Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose<sup>1</sup>

Stolzmann, Paul; Leschka, Sebastian; Scheffel, Hans; Krauß, Tobias; Desbiolles, Lotus; Plass, André; Genoni, Michele; Flohr, Thomas; Wildermuth, Simon; Marinček, Borut; Alkadhi, Hatem

doi:10.1148/radiol.2483072032

Cited by 245 publications

(202 citation statements)

References 33 publications

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“…This limitation could be overcome by more extensive implementation of dose-saving algorithms, which are likely to result in substantial dose reduction to \3 mSv, without degradation of image quality. 30,31 CONCLUSION A strong positive relationship exists between FRS and the prevalence and extent atherosclerosis on CACS and MSCT coronary angiography. Both techniques showed a high prevalence of normal coronary arteries in low FRS patients versus a low prevalence in high FRS patients.…”

Section: Discussionmentioning

confidence: 94%

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

Nucifora

Schuijf

Werkhoven

et al. 2009

Journal of Nuclear Cardiology

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Background. Non-invasive assessment of subclinical atherosclerosis by means of coronary artery calcium scoring (CACS) and multi-slice computed tomography (MSCT) coronary angiography could improve patients' risk stratification. However, data relating observations on CACS and MSCT coronary angiography to traditional risk assessment are scarce.Methods and Results. In 314 consecutive outpatients (54 ± 13 years, 56% males) without known CAD, CACS and 64-slice MSCT coronary angiography were performed. According to the Framingham risk score (FRS), 51% of patients were at low, 24% at intermediate and 25% at high risk, respectively. MSCT angiograms showing atherosclerosis were classified as showing obstructive ( ‡50% luminal narrowing) CAD or not. Both CACS and MSCT coronary angiography showed a high prevalence of normal coronary arteries in low FRS patients (70% and 61%, respectively). An increase in the prevalence of CACS >400 (4% low vs 19% intermediate vs 36% high), CAD (39% low vs 79% intermediate vs 91% high), and obstructive CAD (15% low vs 43% intermediate vs 58% high) was observed across the FRS categories (P < .0001 for all comparisons).Conclusions. A strong positive relationship exists between FRS and the prevalence and extent of atherosclerosis. Especially in intermediate FRS patients, CACS and MSCT coronary angiography provide useful information on the presence of subclinical atherosclerosis. (J Nucl Cardiol 2009;16:368-75.)

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Section: Discussionmentioning

confidence: 94%

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

Nucifora

Schuijf

Werkhoven

et al. 2009

Journal of Nuclear Cardiology

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“…Therefore, high-pitch CT enables the acquisition of all axial image planes that comprise the aortic valve-aortic root complex in 250-300 ms, corresponding to an anatomical length of 9.6 cm-11.6 cm in the z-axis, hence capturing the region of interest during a fraction of a single heart beat [11]. Compared to conventional prospectively ECG-gated CTA, stair-step motion artifacts may therefore be eliminated [3].…”

Section: Discussionmentioning

confidence: 99%

“…In case of non-diagnostic image quality, retrospectively ECG-gated acquisitions allow for alternate data reconstructions out of any other time point of the cardiac cycle. However the downside of retrospectively ECG-gated acquisitions is a relatively high radiation dose exposure compared to prospectively ECG-gated acquisitions, which, however, only allow for data reconstructions out of a predefined time point of the cardiac cycle [3].…”

