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Coronary CT angiography in patients with atrial fibrillation: Standard-dose and low-dose imaging with a high-resolution whole-heart CT scanner

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

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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Abbreviations

3D:

Three-dimensional

AF:

Atrial fibrillation

BMI:

Body mass index

bpm:

Beats per minute

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

DLP:

Dose length product

DSCT:

Dual-source computed tomography

ECG:

Electrocardiography

HR:

Heart rate

ICA:

Invasive coronary angiography

LA:

Left atrium

LAD:

Left anterior descending artery

LCx:

Left circumflex artery

LD-CCTA:

Low-dose coronary computed tomography angiography

LM:

Left main

MDCT:

Multidetector-row computed tomography

MPR:

Multiplanar reconstruction

PV:

Pulmonary veins

PVI:

Pulmonary vein isolation

RCA:

Right coronary artery

SD:

Standard deviation

SD-CCTA:

Standard-dose coronary computed tomography angiography

SR:

Sinus rhythm

SSCT:

Single-source computed tomography

VRT:

Volume-rendering technique

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Funding

This study has received funding by Rhoen-Klinikum Aktiengesellschaft, Bad Neustadt, Germany (grant FB81).

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Authors and Affiliations

  1. Department of Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany

    Anna Matveeva, Rainer R. Schmitt, Karoline Edtinger & Matthias Wagner

  2. Department of Cardiology, Cardiovascular Centre GmbH, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany

    Sebastian Kerber, Thomas Deneke & Sebastian Barth

  3. Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054, Erlangen, Germany

    Michael Uder

Authors
  1. Anna Matveeva
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  5. Sebastian Kerber
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  7. Michael Uder
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Corresponding author

Correspondence to Anna Matveeva.

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Guarantor

The scientific guarantor of this publication is Rainer R. Schmitt: Department of Diagnostic and Interventional Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, Bad Neustadt an der Saale, 97616, Germany.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Rainer R. Schmitt has received a speaker honorarium from GE Healthcare and Bracco Diagnostics. Matthias Wagner has received a speaker honorarium from GE Healthcare. All other authors report no conflict of interest to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Matveeva, A., Schmitt, R.R., Edtinger, K. et al. Coronary CT angiography in patients with atrial fibrillation: Standard-dose and low-dose imaging with a high-resolution whole-heart CT scanner. Eur Radiol 28, 3432–3440 (2018). https://doi.org/10.1007/s00330-017-5282-1

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  • DOI: https://doi.org/10.1007/s00330-017-5282-1

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