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Prospectively versus retrospectively ECG-gated 256-slice coronary CT angiography: image quality and radiation dose over expanded heart rates

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Abstract

To compare image quality and radiation dose estimates for coronary computed tomography angiography (CCTA) obtained with a prospectively gated transaxial (PGT) CT technique and a retrospectively gated helical (RGH) CT technique using a 256-slice multidetector CT (MDCT) scanner and establish an upper limit of heart rate to achieve reliable diagnostic image quality using PGT. 200 patients (135 males, 65 females) with suspected coronary artery disease (CAD) underwent CCTA on a 256-slice MDCT scanner. The PGT patients were enrolled prospectively from January to June, 2009. For each PGT patient, we found the paired ones in retrospective-gating patients database and randomly selected one patient in these match cases and built up the RGH group. Image quality for all coronary segments was assessed and compared between the two groups using a 4-point scale (1: non-diagnostic; 4: excellent). Effective radiation doses were also compared. The average heart rate ± standard deviation (HR ± SD) between the two groups was not significantly different (PGT: 64.6 ± 12.9 bpm, range 45–97 bpm; RGH: 66.7 ± 10.9 bpm, range 48–97 bpm, P = 0.22). A receiver-operating characteristic (ROC) analysis determined a cutoff HR of 75 bpm up to which diagnostic image quality could be achieved using the PGT technique (P < 0.001). There were no significant differences in assessable coronary segments between the two groups for HR ≤ 75 bpm (PGT: 99.9% [961 of 962 segments]; RGH: 99.8% [1038 of 1040 segments]; P = 1.0). At HR > 75 bpm, the performance of the PGT technique was affected, resulting in a moderate reduction of percentage assessable coronary segments using this approach (PGT: 95.5% [323 of 338 segments]; RGH: 98.5% [261 of 265 segments]; P = 0.04). The mean estimated effective radiation dose for the PGT group was 3.0 ± 0.7 mSv, representing reduction of 73% compared to that of the RGH group (11.1 ± 1.6 mSv) (P < 0.001). Prospectively-gated axial coronary computed tomography using a 256-slice multidetector CT scanner with a 270 ms tube rotation time enables a significant reduction in effective radiation dose while simultaneously providing image quality comparable to the retrospectively gated helical technique. Our experience demonstrates the applicability of this technique over a wider range of heart rates (up to 75 bpm) than previously reported.

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Acknowledgments

This work was supported by two provincial government funds—Innovative Reaserch Team of Liaoning Educational Committee (LT2010105) and Liaoning Doctoral Science Foundation (20071048).

Conflict of interest

Authors who are not employees of Philips Healthcare (Cleveland, OH, USA) controlled the inclusion of all data and information that might have represented a conflict of interest for the authors who are employees of that company.

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Authors and Affiliations

  1. Department of Radiology, Shengjing Hospital of China, Medical University, 36 Sanhao Street, 110004, Shenyang, Liaoning Province, People’s Republic of China

    Yang Hou, Yong Yue, Wenli Guo, Guoqiang Feng, Tao Yu, Guangwei Li & Qiyong Guo

  2. CT Clinical Science, Philips Healthcare, Cleveland, OH, 44143, USA

    Mani Vembar & Mark E. Olszewski

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  1. Yang Hou
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  2. Yong Yue
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  3. Wenli Guo
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  9. Qiyong Guo
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Correspondence to Qiyong Guo.

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Hou, Y., Yue, Y., Guo, W. et al. 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 (2012). https://doi.org/10.1007/s10554-010-9760-7

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  • DOI: https://doi.org/10.1007/s10554-010-9760-7

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