefacts. We investigated whether MSR of myocardial CT perfusion (CTP) can improve diagnostic performance in detecting obstructive coronary artery disease (CAD) compared with halfscan reconstruction (HSR). METHODS A total of 134 patients (median age 65.7 years) with clinical indication for invasive coronary angiography and without cardiac surgery prospectively underwent static CTP. In 93 patients with multisegment acquisition, we retrospectively performed both MSR and HSR and searched both reconstructions for perfusion defects. Subgroups with known (n = 68) or suspected CAD (n = 25) and high heart rate (n = 30) were analysed. The area under the curve (AUC) was compared applying DeLong approach using ≥ 50% stenosis on invasive coronary angiography as reference standard. RESULTS Per-patient analysis revealed the overall AUC of MSR (0.65 [95% confidence interval 0.53, 0.78]) to be inferior to that of HSR (0.79 [0.69, 0.88]; p = 0.011). AUCs of MSR and HSR were similar in all subgroups analysed (known CAD 0.62 [0.45, 0.79] versus 0.72 [0.57, 0.86]; p = 0.157; suspected CAD 0.80 [0.63, 0.97] versus 0.89 [0.77, 1.00]; p = 0.243; high heart rate 0.46 [0.19, 0.73] versus 0.55 [0.33, 0.77]; p = 0.389). Median stress radiation dose was higher for MSR than for HSR (6.67 mSv versus 3.64 mSv, p < 0.001). CONCLUSIONS MSR did not improve diagnostic performance of myocardial CTP imaging while increasing radiation dose compared with HSR. TRIAL REGISTRATION CORE320: clinicaltrials.gov NCT00934037, CARS-320: NCT00967876.
Collapse
Affiliation(s)
- Daniel Preuß
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Gonzalo Garcia
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| |
Collapse
|
2
|
Zhang Q, Mi H, Shi X, Li W, Guo S, Wang P, Suo H, Wang Z, Jin S, Yan F, Niu Y, Xian J. Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography. Acad Radiol 2021; 28:1072-1080. [PMID: 32553279 DOI: 10.1016/j.acra.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To test whether higher iodine concentration together with higher noise level could lead to a further dose reduction in an already low dose coronary CT angiography (CCTA) protocol without comprising image quality. MATERIALS AND METHODS One hundred eighty patients with suspected coronary artery disease (CAD) were randomly assigned into three groups: (a) conventional dose (CD) group, 100 kV with a noise index (NI) of 25 and iohexol (350 mg I/ml); (b) low dose (LD) group, 80 kV with a NI of 25 and iohexol (350 mg I/ml); (c) further low dose (FLD) group, 80 kV with a NI of 30 and iomeprol (400 mg I/ml). The volume and injection rate of contrast medium were fixed at 60 ml and 5 ml/s. The radiation dose (volume CT dose index [CTDIvol], dose length product [DLP], and effective dose [ED]) were recorded. For image quality, both quantitative (enhancement, noise, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) and qualitative indices were assessed. RESULTS Compared to the CD group, ED was reduced by 16% and 42% in the LD and FLD groups, respectively (p < 0.05). Qualitative analysis showed no significant difference among the 3 groups (p > 0.05), while quantitative analysis revealed significantly higher attenuation in the LD and FLD groups. Signal-to-noise ratios and CNRs of the LD and FLD groups were significantly higher except for the CNR at the left circumflex branch of the FLD group (p < 0.05). CONCLUSION Increasing iodine concentration and noise level may further reduce the radiation dose by 26% on top of a 16% reduction from 100 kV to 80 kV without image quality compromise.
Collapse
Affiliation(s)
- Qing Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Haifeng Mi
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Xubo Shi
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Senlin Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Ping Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Hongna Suo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Ziyi Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Shanshan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Yantao Niu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China.