Section: Introductionmentioning

confidence: 99%

High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

et al. 2010

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Purpose To compare image quality and radiation dose of high-pitch computed tomography angiography(CTA) of the aortic valve-aortic root complex with and without prospective ECG-gating compared to a retrospectively ECG-gated standard-pitch acquisition. Materials and Methods 120 patients(mean age 68 ± 13 years) were examined using a 128-slice dual-source CT system using prospectively ECG-gated high-pitch (group A; n=40), non-ECG-gated high-pitch(group B; n= 40) or retrospectively ECG-gated standard-pitch(C; n=40) acquisition techniques. Image quality of the aortic root, valve and ascending aorta including the coronary ostia was assessed by two independent readers. Image noise was measured, radiation dose estimates were calculated. Results Interobserver agreement was good(κ=0.64-0.78). Image quality was diagnostic in 38/40 patients(group A), 37/40(B) and 38/40(C) with no significant difference in number of patients with diagnostic image quality among all groups (p = 0.56). Significantly more patients showed excellent image quality in group A compared to groups B and C(each, p<0.01). Average image noise was significantly different between all groups(p<0.05). Mean radiation dose estimates in groups A and B(each; 2.4±0.3 mSv) were significantly lower compared to group C(17.5±4.4 mSv; p<0.01). Conclusion High-pitch dual-source CTA provides diagnostic image quality of the aortic valve-aortic root complex even without ECG-gating at 86% less radiation dose when compared to a standard-pitch ECG-gated acquisition.

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“…Indeed, at such high-pitch, 9.6e11.6 cm in the z-axis, acquisition can be performed in 250e300 ms, corresponding to a scan of the entire heart volume during a fraction of a single heartbeat. As a consequence, step-motion artifacts are virtually inexistent 20 ECG-gated aortic CT has already been used for the combined assessment of the aorta and the coronary arteries. Nevertheless, authors reported limitations especially for the analysis of the cor- acceptable image quality and diagnostic performance required a low heart rate (respectively less than 63 and 75 bpm), which may be related to a standardized CTA protocol with a tube voltage of 100 kV, a relative low-pitch protocol or the absence of iterative reconstructions.…”

Section: Discussionmentioning

confidence: 99%

ECG-triggered high-pitch CT for simultaneous assessment of the aorta and coronary arteries

Hachulla

Ronot

Noble

et al. 2016

Journal of Cardiovascular Computed Tomography

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a b s t r a c tObjectives: To study the image quality of ECG-gated-computed tomography (CT) acquisition with a highpitch CT imaging for the exploration of both the aorta and coronary arteries.Methods: Eighty-four patients underwent high-pitch ECG-gated aortic CT without b-blockers with iterative reconstruction algorithms. Contrast-to-noise ratio (CNR) between vessels and adjacent perivascular fat tissue were calculated on the aorta and the coronary arteries. Dose-length-products (DLP) were recorded. Two blinded readers graded image quality of the aorta and the coronary arteries on a 3-point scale. Coronary artery stenoses were compared with coronary angiograms in 24 patients. Kappa values were calculated. Results: High-pitch acquisition resulted in a mean DLP of 234 ± 93 mGy cm(4.2 mSv) for an acquisition of the entire aorta, (mean 73 ± 16 bpm). CNR for ascending aorta was 10.6 ± 4 and CNR for coronary arteries was 9.85 ± 4.1. Image quality was excellent in 79/84 patients (94%), and excellent or moderate but diagnostic in 1087/1127 coronary artery segments (96%). 74 significant stenoses were observed, and 38/ 40 significant stenoses were confirmed by coronary angiography (K ¼ 0.91, Sensitivity ¼ 0.97, Specificity ¼ 0.98). Conclusion: High-pitch ECG-gated aortic CT with iterative reconstructions allows an accurate exploration of both aorta and coronary arteries during the same acquisition, with limited dose deposition, despite the lack of b-blockers and relatively high heart rate. Radiologists need to be aware of the necessity to analyze and report coronary artery disease in aortic examination.

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Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose¹

Abstract: Dual-source SAS-mode CT coronary angiography yielded diagnostic image quality for 97.9% of coronary segments at a low radiation dose.

Cited by 245 publications

References 33 publications

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

ECG-triggered high-pitch CT for simultaneous assessment of the aorta and coronary arteries

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Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose1

Abstract: Dual-source SAS-mode CT coronary angiography yielded diagnostic image quality for 97.9% of coronary segments at a low radiation dose.

Cited by 245 publications

References 33 publications

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography

High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

ECG-triggered high-pitch CT for simultaneous assessment of the aorta and coronary arteries

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Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose¹