European Radiology

, Volume 27, Issue 6, pp 2298–2308 | Cite as

Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population

  • Stefanie Mangold
  • Julian L. Wichmann
  • U. Joseph SchoepfEmail author
  • Damiano Caruso
  • Christian Tesche
  • Daniel H. Steinberg
  • Akos Varga-Szemes
  • Andrew C. Stubenrauch
  • Richard R. BayerII
  • Matthew Biancalana
  • Konstantin Nikolaou
  • Carlo N. De Cecco



To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients.


We retrospectively analyzed 76 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography. Prospectively ECG-triggered acquisition was performed with automated tube voltage selection (ATVS). Patients were dichotomized based on body mass index in groups A (<30 kg/m2, n = 37) and B (≥30 kg/m2, n = 39) and based on tube voltage in groups C (<120 kV, n = 46) and D (120 kV, n = 30). Coronary arteries were assessed for significant stenoses (≥50 % luminal narrowing) and diagnostic accuracy was calculated.


Per-patient overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 96.9 %, 95.5 %, 93.9 %, 97.7 % and 96.1 %, respectively. Sensitivity and NPV were lower in groups B and D compared to groups A and C, but no statistically significant differences were observed (group A vs. B: sensitivity, 100.0 % vs. 93.3 %, p = 0.9493; NPV, 100 % vs. 95.5 %, p = 0.9812; group C vs. D: sensitivity, 100.0 % vs. 92.3 %, p = 0.8462; NPV, 100.0 % vs. 94.1 %, p = 0.8285).


CCTA using 3rd-generation DSCT and (ATVS) provides high diagnostic accuracy in both non-obese and obese patients.

Key Points

Coronary CTA provides high diagnostic accuracy in non-obese and obese patients.

Diagnostic accuracy between obese and non-obese patients showed no significant difference.

<120 kV studies were performed in 44 % of obese patients.

Current radiation dose-saving approaches can be applied independent of body habitus.


Coronary CT angiography Dual-source CT Automated tube voltage selection Diagnostic accuracy Obesity 



Coronary CT angiography


Invasive coronary angiography


Coronary artery disease


Positive predictive value


Dual-source CT


Automated tube voltage selection


Body-mass index


Region of interest


Hounsfield unit


Left main


Left anterior descending


Circumflex artery


Right coronary artery


Standard deviation


Signal-to-noise ratio


Contrast-to-noise ratio


Volume CT dose index


Dose-length product


Effective dose


Size-specific dose estimates


Negative predictive value



The scientific guarantor of this publication is Prof. Dr. U. Joseph Schoepf.

The authors of this manuscript declare relationships with the following companies: Dr. Schoepf is a consultant for and receives research support from Astellas, Bayer, Bracco, GE, Medrad, and Siemens. Mr. Canstein is a Siemens employee. The other authors have no conflicts of interest to disclose.

The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained.

Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, cross sectional study, performed at one institution.

Supplementary material

330_2016_4601_MOESM1_ESM.docx (12 kb)
Supplementary Table 1 (DOCX 12 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Stefanie Mangold
    • 1
    • 2
  • Julian L. Wichmann
    • 1
    • 3
  • U. Joseph Schoepf
    • 1
    • 4
    Email author
  • Damiano Caruso
    • 1
    • 5
  • Christian Tesche
    • 1
    • 6
  • Daniel H. Steinberg
    • 4
  • Akos Varga-Szemes
    • 1
  • Andrew C. Stubenrauch
    • 1
  • Richard R. BayerII
    • 4
  • Matthew Biancalana
    • 1
  • Konstantin Nikolaou
    • 2
  • Carlo N. De Cecco
    • 1
  1. 1.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Diagnostic and Interventional RadiologyEberhard-Karls University TuebingenTuebingenGermany
  3. 3.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  4. 4.Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  5. 5.Department of Radiological Sciences, Oncology and PathologyUniversity of Rome “Sapienza”RomeItaly
  6. 6.Department of CardiologyHeart Centre Munich-BogenhausenMunichGermany

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