European Radiology

, Volume 23, Issue 11, pp 2927–2933

Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction

  • Wei-Hua Yin
  • Bin Lu
  • Zhi-Hui Hou
  • Nan Li
  • Lei Han
  • Yong-Jian Wu
  • Hong-Xia Niu
  • Justin R. Silverman
  • Carlo Nicola De Cecco
  • U. Joseph Schoepf
Computed Tomography

DOI: 10.1007/s00330-013-2920-0

Cite this article as:
Yin, W., Lu, B., Hou, Z. et al. Eur Radiol (2013) 23: 2927. doi:10.1007/s00330-013-2920-0

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.

Keywords

Coronary computed tomography angiographyHigh-pitch spiral acquisitionIterative reconstructionAccuracyRadiation dose

Abbreviations and acronyms

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

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Wei-Hua Yin
    • 1
    • 3
  • Bin Lu
    • 1
    • 3
  • Zhi-Hui Hou
    • 1
    • 3
  • Nan Li
    • 1
    • 3
  • Lei Han
    • 1
    • 3
  • Yong-Jian Wu
    • 2
  • Hong-Xia Niu
    • 2
  • Justin R. Silverman
    • 1
    • 3
  • Carlo Nicola De Cecco
    • 1
    • 3
  • U. Joseph Schoepf
    • 1
    • 3
  1. 1.Department of RadiologyState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of CardiologyState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  3. 3.Department of Radiology and Radiological Science and Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA