Radiation Dose and Image Quality of Prospective Triggering With Dual-Source Cardiac Computed Tomography

Blankstein, Ron; Shah, Amar; Pale, Rodrigo; Abbara, Suhny; Bezerra, Hiram G.; Bolen, Michael A.; Mamuya, Wilfred; Hoffmann, Udo; Brady, Thomas J.; Cury, Ricardo C.

doi:10.1016/j.amjcard.2008.12.045

Cited by 49 publications

(29 citation statements)

References 6 publications

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“…In 16 out of 22 studies, the number of patients included in the studies was matched in both groups, while in four studies a significantly small number of patients were included in the prospective ECG-gating group when compared to that included in the corresponding retrospective gating group [27,28,30,36]. In the remaining two studies, the number of patients included in the prospective gating group is more than 3 times of that included in the retrospective groups [32,37].…”

Section: General Informationmentioning

confidence: 96%

“…In the remaining two studies, the number of patients included in the prospective gating group is more than 3 times of that included in the retrospective groups [32,37]. Patients' age, heart rate and BMI were matched in both groups in all of the studies except in one study, where significantly younger patients were selected in the prospective ECG-gating group [27].…”

Section: General Informationmentioning

confidence: 99%

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

Sun

2012

European Journal of Radiology

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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

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Section: General Informationmentioning

confidence: 96%

Section: General Informationmentioning

confidence: 99%

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

Sun

2012

European Journal of Radiology

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“…This includes the use of prospectively ECG-triggered axial image acquisition [5][6][7], various forms of tube current modulation [8] and lowering of tube voltage [8,9]. Even though the results concerning image quality in the published trials have generally been satisfactory [10,11], there is concern that low-dose protocols may negatively influence image quality. This may, in fact, prevent their use.…”

Section: Introductionmentioning

confidence: 98%

Radiation exposure and image quality in staged low-dose protocols for coronary dual-source CT angiography: a randomized comparison

et al. 2009

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“…The described protocol requires double the contrast material dose required for conventional CT angiography and therefore should be avoided in patients with renal dysfunction. Although performing axial (prospective ECG triggered) examinations has been shown in recent studies (22) to substantially decrease the radiation dose, we chose not to use axial scanning for the stress image acquisitions because of the chronotropic effects of adenosine: The use of this agent would have increased the heart rate beyond the low rates known to be most suitable for axial scanning. If future scanners enable reliable prospectively ECG-gated axial scanning at high heart rates, further decreases in radiation dose may be achieved.…”

Section: Cardiac Imaging: Perfusion Imaging With Dual-source Techniqumentioning

confidence: 99%

Incremental Value of Adenosine-induced Stress Myocardial Perfusion Imaging with Dual-Source CT at Cardiac CT Angiography

Rocha-Filho

Blankstein²,

Shturman³

et al. 2010

Radiology

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222

119

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Purpose:First, to assess the feasibility of a protocol involving stressinduced perfusion evaluated at computed tomography (CT) combined with cardiac CT angiography in a single examination and second, to assess the incremental value of perfusion imaging over cardiac CT angio graphy in a dual-source technique for the detection of obstructive coronary artery disease (CAD) in a high-risk population. Materials and Methods:Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Thirty-fi ve patients at high risk for CAD were prospectively enrolled for evaluation of the feasibility of CT perfusion imaging. All patients underwent retrospectively electrocardiographically gated (helical) adenosine stress CT perfusion imaging followed by prospectively electrocardiographically gated (axial) rest myocardial CT perfusion imaging. Analysis was performed in three steps: (a) Coronary arterial stenoses were scored for severity and reader confi dence at cardiac CT angiography, (b) myocardial perfusion defects were identifi ed and scored for severity and reversibility at CT perfusion imaging, and (c) coronary stenosis severity was reclassifi ed according to perfusion fi ndings at combined cardiac CT angiography and CT perfusion imaging. The sensitivity, specifi city, negative predictive value (NPV), and positive predictive value (PPV) of cardiac CT angiography before and after CT perfusion analysis were calculated. Results:With use of a reference standard of greater than 50% stenosis at invasive angiography, all parameters of diagnostic accuracy increased after CT perfusion analysis: Sensitivity increased from 83% to 91%; specifi city, from 71% to 91%; PPV, from 66% to 86%; and NPV, from 87% to 93%. The area under the receiver operating characteristic curve increased signifi cantly, from 0.77 to 0.90 ( P , .005). Conclusion:A combination protocol involving adenosine perfusion CT imaging and cardiac CT angiography in a dual-source technique is feasible, and CT perfusion adds incremental value to cardiac CT angiography in the detection of signifi cant CAD.q RSNA, 2010

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Radiation Dose and Image Quality of Prospective Triggering With Dual-Source Cardiac Computed Tomography

Cited by 49 publications

References 6 publications

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

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

Radiation exposure and image quality in staged low-dose protocols for coronary dual-source CT angiography: a randomized comparison

Incremental Value of Adenosine-induced Stress Myocardial Perfusion Imaging with Dual-Source CT at Cardiac CT Angiography

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