Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction
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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.
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.
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.
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.
• 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.
- Taylor, AJ, Cerqueira, M, Hodgson, JM (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56: pp. 1864-1894 CrossRef
- Alkadhi, H, Stolzmann, P, Desbiolles, L (2010) Low-dose, 128-slice, dual source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode. Heart 96: pp. 933-938 CrossRef
- Achenbach, S, Goroll, T, Seltmann, M (2011) Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. J Am Coll Cardiol Img 4: pp. 328-337 CrossRef
- Tricarico, F, Hlavacek, AM, Schoepf, UJ (2013) Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques. Eur Radiol 3: pp. 1306-1315 CrossRef
- Renker, M, Nance, JW, Schoepf, UJ (2011) Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction. Radiology 260: pp. 390-399 CrossRef
- Schuhbaeck, A, Achenbach, S, Layritz, C (2013) Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction. Eur Radiol 23: pp. 597-606 CrossRef
- Baek, J, Pelc, NJ (2010) The noise power spectrum in CT with direct fan beam reconstruction. Med Phys 37: pp. 2074-2081 CrossRef
- Renker, M, Ramachandra, A, Schoepf, UJ (2011) Iterative image reconstruction techniques: Applications for cardiac CT. J Cardiovasc Comput Tomogr 5: pp. 225-230 CrossRef
- Winklehner, A, Karlo, C, Puippe, G (2011) Raw data-based iterative reconstruction in body CTA: evaluation of radiation dose saving potential. Eur Radiol 21: pp. 2521-2526 CrossRef
- Boone, J, Strauss, K, Cody, D (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. Report of the American Association of Physicists in Medicine (AAPM) Task Group 204. American Association of Physicists in Medicine, College Park
- Raff, GL, Abidov, A, Achenbach, S (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3: pp. 122-136 CrossRef
- Sun, ML, Lu, B, Wu, RZ (2011) Diagnostic accuracy of dual-source CT coronary angiography with prospective ECG-triggering on different heart rate patients. Eur Radiol 21: pp. 1635-1642 CrossRef
- Rixe, J, Rolf, A, Conradi, G (2008) Image quality on dual-source computed-tomographic coronary angiography. Eur Radiol 18: pp. 1857-1862 CrossRef
- Budoff, MJ, Dowe, D, Jollis, JG (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenoses 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: pp. 1724-1732 CrossRef
- Ebersberger, U, Tricarico, F, Schoepf, UJ (2013) CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction. Eur Radiol 23: pp. 125-132 CrossRef
- Bastarrika, G, Broncano, J, Arraiza, M (2011) Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients. Eur Radiol 21: pp. 1887-94 CrossRef
- Gosling, O, Loader, R, Venables, P (2010) A comparison of radiation doses between state-of-the-art multislice CT coronary angiography with iterative reconstruction, multislice CT coronary angiography with standard filtered back-projection and invasive diagnostic coronary angiography. Heart 96: pp. 922-926 CrossRef
- Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction
Volume 23, Issue 11 , pp 2927-2933
- Cover Date
- Print ISSN
- Online ISSN
- Springer Berlin Heidelberg
- Additional Links
- Coronary computed tomography angiography
- High-pitch spiral acquisition
- Iterative reconstruction
- Radiation dose
- Industry Sectors
- Author 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
- 3. Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
- 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