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Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease

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Abstract

Objectives

To evaluate the accuracy of low-dose coronary CTA with iterative reconstruction (IR) in the diagnosis of coronary artery disease (CAD) in patients with suspected CAD.

Methods

Ninety-six patients with suspected CAD underwent low-dose prospective electrocardiogram-gated coronary CTA, with images reconstructed using IR. Image quality (IQ) of coronary segments were graded on a 4-point scale (4, excellent; 1, non-diagnostic). With invasive coronary angiography (ICA) considered the “gold standard”, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of coronary CTA were calculated on segment-, vessel- and patient-based levels. The patient data were divided into two groups (Agatston scores of ≥ 400 and <400). The differences in diagnostic performance between the two groups were tested.

Results

Diagnostic image quality was found in 98.1 % (1,232/1,256) of segments. The sensitivity, specificity, PPV, NPV and accuracy were 90.8 %, 95.3 %, 81.8 %, 97.8 % and 94.3 % (segment-based) and 97.2 %, 83.3 %, 94.6 %, 90.9 % and 93.8 % (patient-based). Significant differences between the two groups were seen in specificity, PPV and accuracy (92.1 % vs. 97.9 %, 76.0 % vs. 86.7 %, 91.7 % vs. 96.6 %, P < 0.05; segment-based). The average effective dose was 1.30 ± 0.15 mSv.

Conclusion

Low-dose prospective coronary CTA with IR can acquire satisfactory image quality and show high diagnostic accuracy in patients with suspected CAD; however, blooming continues to pose a challenge in severely calcified segments.

Key Points

• Coronary artery disease (CAD) is increasingly investigated using coronary CTA.

• The iterative reconstruction (IR) algorithm is promising in decreasing radiation doses.

• Low-dose prospective coronary CTA with IR can acquire satisfactory image quality.

• Low-dose prospective coronary CTA with IR can show high diagnostic accuracy.

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Acknowledgements

The work presented was supported by government funding through the Shenyang Science and Technology Research Program (F12-193-9-35).

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Correspondence to Yang Hou.

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Hou, Y., Ma, Y., Fan, W. et al. Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease. Eur Radiol 24, 3–11 (2014). https://doi.org/10.1007/s00330-013-2969-9

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  • DOI: https://doi.org/10.1007/s00330-013-2969-9

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