Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction
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.
KeywordsCoronary computed tomography angiography High-pitch spiral acquisition Iterative reconstruction Accuracy Radiation dose
Abbreviations and acronyms
Body mass index
Coronary artery disease
Catheter coronary angiography
Coronary computed tomography angiography
CT volume dose index
Filtered back projection
Left anterior descending coronary artery
Left circumflex coronary artery
Left main coronary artery
Right coronary artery
Region of interest
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