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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

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

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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Abbreviations

BMI:

Body mass index

CAD:

Coronary artery disease

CCA:

Catheter coronary angiography

cCTA:

Coronary computed tomography angiography

CI:

Confidence interval

CTDIvol :

CT volume dose index

DLP:

Dose-length product

ECG:

Electrocardiogram

ED:

Effective dose

FBP:

Filtered back projection

LAD:

Left anterior descending coronary artery

LCx:

Left circumflex coronary artery

LM:

Left main coronary artery

ROC:

Receiver-operating characteristics

RCA:

Right coronary artery

ROI:

Region of interest

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Acknowledgement

This study received a grant from the Ministry of Science and Technology of China, grant No. 2007BAI05B02, and was supported in part by a research grant provided by Bayer Healthcare, Berlin, Germany.

UJS is a consultant for and receives research support from Bayer Healthcare, Bracco, GE Healthcare, and Siemens. The other authors have no industry relationships or conflicts of interest relevant to this investigation to disclose.

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Authors and Affiliations

  1. Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-cheng District, Beijing, 100037, China

    Wei-Hua Yin, Bin Lu, Zhi-Hui Hou, Nan Li, Lei Han, Justin R. Silverman, Carlo Nicola De Cecco & U. Joseph Schoepf

  2. Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-cheng District, Beijing, 100037, China

    Yong-Jian Wu & Hong-Xia Niu

  3. Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Wei-Hua Yin, Bin Lu, Zhi-Hui Hou, Nan Li, Lei Han, Justin R. Silverman, Carlo Nicola De Cecco & U. Joseph Schoepf

Authors
  1. Wei-Hua Yin
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  2. Bin Lu
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  3. Zhi-Hui Hou
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  4. Nan Li
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  5. Lei Han
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  7. Hong-Xia Niu
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  8. Justin R. Silverman
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  9. Carlo Nicola De Cecco
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  10. U. Joseph Schoepf
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Corresponding author

Correspondence to Bin Lu.

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Yin, WH., Lu, B., Hou, ZH. et al. Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction. Eur Radiol 23, 2927–2933 (2013). https://doi.org/10.1007/s00330-013-2920-0

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  • DOI: https://doi.org/10.1007/s00330-013-2920-0

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