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Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT

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Abstract

Background

The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a ‘real-life’ clinical setting.

Methods

Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA.

Results

SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts.

Conclusion

SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.

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Abbreviations

DSCT:

Dual-source CT

HR:

Heart rates

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Marco M. Ochs, Fabian aus dem Siepen, Thomas Fritz, Florian Andre, Sebastian Seitz, Matthias G. W. Friedrich, Hugo A. Katus & Sebastian J. Buss

  2. Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany

    Yuriy Bogomazov, Roman Sokiranski, Andre Sommer, Friedemann Gückel, Matthias Brado, Johannes Görich & Sebastian J. Buss

  3. Department of Cardiology, Angiology and Pneumology, GRN Hospital Weinheim, Röntgenstr. 1, 69469, Weinheim, Germany

    Grigorios Korosoglou

  4. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69198, Heidelberg, Germany

    Christopher L. Schlett & Hans-Ulrich Kauczor

  5. Department of Cardiology and Angiology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    Gitsios Gitsioudis

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  1. Marco M. Ochs
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  2. Fabian aus dem Siepen
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Correspondence to Marco M. Ochs.

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Ochs, M.M., Siepen, F.a.d., Fritz, T. et al. Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT. Clin Res Cardiol 106, 485–492 (2017). https://doi.org/10.1007/s00392-017-1077-2

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