| |
Collapse
|
3
|
Masuda T, Funama Y, Nakaura T, Satou T, Okimoto T, Yamashita Y, Imada N, Awai K. Radiation Dose Reduction at Low Tube Voltage CCTA Based on the CNR Index. Acad Radiol 2018; 25:1298-1304. [PMID: 29599007 DOI: 10.1016/j.acra.2018.01.019] [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: 10/11/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES We compared the radiation dose and diagnostic accuracy on 120- and 100-kVp coronary computed tomography angiography (CCTA) scans whose contrast-to-noise ratio (CNR) was the same. MATERIALS AND METHODS We studied 1311 coronary artery segments from 100 patients. For 120-kVp scans, the targeted image level was set at 25 Hounsfield units (HU). For 100-kVp scans, the targeted noise level was set at 30 HU to obtain the same CNR as at 120 kVp. We compared the CNR and the radiation dose on scans acquired at 120 and 100 kVp. Invasive coronary angiography (ICA) images were evaluated by an interventional coronary angiography specialist, and CCTA images were evaluated by a radiologist. Coronary artery disease was defined as a luminal narrowing ≧50% for ICA and CCTA. With ICA considered the gold standard, the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed on both 120- and 100-kVp CCTA images. We also compared the diagnostic accuracy for area under the receiver operating characteristic curve of the ICA and CCTA performed at 120 and 100 kVp. Two blinded observers visually evaluated the septal branch. RESULTS The mean dose-length product was 48% lower at 100 kVp than at 120 kVp (P < .01). Under the 120-kVp CCTA protocol, the area under the curve, 95% confidence interval, sensitivity, specificity, positive predictive value, and negative predictive value were 0.94%, 0.91%-0.96%, 94.0%, 93.0%, 82.3%, and 98.1%, respectively; at 100 kVp these values were 0.94%, 0.92%-0.97%, 96.1%, 92.0%, 85.2%, and 98.0%, respectively. Area under the receiver operating characteristic curve analysis revealed no significant difference in diagnostic accuracy between the two protocols (P = .87). CONCLUSIONS At the same CNR, the 100-kVp CCTA protocol may help to reduce the radiation dose by approximately 50% compared to the 120-kVp protocol without degradation of diagnostic accuracy.
Collapse
|
4
|
Wang XP, Zhu XM, Zhu YS, Liu WY, Yang XH, Huang WW, Xu Y, Tang LJ. Automatic tube potential selection with tube current modulation in coronary CT angiography: Can it achieve consistent image quality among various individuals? Exp Ther Med 2018; 16:253-259. [PMID: 29896246 PMCID: PMC5995055 DOI: 10.3892/etm.2018.6158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/06/2018] [Indexed: 11/06/2022] Open
Abstract
The present study included a total of 111 consecutive patients who had undergone coronary computed tomography (CT) angiography, using a first-generation dual-source CT with automatic tube potential selection and tube current modulation. Body weight (BW) and body mass index (BMI) were recorded prior to CT examinations. Image noise and attenuation of the proximal ascending aorta (AA) and descending aorta (DA) at the middle level of the left ventricle were measured. Correlations between BW, BMI and objective image quality were evaluated using linear regression. In addition, two subgroups based on BMI (BMI ≤25 and >25 kg/m2) were analyzed. Subjective image quality, image noise, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) were all compared between those. The image noise of the AA increased with the BW and BMI (BW: r=0.453, P<0.001; BMI: r=0.545, P<0.001). The CNR and SNR of the AA were inversely correlated with BW and BMI, respectively. The image noise of the DA and the CNR and SNR of the DA exhibited a similar association to those with the BW or BMI. The BMI >25 kg/m2 group had a significant increase in image noise (33.1±6.9 vs. 27.8±4.0 HU, P<0.05) and a significant reduction in CNR and SNR, when compared with those in the BMI ≤25 kg/m2 group (CNR: 18.9±4.3 vs. 16.1±3.7, P<0.05; SNR: 16.0±3.8 vs. 13.6±3.2, P<0.05). Patients with a BMI of ≤25 kg/m2 had more coronary artery segments scored as excellent, compared with patients with a BMI of >25 kg/m2 (P=0.02). In conclusion, this method is not able to achieve a consistent objective image quality across the entire patient population. The impact of BW and BMI on objective image quality was not completely eliminated. BMI-based adjustment of the tube potential may achieve a more consistent image quality compared to automatic tube potential selection, particularly in patients with a larger body habitus.
Collapse
Affiliation(s)
- Xiao-Ping Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Mei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yin-Su Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wang-Yan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Han Yang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wei-Wei Huang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Li-Jun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| |
Collapse
|
5
|
Low radiation dose computed tomography coronary angiography: evaluation of the variations in coronary arteries. Surg Radiol Anat 2016; 38:1123-1134. [DOI: 10.1007/s00276-016-1693-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/08/2016] [Indexed: 11/26/2022]
|