Prospectively ECG-triggered sequential dual-source coronary CT angiography in patients with atrial fibrillation: comparison with retrospectively ECG-gated helical CT
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To investigate the feasibility of applying prospectively ECG-triggered sequential coronary CT angiography (CCTA) to patients with atrial fibrillation (AF) and evaluate the image quality and radiation dose compared with a retrospectively ECG-gated helical protocol.
100 patients with persistent AF were enrolled. Fifty patients were randomly assigned to a prospective protocol and the other patients to a retrospective protocol using a second-generation dual-source CT (DS-CT). Image quality was evaluated using a four-point grading scale (1 = excellent, 2 = good, 3 = moderate, 4 = poor) by two reviewers on a per-segment basis. The coronary artery segments were considered non-diagnostic with a quality score of 4. The radiation dose was evaluated.
Diagnostic segment rate in the prospective group was 99.4 % (642/646 segments), while that in the retrospective group was 96.5 % (604/626 segments) (P < 0.001). Effective dose was 4.29 ± 1.86 and 11.95 ± 5.34 mSv for each of the two protocols (P < 0.001), which was a 64 % reduction in the radiation dose for prospective sequential imaging compared with retrospective helical imaging.
In AF patients, prospectively ECG-triggered sequential CCTA is feasible using second-generation DS-CT and can decrease >60 % radiation exposure compared with retrospectively ECG-gated helical imaging while improving diagnostic image quality.
• Coronary computed tomographic angiography (CCTA) can be difficult in patients with arrhythmias.
• Prospectively ECG-triggered sequential CCTA is feasible in patients with atrial fibrillation.
• Prospective sequential imaging can improve quality compared with retrospective analysis.
• Prospective sequential imaging decreases radiation exposure by 64 % compared with retrospective mode.
- Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336 CrossRef
- Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732 CrossRef
- Johnson TR, Nikolaou K, Busch S et al (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691 CrossRef
- Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428 CrossRef
- Heuschmid M, Kuettner A, Schroeder S et al (2005) ECG gated 16-MDCT of the coronary arteries: assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol 184:1413–1419 CrossRef
- Pugliese F, Mollet NR, Runza G et al (2006) Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 16:575–582 CrossRef
- Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557 CrossRef
- Sun Z, Jiang W (2006) Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta analysis. Eur J Radiol 60:279–286 CrossRef
- Chatap G, Giraud K, Vincent JP (2002) Atrial fibrillation in the elderly: facts and management. Drugs Aging 19:819–846 CrossRef
- Peters NS, Schilling RJ, Kanagaratnam P, Markides V (2002) Atrial fibrillation: strategies to control, combat, and cure. Lancet 359:593–603 CrossRef
- Fuster V, Rydén LE, Cannom DS et al (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114:e257–354 CrossRef
- Yang L, Zhang Z, Fan Z et al (2009) 64-MDCT coronary angiography of patients with atrial fibrillation: influence of heart rate on image quality and efficacy in evaluation of coronary artery disease. AJR Am J Roentgenol 193:795–801 CrossRef
- Rist C, Johnson TR, Müller-Starck J et al (2009) Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation. Invest Radiol 44:159–167 CrossRef
- Oncel D, Oncel G, Tastan A (2007) Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experience. Radiology 245:703–711 CrossRef
- Brodoefel H, Burgstahler C, Tsiflikas I et al (2008) Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology 247:346–355 CrossRef
- Lee AM, Engel L-C, Shah B et al (2012) Coronary computed tomography angiography during arrhythmia: Radiation dose reduction with prospectively ECG-triggered axial and retrospectively ECG-gated helical 128-slice dual-source CT. J Cardiovasc Comput Tomogr 6:172–183.e2 CrossRef
- Raff GL, Abidov A, Achenbach S, Society of Cardiovascular Computed Tomography et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3:122–136 CrossRef
- Shuman WP, Branch KR, May JM et al (2008) Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 248:431–437 CrossRef
- Halliburton SS, Abbara S, Chen MY, Society of Cardiovascular Computed Tomography et al (2011) SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 5:198–224 CrossRef
- Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174 CrossRef
- Nissen SE (2008) Limitations of computed tomography coronary angiography. J Am Coll Cardiol 52:2145–2147 CrossRef
- Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323 CrossRef
- Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284 CrossRef
- Klass O, Jeltsch M, Feuerlein S et al (2009) Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique. Eur Radiol 19:829–836 CrossRef
- Stolzmann P, Leschka S, Scheffel H et al (2008) Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. Radiology 249:71–80 CrossRef
- Wang Y, Zhang Z, Kong L et al (2008) Dual-source CT coronary angiography in patients with atrial fibrillation: comparison with single-source CT. Eur J Radiol 68:434–441 CrossRef
- Weustink AC, Mollet NR, Pugliese F et al (2008) Optimal electrocardiographic pulsing windows and heart rate: effect on image quality and radiation exposure at dual-source coronary CT angiography. Radiology 248:792–798 CrossRef
- Prospectively ECG-triggered sequential dual-source coronary CT angiography in patients with atrial fibrillation: comparison with retrospectively ECG-gated helical CT
Volume 23, Issue 7 , pp 1822-1828
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Dual-source CT
- Coronary arteries
- Image quality
- Radiation dose
- Atrial fibrillation
- Industry Sectors
- Author Affiliations
- 1. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, 100029, Beijing, China
- 2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- 3. Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China