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Comparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism

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Abstract

Objective To prospectively compare cardiac ventricular measurements from non-gated CT and end-diastolic ECG-gated CT in patients with acute pulmonary embolism (PE). Materials and methods With institutional review board approval, 30 adult patients (16 female, mean age = 56 years, range = 26–77 years) underwent ECG-gated cardiac CT within 36 h of their CT diagnosis of acute PE to assess the right ventricle (RV). The axial and reformatted four-chamber ventricular diameters, areas and volumes were measured for both the non-gated CT and the ECG-gated CT in end-diastole and end-systole. Spearman’s rank correlation coefficient (RCC) was calculated to compare measurements from the non-gated CT to the gated end-diastolic measurements. The median absolute differences between the gated and non-gated measurements relative to the gated measurements were provided to summarize the degree to which the two measurements differ. A statistical model was constructed to test for potential improvement in specificity for the prediction of 30-day mortality after acute PE using right ventricular measurements from ECG-gated CT versus non-gated CT. Results The RCC (0.90 confidence interval) for non-gated and ECG-gated end-diastolic four-chamber and axial RV/LV diameter ratios were 0.83 (0.68–0.90) and 0.88 (0.74–0.95). The median absolute percent differences suggested a high degree of concordance between gated and non-gated measurements. The statistical model predicted that measuring the RV/LV diameter ratio from end-diastole using ECG-gated CT rather than non-gated CT would yield a potential improvement in specificity for death after PE of 0.035 (0.020–0.060) for axial diameter ratios and 0.035 (0.020–0.055) for four-chamber diameter ratios. Conclusion The benefit from a separate ECG-gated CT scan for the evaluation of RV ventricular diameter, area, and volume measurements is minimal and does not justify its routine clinical use.

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Authors and Affiliations

  1. Department of Radiology and Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Michael T. Lu, Hale Ersoy, Amanda G. Whitmore, Noah A. Levit & Frank J. Rybicki

  2. Department of Biostatistics, Harvard University, Boston, MA, USA

    Tianxi Cai

  3. Cardiovascular Division and Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Samuel Z. Goldhaber

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  1. Michael T. Lu
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  2. Tianxi Cai
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  3. Hale Ersoy
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  4. Amanda G. Whitmore
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  5. Noah A. Levit
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  6. Samuel Z. Goldhaber
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  7. Frank J. Rybicki
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Correspondence to Frank J. Rybicki.

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Lu, M.T., Cai, T., Ersoy, H. et al. Comparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism. Int J Cardiovasc Imaging 25, 101–107 (2009). https://doi.org/10.1007/s10554-008-9342-0

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  • DOI: https://doi.org/10.1007/s10554-008-9342-0

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