European Radiology

, Volume 23, Issue 11, pp 2927–2933 | Cite as

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



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.

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.


Coronary 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


Confidence interval


CT volume dose index


Dose-length product




Effective dose


Filtered back projection


Left anterior descending coronary artery


Left circumflex coronary artery


Left main coronary artery


Receiver-operating characteristics


Right coronary artery


Region of interest


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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

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