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Image quality and diagnostic value of ultra low-voltage, ultra low-contrast coronary CT angiography

  • Cardiac
  • Published:
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Abstract

Objective

To explore the image quality (IQ) and diagnostic value of 70 kVp turbo high-pitch coronary CT angiography (THP-CCTA) using automated tube voltage selection (ATVS) and 30 mL of low-concentration contrast agent.

Methods

Patients who underwent 70 kVp THP-CCTA using ATVS with 30 mL of contrast agent (group A) were prospectively enrolled, and those who underwent conventional CCTA (100/120 kVp, prospective sequential mode with 65–75 mL of contrast agent) (group B) were retrospectively selected for study. IQ was assessed subjectively on a 5-point scale, and diagnostic value was assessed based on invasive coronary angiography as the gold standard. Heart rate (HR), HR fluctuation (HRF), body mass index (BMI), effective radiation dose (ED), and iodine uptake (IU) were recorded.

Results

A total of 796 patients (398/398 in groups A/B) were included. Between-group differences in age, gender, BMI, HR, HRF, and IQ values were not significant. The ED/IU values were 0.3 ± 0.1 mSv/9.0 ± 0.0 g and 5.8 ± 1.8 mSv/22.9 ± 1.0 g in groups A and B, respectively (p < 0.01). The sensitivity, specificity, positive and negative predictive values, and accuracy of THP-CCTA for the diagnosis of ≥ 50% stenosis were 94.8%, 97.5%, 92.0%, 98.4%, and 96.9% respectively. The mean HR and coronary calcium score were independent predictors of diagnostic image quality, and the best cutoff values were 71.5 bpm and 444.1 respectively.

Conclusion

This third-generation dual-source CT imaging modality, a 70-kVp THP-CCTA system using ATVS with 30 mL of low-concentration contrast agent, produces high-quality images with high diagnostic accuracy for significant stenosis, with ultra low ED and IU. This technique was most promising in individuals with an HR < 71.5 bpm and coronary calcium score < 444.1.

Key Points

• Turbo high-pitch CCTA using 70 kVp via automated tube voltage selection and 30 mL of low-concentration contrast agent is feasible.

• This protocol provides high diagnostic accuracy for significant coronary stenosis and reduces radiation doses and iodine uptake significantly.

• This protocol was most promising in individuals with an HR < 71.5 bpm and coronary calcium score < 444.1.

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Abbreviations

ATVS:

Automated tube voltage selection

AUCs:

Areas under curves

BMI:

Body mass index

DLP:

Dose length product

DSCT:

Dual-source CT

ED:

Effective radiation dose

HR:

Heart rate

HRF:

HR fluctuation

ICA:

Invasive coronary angiography

IQ:

Image quality

IU:

Iodine uptake

ROC:

Receiver operating characteristic

THP-CCTA:

Turbo high-pitch coronary CT angiography

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Acknowledgements

Thanks to BioMed Proofreading LLC for polishing this article.

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The authors state that this work has not received any funding.

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Author notes

  1. Xin-yi Meng contributed equally to this work and should be considered co-first author.

Authors and Affiliations

  1. Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, 222#, Zhong Shan Road, Dalian, 116011, Liaoning, China

    Chong-fu Jia, Xi-xia Sun, Zhi-qiang Yang, Yu-jie Zou, Xiang-yue Wang, Shuang Pan & Zhao-qian Wang

  2. Invasive Technology Department, Qingdao City Chengyang District People’s Hospital, 600#, Chang Cheng Road, Qingdao, 266109, Shandong, China

    Jie Zhong

  3. Radiology Department, Xi’an No. 3 Hospital, 10#, Feng Cheng Road, Xi’an, 710000, Shaanxi, China

    Xin-yi Meng

  4. Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222#, Zhong Shan Road, Dalian, 116011, Liaoning, China

    Da Yin

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  1. Chong-fu Jia
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Correspondence to Zhao-qian Wang.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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• case-control study

• performed at one institution

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Jia, Cf., Zhong, J., Meng, Xy. et al. Image quality and diagnostic value of ultra low-voltage, ultra low-contrast coronary CT angiography. Eur Radiol 29, 3678–3685 (2019). https://doi.org/10.1007/s00330-019-06111-0

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  • DOI: https://doi.org/10.1007/s00330-019-06111-0

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