European Radiology

, Volume 29, Issue 5, pp 2218–2225 | Cite as

Clinical feasibility of catheter-directed selective intracoronary computed tomography angiography using an extremely low dose of iodine in patients with coronary artery disease

  • Youngtaek Hong
  • Hyung-Bok Park
  • Byoung Kwon Lee
  • Seongmin Ha
  • Yeonggul Jang
  • Byunghwan Jeon
  • Sunghee Jung
  • Hackjoon Shim
  • Yang Soo Jang
  • Hyuk-Jae ChangEmail author
Computed Tomography



This study aimed to evaluate the clinical feasibility of catheter-directed selective computed tomography angiography (S-CTA) in patients with coronary artery disease (CAD).


We prospectively enrolled 65 patients diagnosed with CAD who underwent conventional computed tomography angiography (C-CTA). C-CTA was performed with 60–90 mL of contrast medium (370 mg iodine/mL), whereas S-CTA was performed with 15 mL of contrast medium and 17.19 mg iodine/mL. Luminal enhancement range, homogeneity of luminal enhancement, image quality, plaque volume (PV), and percent aggregate plaque volume (%APV) were measured. Paired Student’s t test, Wilcoxon rank-sum test, and Pearson’s correlation coefficient were used to compare two methods.


Luminal enhancement was significantly higher on S-CTA than on C-CTA (324.4 ± 8.0 Hounsfield unit (HU) vs. 312.0 ± 8.0 HU, p < 0.0001 in the per-vessel analysis). Transluminal attenuation gradient showed a significantly slower reduction pattern on S-CTA than on C-CTA (-0.65 HU/10 mm vs. -0.89 HU/10 mm, p < 0.0001 in the per-vessel analysis). Image noise was significantly lower on S-CTA than on C-CTA (39.6 ± 10.0 HU vs. 43.9 ± 9.4 HU, p < 0.0001). There was excellent correlation between S-CTA and C-CTA with respect to PV and %APV (r = 0.99, r = 0.98, respectively).


S-CTA might be useful in facilitating atherosclerotic plaque analysis and providing guidance for complex lesions such as chronic total occlusion, particularly in cases in which on-site procedure planning is required.

Key Points

Selective computed tomography angiography (S-CTA) can serve as an intraprocedural computed tomography angiography protocol.

• S-CTA was performed with low dose of iodine compared with conventional computed tomography angiography.

• S-CTA enables on-site atherosclerotic plaque analysis.


Coronary arteries Coronary angiography Contrast media Cardiac imaging technique Atherosclerotic plaque 



Aggregated plaque volume


Coronary artery disease


Conventional computed tomography angiography


Computational fluid dynamics


Contrast-to-noise ratio


Computed tomography angiography


Chronic total occlusion


Fractional flow reserve


Hounsfield unit


Invasive coronary angiography


Intravascular ultrasound


Plaque volume


Region of interest


Selective computed tomography angiography


Signal-to-noise ratio


Transluminal attenuation gradient



This research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP) (No. 2012027176).

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Chang Hyuk-Jae.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

Dr. Sung Ji-Min kindly provided statistical advice for this manuscript.

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Experimental

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Youngtaek Hong
    • 1
  • Hyung-Bok Park
    • 2
  • Byoung Kwon Lee
    • 3
  • Seongmin Ha
    • 4
  • Yeonggul Jang
    • 1
  • Byunghwan Jeon
    • 1
  • Sunghee Jung
    • 1
  • Hackjoon Shim
    • 5
  • Yang Soo Jang
    • 6
  • Hyuk-Jae Chang
    • 6
    • 7
    Email author
  1. 1.Brain Korea 21 Project for Medical ScienceYonsei UniversitySeoulSouth Korea
  2. 2.Division of Cardiology, Department of Internal Medicine, International St. Mary’s HospitalCatholic Kwandong University College of MedicineGangneungSouth Korea
  3. 3.Division of Cardiology, Department of Internal Medicine, Heart Center, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  4. 4.Graduate School of Biomedical EngineeringYonsei University College of MedicineSeoulSouth Korea
  5. 5.Cardiovascular Research InstituteYonsei University College of MedicineSeoulSouth Korea
  6. 6.Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulSouth Korea
  7. 7.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulSouth Korea

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