Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle: a preliminary study

Liang, Jing; Wang, H.; Xu, Li; Yang, Lin; Dong, Linggen; Fan, Zhanming; Wang, Renxi; Sun, Zhonghua

doi:10.1016/j.crad.2017.03.004

Cited by 30 publications

(18 citation statements)

References 31 publications

(42 reference statements)

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“…Prospective ECG-triggered sequential scanning is one of the most effective dose-saving strategies (28–31) but has been limited to heart rates <60–65 bpm (32–34). With the newest high-end scanners, prospective ECG-triggering can be used in heart rates up to 75 bpm (35,36) or higher (37). Thus, a greater proportion of the HTX population could benefit from this dose-reducing approach.…”

Section: Discussionmentioning

confidence: 99%

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

et al. 2017

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Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population.

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Section: Discussionmentioning

confidence: 99%

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

et al. 2017

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“…Coronary computed tomography angiography (CCTA) is the first-line diagnostic imaging method for children with coronary artery diseases (1)(2)(3), such as those of abnormal origin (4) and coronary aneurysm (5). Reducing radiation and contrast medium doses while providing acceptable image quality (6,7), eliminating motion artifacts (8,9), and maintaining fast and easy operation remains the research focuses. In recent years, through the application of faster gantry rotation and motion correction algorithms such as the Snapshot Freeze (SSF) and wide-detector coverage for the single-beat cardiac scan technique and other technologies, CCTA image quality has been significantly improved.…”

Section: Introductionmentioning

confidence: 99%

Performance evaluation of using shorter contrast injection and 70 kVp with deep learning image reconstruction for reduced contrast medium dose and radiation dose in coronary CT angiography for children: a pilot study

Sun¹,

Li²,

Li³

et al. 2021

Quant Imaging Med Surg

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Background: Iterative reconstruction algorithms are often used to reduce image noise in low-dose coronary computed tomography angiography (CCTA) but encounter limitations. The newly introduced deep learning image reconstruction (DLIR) algorithm may provide new opportunities. We assessed the image quality and diagnostic performance of DLIR in low radiation dose and contrast medium dose CCTA of pediatric patients with 70 kVp and a shortened injection protocol.Methods: This was a prospective study. A total of 27 consecutive arrhythmic pediatric patients were enrolled in the study group and underwent CCTA using a prospective ECG-triggered single-beat protocol: tube voltage 70 kVp, automatic tube current modulation for a noise index (NI) of 22, and contrast dose of 0.4-0.6 mL/kg. Images were reconstructed with DLIR. They were compared with 27 matched patients in the control group scanned with 80 kVp, a lower NI setting (NI =19), and a higher contrast dose (0.8-1.2 mL/kg).The images in the control group were reconstructed using the adaptive statistical iterative reconstruction (ASIR-V) algorithm. The image contrast, image quality, and diagnostic confidence were assessed by 2 experienced radiologists using a 5-point scale (1: nondiagnostic and 5: excellent). The CT value and standard deviation of the aorta and perivascular tissue were measured, and the contrast-to-noise ratio (CNR) for the aorta was calculated. The contrast medium and radiation doses were compared. Results: The study and control groups had similar image contrast scores (4.75±0.57 vs. 4.78±0.42), image quality scores (3.67±0.47 vs. 3.44±0.51), and diagnostic confidence (4.74±0.44 vs. 4.74±0.45) (all P>0.05). There was an adequate enhancement in the aorta (614.74±127.73 vs. 705.89±111.20 HU) and similar CNR (20.34±4.64 vs. 20.99±4.14) in both groups. The image noise of the study group was lower in the aorta (30.61±3.88 vs. 34.77±3.49) and similar in perivascular tissue (27.66±6.24 vs. 27.55±3.33) compared with the control group. The study group reduced the total contrast medium dose by 53% to 15.07±3.68 ml and radiation dose by 36% to 0.57±0.31 mSv. Conclusions:The DLIR algorithm in CCTA for children using 70 kVp tube voltage with a shortened contrast medium injection protocol maintains image quality and diagnostic confidence while significantly reducing contrast medium dose and radiation dose compared with the use of the conventional CCTA protocol.

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“…These include new iterations of dual‐source technology, as well as other technical improvements such as increased detector coverage and faster gantry rotation speeds. Proprietary software algorithms have also been designed to reduce effects from cardiovascular motion (Snapshot Freeze (GE Healthcare) 4 , 5 , Adaptive Motion Correction (Canon Medical)) 6 . It remains unclear if their implementation has achieved the desired improvement in terms of the diagnostic accuracy of prospectively gated CTCA at high heart rates.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of prospectively gated, 128‐slice or greater CTCA at high heart rates: a systematic review and meta‐analysis

Mander

Dobeli

Steffensen

et al. 2021

J of Medical Radiation Sci

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Introduction: Prospectively gated 64-slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128-slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm. Methods: A systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full-text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS-2 tool. Results: Ten studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta-analysis, including six of which reported data at the patient level. Meta-analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88). Conclusions: Prospectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128-slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.

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Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle: a preliminary study

Abstract: CCTA using a 256-detector row CT with the snapshot freeze (SSF) technique can be performed in a single cardiac cycle with acquisition of images with high diagnostic value and low radiation dose in patients with high heart rates.

Cited by 30 publications

References 31 publications

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

Performance evaluation of using shorter contrast injection and 70 kVp with deep learning image reconstruction for reduced contrast medium dose and radiation dose in coronary CT angiography for children: a pilot study

Diagnostic accuracy of prospectively gated, 128‐slice or greater CTCA at high heart rates: a systematic review and meta‐analysis

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