Skip to main content


Log in

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

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript



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.


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.


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.


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Alkadhi H, Stolzmann P, Desbiolles L et al (2010) 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode. Heart 96:933–938

    Article  PubMed  Google Scholar 

  2. Carrascosa P, Capunay C, Deviggiano A et al (2010) Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate. J Cardiovasc Comput Tomogr 4:197–205

    Article  PubMed  Google Scholar 

  3. Kerl JM, Schoepf UJ, Zwerner PL et al (2011) Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard. Eur Radiol 21:1895–1903

    Article  PubMed  Google Scholar 

  4. Sun ML, Lu B, Wu RZ et al (2011) Diagnostic accuracy of dual-source CT coronary angiography with prospective ECG-triggering on different heart rate patients. Eur Radiol 21:1635–1642

    Article  PubMed  Google Scholar 

  5. Hu XH, Zheng WL, Wang D, Xie SS, Wu R, Zhang SZ (2012) Accuracy of high-pitch prospectively ECG-triggering CT coronary angiography for assessment of stenosis in 103 patients: comparison with invasive coronary angiography. Clin Radiol 67:1083–1088

    Article  CAS  PubMed  Google Scholar 

  6. Zhang C, Zhang Z, Yan Z, Xu L, Yu W, Wang R (2011) 320-row CT coronary angiography: effect of 100-kV tube voltages on image quality, contrast volume, and radiation dose. Int J Cardiovasc Imaging 27:1059–1068

    Article  PubMed  Google Scholar 

  7. Hou Y, Yue Y, Guo W et al (2012) Prospectively versus retrospectively ECG-gated 256-slice coronary CT angiography: image quality and radiation dose over expanded heart rates. Int J Cardiovasc Imaging 28:153–162

    Article  PubMed  Google Scholar 

  8. Zhao L, Zhang Z, Fan Z, Yang L, Du J (2011) Prospective versus retrospective ECG gating for dual source CT of the coronary stent: comparison of image quality, accuracy, and radiation dose. Eur J Radiol 77:436–442

    Article  PubMed  Google Scholar 

  9. Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875

    Article  PubMed  Google Scholar 

  10. Leipsic J, Labounty TM, Heilbron B et al (2010) Adaptive statistical iterative reconstruction: assessment of image noise and image quality in coronary CT angiography. AJR Am J Roentgenol 195:649–654

    Article  PubMed  Google Scholar 

  11. Bittencourt MS, Schmidt B, Seltmann M et al (2011) Iterative reconstruction in image space (IRIS) in cardiac computed tomography: initial experience. Int J Cardiovasc Imaging 27:1081–1087

    Article  PubMed  Google Scholar 

  12. Hou Y, Liu X, Xv S, Guo WL, Guo QY (2012) Comparisons of image quality and radiation dose between iterative reconstruction and filtered back projection reconstruction algorithms in 256-slice MDCT coronary angiography. AJR Am J Roentgenol 199:1–7

    Article  Google Scholar 

  13. Leipsic J, Labounty TM, Heilbron B et al (2010) Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. AJR Am J Roentgenol 195:655–660

    Article  PubMed  Google Scholar 

  14. Park EA, Lee W, Kim KW et al (2012) Iterative reconstruction of dual-source coronary CT angiography: assessment of image quality and radiation dose. Int J Cardiovasc Imaging 28:1775–1786

    Article  PubMed  Google Scholar 

  15. Wang R, Schoepf UJ, Wu R et al (2012) Image quality and radiation dose of low dose coronary CT angiography in obese patients: Sinogram affirmed iterative reconstruction versus filtered back projection. Eur J Radiol 81:3141–3145

    Article  PubMed  Google Scholar 

  16. Funama Y, Taguchi K, Utsunomiya D et al (2011) Combination of a low-tube-voltage technique with hybrid iterative reconstruction (iDose) algorithm at coronary computed tomographic angiography. J Comput Assist Tomogr 35:480–485

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hou Y, Xv S, Guo WL, Vembar M, Guo QY (2012) The optimal dose reduction level using iterative reconstruction with prospective ECG-triggered coronary CTA using 256-slice MDCT. Eur J Radiol 81:3905–3911

    Article  PubMed  Google Scholar 

  18. Moscariello A, Takx RA, Schoepf UJ et al (2011) Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection. Eur Radiol 21:2130–2138

    Article  PubMed  Google Scholar 

  19. Noël PB, Fingerle AA, Renger B et al (2011) Initial performance characterization of a clinical noise-suppressing reconstruction algorithm for MDCT. AJR Am J Roentgenol 197:1404–1409

    Article  PubMed  Google Scholar 

  20. Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc committee for grading of coronary artery disease, council on cardiovascular surgery, American Heart Association. Circulation 51:5–40

    Article  CAS  PubMed  Google Scholar 

  21. McCollough C, Cody D, Edyvean S et al (2008) The measurement, reporting, and management of radiation dose in CT. Tech. Rep. 96 2008. American Association of Physicists in Medicine, College Park MD, USA

    Google Scholar 

  22. Earls JP, Berman EL, Urban BA et al (2008) Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology 246:742–753

    Article  PubMed  Google Scholar 

  23. Husmann L, Valenta I, Gaemperli O et al (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197

    Article  PubMed  Google Scholar 

  24. Klass O, Walker M, Siebach A et al (2010) Prospectively gated axial CT coronary angiography: comparison of image quality and effective radiation dose between 64- and 256-slice CT. Eur Radiol 20:1124–1131

    Article  PubMed  Google Scholar 

  25. Hara AK, Paden RG, Silva AC, Kujak JL, Lawder HJ, Pavlicek W (2009) Iterative reconstruction technique for reducing body radiation dose at CT: feasibility study. AJR Am J Roentgenol 193:764–771

    Article  PubMed  Google Scholar 

  26. Sun Z, Ng KH (2012) Prospective versus retrospective ECG-gated multislice CT coronary angiography: a systematic review of radiation dose and diagnostic accuracy. Eur J Radiol 81:e94–e100

    Article  PubMed  Google Scholar 

  27. Park MJ, Jung JI, Choi YS et al (2011) Coronary CT angiography in patients with high calcium score: evaluation of plaque characteristics and diagnostic accuracy. Int J Cardiovasc Imaging 27:43–51

    Article  PubMed  Google Scholar 

  28. Meng L, Cui L, Cheng Y et al (2009) Effect of heart rate and coronary calcification on the diagnostic accuracy of the dual-source CT coronary angiography in patients with suspected coronary artery disease. Korean J Radiol 10:347–354

    Article  PubMed Central  PubMed  Google Scholar 

  29. Scheffel H, Stolzmann P, Schlett CL et al (2012) Coronary artery plaques: cardiac CT with model-based and adaptive-statistical iterative reconstruction technique. Eur J Radiol 81:e363–e369

    Article  PubMed  Google Scholar 

  30. Renker M, Nance JW Jr, Schoepf UJ et al (2011) Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction. Radiology 260:390–399

    Article  PubMed  Google Scholar 

Download references


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

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yang Hou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: