Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy

Abstract

Purpose: To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and Methods:A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies.Results: 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p<0.001). The mean dose length product was 225 mGy.cm (95% CI: 188, 262 mGy.cm) and 822 mGy.cm (95% CI: 630, 1013 mGy.cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p<0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p=0.047). Conclusion:Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value.3

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

“…No bblockers or nitrates were administered for heart rate control or coronary vasodilation. 11 Supplementary unenhanced or delayed acquisitions were performed according to the clinical situation, especially for patients with treated abdominal aortic aneurysm or suspected dissection. But, only arterial phase was used to assess the feasibility of a combined assessment of both the aorta and the coronary arteries.…”

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

“…(2,3) Although high diagnostic accuracy is achieved with both retrospective and prospective ECG-gated CCTA for detecting CAD (Fig. 1), the radiation doses associated with these two cardiac examinations are significantly different due to the different approaches used for coronary artery scanning.…”

“…(2,3) Prospective ECG-gated CCTA also promises high sensitivity (range 93.7%-100.0%), specificity (range 82.7%-97.0%) and NPV (range 95%-98%) in the assessment of CAD. (2,3) Although high diagnostic accuracy is achieved with both retrospective and prospective ECG-gated CCTA for detecting CAD (Fig. 1), the radiation doses associated with these two cardiac examinations are significantly different due to the different approaches used for coronary artery scanning.…”

Coronary CT Angiography in Coronary Artery Disease: from Diagnosis to Prevention

“…18,19,38,39 Table 1 summarizes the diagnostic value of these systematic reviews and meta-analyses of studies performed with CCTA in CAD.…”

“…8,9,[17][18][19][20] tion, or even the acquisition of whole-heart coverage in one gantry rotation. Two recently reported systematic reviews and meta-analyses further confirmed the high diagnostic accuracy of 320-slice CCTA.…”