Abstract
Purpose
To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients.
Methods
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.
Results
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).
Conclusion
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.
Similar content being viewed by others
Abbreviations
- CCTA:
-
Coronary CT angiography
- ICA:
-
Invasive coronary angiography
- CAD:
-
Coronary artery disease
- PPV:
-
Positive predictive value
- DSCT:
-
Dual-source CT
- ATVS:
-
Automated tube voltage selection
- BMI:
-
Body-mass index
- ROI:
-
Region of interest
- HU:
-
Hounsfield unit
- LM:
-
Left main
- LAD:
-
Left anterior descending
- CX:
-
Circumflex artery
- RCA:
-
Right coronary artery
- SD:
-
Standard deviation
- SNR:
-
Signal-to-noise ratio
- CNR:
-
Contrast-to-noise ratio
- CTDIvol :
-
Volume CT dose index
- DLP:
-
Dose-length product
- ED:
-
Effective dose
- SSDE:
-
Size-specific dose estimates
- NPV:
-
Negative predictive value
References
Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791
Stein PD, Beemath A, Kayali F, Skaf E, Sanchez J, Olson RE (2006) Multidetector computed tomography for the diagnosis of coronary artery disease: a systematic review. Am J Med 119:203–216
Menke J, Unterberg-Buchwald C, Staab W, Sohns JM, Seif Amir Hosseini A, Schwarz A (2013) Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: meta-analysis of diagnostic accuracy, image quality, and radiation dose. Am Heart J 165:154–163, e3
Layritz C, Schmid J, Achenbach S et al (2014) Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. Eur Heart J Cardiovasc Imaging 15:1238–1245
Stehli J, Fuchs TA, Bull S et al (2014) Accuracy of coronary CT angiography using a submillisievert fraction of radiation exposure: comparison with invasive coronary angiography. J Am Coll Cardiol 64:772–780
Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557
Meinel FG, Canstein C, Schoepf UJ et al (2014) Image quality and radiation dose of low tube voltage 3rd generation dual-source coronary CT angiography in obese patients: a phantom study. Eur Radiol 24:1643–1650
Geyer LL, Glenn GR, De Cecco CN et al (2015) CT evaluation of small-diameter coronary artery stents: effect of an integrated circuit detector with iterative reconstruction. Radiology 273:706–714
Hell MM, Bittner D, Schuhbaeck A et al (2014) Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. J Cardiovasc Comput Tomogr 8:418–425
Geyer LL, Schoepf UJ, Meinel FG et al (2015) State of the art: iterative CT reconstruction techniques. Radiology 276:339–357
Winklehner A, Gordic S, Lauk E et al (2015) Automated attenuation-based tube voltage selection for body CTA: performance evaluation of 192-slice dual-source CT. Eur Radiol 25:2346–2353
Goetti R, Winklehner A, Gordic S et al (2012) Automated attenuation-based kilovoltage selection: preliminary observations in patients after endovascular aneurysm repair of the abdominal aorta. AJR Am J Roentgenol 199:W380–W385
Layritz C, Muschiol G, Flohr T et al (2013) Automated attenuation-based selection of tube voltage and tube current for coronary CT angiography: reduction of radiation exposure versus a BMI-based strategy with an expert investigator. J Cardiovasc Comput Tomogr 7:303–310
Lurz M, Lell MM, Wuest W et al (2015) Automated tube voltage selection in thoracoabdominal computed tomography at high pitch using a third-generation dual-source scanner: image quality and radiation dose performance. Investig Radiol 50:352–360
Krazinski AW, Meinel FG, Schoepf UJ et al (2014) Reduced radiation dose and improved image quality at cardiovascular CT angiography by automated attenuation-based tube voltage selection: intra-individual comparison. Eur Radiol 24:2677–2684
Spearman JV, Schoepf UJ, Rottenkolber M et al (2015) Effect of automated attenuation-based tube voltage selection on radiation dose at CT: an observational study on a global scale. Radiology 279:167–174
Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358
Alkadhi H, Stolzmann P, Scheffel H et al (2008) Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters. Eur J Radiol 68:385–391
Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–266
Christner JA, Braun NN, Jacobsen MC, Carter RE, Kofler JM, McCollough CH (2012) Size-specific dose estimates for adult patients at CT of the torso. Radiology 265:841–847
Boone JM SK, Cody DD, McCollough CH, McNitt-Gray MF, Toth TL (2011) Size-specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. Report of Am Assoc Phys Med AAPM Task Group 204. American Association of Physicists in Medicine, College Park
Fine JJ, Hopkins CB, Ruff N, Newton FC (2006) Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease. Am J Cardiol 97:173–174
Ropers D, Rixe J, Anders K et al (2006) Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348
Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323
Gordic S, Desbiolles L, Stolzmann P et al (2014) Advanced modelled iterative reconstruction for abdominal CT: qualitative and quantitative evaluation. Clin Radiol 69:e497–e504
Solomon J, Mileto A, Ramirez-Giraldo JC, Samei E (2015) Diagnostic performance of an advanced modeled iterative reconstruction algorithm for low-contrast detectability with a third-generation dual-source multidetector ct scanner: potential for radiation dose reduction in a multireader study. Radiology 275:735–745
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
Oda S, Weissman G, Vembar M, Weigold WG (2014) Iterative model reconstruction: improved image quality of low-tube-voltage prospective ECG-gated coronary CT angiography images at 256-slice CT. Eur J Radiol 83:1408–1415
Renker M, Ramachandra A, Schoepf UJ et al (2011) Iterative image reconstruction techniques: applications for cardiac CT. J Cardiovasc Comput Tomogr 5:225–230
Brodoefel H, Tsiflikas I, Burgstahler C et al (2008) Cardiac dual-source computed tomography: effect of body mass index on image quality and diagnostic accuracy. Investig Radiol 43:712–718
Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382
Schuhbaeck A, Achenbach S, Layritz C et al (2013) Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction. Eur Radiol 23:597–606
Sun G, Hou YB, Zhang B et al (2015) Application of low tube voltage coronary CT angiography with low-dose iodine contrast agent in patients with a BMI of 26-30 kg/m2. Clin Radiol 70:138–145
Zhang LJ, Qi L, Wang J et al (2014) Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol 24:1537–1546
Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Table 1
(DOCX 12 kb)
Rights and permissions
About this article
Cite this article
Mangold, S., Wichmann, J.L., Schoepf, U.J. et al. 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. Eur Radiol 27, 2298–2308 (2017). https://doi.org/10.1007/s00330-016-4601-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-016-4601-2