Abstract
Purpose
We compared stair-step artifacts and radiation dose between prospective electrocardiography (ECG)-gated coronary computed tomography angiography (prospective CCTA) and retrospective CCTA using 64-detector CT and determined the optimal padding time (PT) for prospective CCTA.
Materials and methods
We retrospectively evaluated 183 patients [mean heart rate (HR) <65 beats/min, maximum HR instability <5 beats/min] who had undergone CCTA. We scored stair-step artifacts from 1 (severe) to 5 (none) and evaluated the effective dose in 53 patients with retrospective CCTA and 130 with prospective CCTA (PT 200 ms, n = 32; PT 50 ms, n = 98).
Results
Mean artifact scores were 4.3 in both retrospective and prospective CCTAs. However, statistically more arteries scored <3 (nonassessable) on prospective CCTA (P < 0.001). Mean scores for prospective CCTA with 200- and 50-ms PT were 4.1 and 4.3, respectively (no significant difference). The radiation dose of prospective CCTA was reduced by 59.1% to 80.7%.
Conclusion
Prospective CCTA reduces the radiation dose and allows diagnostic imaging in most cases but shows more nonevaluable artifacts than retrospective CCTA. Use of 50-ms instead of 200-ms PT appears to maintain image quality in patients with a mean HR < 65 beats/min and HR instability of <5 beats/min.
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References
Hsieh J, Londt J, Vass M, Li J, Tang X, Okerlund D. Stepand-shoot data acquisition and reconstruction for cardiac X-ray computed tomography. Med Phys 2006;33:4236–4248.
Shuman WP, Branch KR, May JM, Mitsumori LM, Lockhart DW, Dubinsky TJ, et al. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 2008;248:431–437.
Hirai N, Horiguchi J, Fujioka C, Kiguchi M, Yamamoto H, Matsuura N, et al. Prospective versus retrospective ECGgated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology 2008;248:424–430.
Gopal A, Mao SS, Karlsberg D, Young E, Waggoner J, Ahmadi N, et al. Radiation reduction with prospective ECGtriggering acquisition using 64-multidetector computed tomographic angiography. Int J Cardiovasc Imaging 2009;25:405–416.
Maruyama T, Takada M, Hasuike T, Yoshikawa A, Namimatsu E, Yoshizumi T. Radiation dose and coronary assessability of prospective electrocardiogram-gated computed tomography coronary angiography: comparison with retrospective electrocardiogram-gated helical scan. J Am Coll Cardiol 2008;52:1450–1455.
Kroft LJ, de Roos A, Geleijns J. Artifacts in ECG-synchronized MDCT coronary angiography. AJR Am J Roentgenol 2007;189:581–591.
Dewey M, Laule M, Krug L, Schnapauff D, Rogalla P, Rutsch W, et al. Multisegment and halfscan reconstruction of 16-slice computed tomography for detection of coronary artery stenoses. Invest Radiol 2004;39:223–229.
Dewey M, Teige F, Laule M, Hamm B. Influence of heart rate on diagnostic accuracy and image quality of 16-slice CT coronary angiography: comparison of multisegment and halfscan reconstruction approaches. Eur Radiol 2007;17:2829–2837.
Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. 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 1975;51(suppl):5–40.
International Commission on Radiological Protection (ICRP). The 2007 Recommendations of the International Commission on Radiological Protection (publication 103). Ann ICRP 2007;37:1–332.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37–46.
Choi HS, Choi BW, Choe KO, Choi D, Yoo KJ, Kimet MI, et al. Pitfalls, artifacts, and remedies in multi-detector row CT coronary angiography. Radiographics 2004;24:787–800.
Husmann L, Herzog BA, Burkhard N, Tatsugami F, Valenta I, Gaemperli O, et al. Body physique and heart rate variability determine the occurrence of stair-step artefacts in 64-slice CT coronary angiography with prospective ECG-triggering. Eur Radiol 2009;19:1698–1703.
Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 2008;24:535–546.
Choi SI, George RT, Schuleri KH, Chun EJ, Lima JA, Lardo AC. Recent developments in wide-detector cardiac computed tomography. Int J Cardiovasc Imaging 2009;25(suppl 1):23–9.
Herzog BA, Husmann L, Burkhard N, Valenta I, Gaemperli O, Tatsugami F, et al. Low-dose CT coronary angiography using prospective ECG-triggering: impact of mean heart rate and heart rate variability on image quality. Acad Radiol 2009;16:15–21.
Abada HT, Larchez C, Daoud B, Sigal-Cinqualbre A, Paul JF. MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose. AJR Am J Roentgenol 2006;186:S387–S390.
Cademartiri F, Mollet NR, Runza G, Baks T, Midiri M, McFadden EP, et al. Improving diagnostic accuracy of MDCT coronary angiography in patients with mild heart rhythm irregularities using ECG editing. AJR Am J Roentgenol 2006;186:634–638.
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Kimura, F., Umezawa, T., Asano, T. et al. Coronary computed tomography angiography using prospective electrocardiography-gated axial scans with 64-detector computed tomography: evaluation of stair-step artifacts and padding time. Jpn J Radiol 28, 437–445 (2010). https://doi.org/10.1007/s11604-010-0448-7
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DOI: https://doi.org/10.1007/s11604-010-0448-7