The feasibility of sub-millisievert coronary CT angiography with low tube voltage, prospective ECG gating, and a knowledge-based iterative model reconstruction algorithm

Park, Chul Hwan; Lee, Joohee; Oh, Chisuk; Han, Kyunghwa; Kim, Tae Hoon

doi:10.1007/s10554-015-0795-7

Cited by 25 publications

(20 citation statements)

References 22 publications

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“…Third, although retrospectively ECG-triggered MDCTA more clearly depicts ventricular morphology than helical CT scanning mode, retrospective ECG-gating is currently not recommended as a routine MDCTA protocol because of its higher radiation dose compared with helical scanning mode. Recent studies showed that the use of prospective ECG-gating significantly reduces the radiation exposure to patients undergoing MDCTA and yields diagnostic image quality in the assessment of coronary arteries [ 42 – 45 ], coronary artery bypasses [ 46 ], and congenital heart disease [ 47 ] with lower radiation dose. Future studies are warranted that evaluate the diagnostic accuracy of low-dose prospectively ECG-triggered MDCTA in patients with CTEPH.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

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PurposeThe aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome.MethodsVascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF).ResultsThe majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors.ConclusionThe majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

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“…[ 25 ] have also reported accurate noninvasive diagnosis of coronary artery disease with the use of a model-based IR-reconstructed CCTA. In our previous study, we reported the feasibility of using CCTA with 80 kVp, 200 mAs, prospective ECG gating, and an IMR algorithm to produce images of markedly higher quality (3.6 ± 0.6), compared with the use of IR and FBP (3.1 ± 0.7 for IR; 2.3 ± 0.6 for FBP, p < 0.01) [ 26 ]. However, to our knowledge, no study has compared the effectiveness of a reduced tube voltage (80 kVp) combined with IMR to the widely used 100 kVp CCTA protocol combined with IR.…”

Section: Discussionmentioning

confidence: 99%

Coronary Computed Tomographic Angiography at 80 kVp and Knowledge-Based Iterative Model Reconstruction Is Non-Inferior to that at 100 kVp with Iterative Reconstruction

Lee¹,

Park²,

Oh³

et al. 2016

PLoS ONE

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The aims of this study were to compare the image noise and quality of coronary computed tomographic angiography (CCTA) at 80 kVp with knowledge-based iterative model reconstruction (IMR) to those of CCTA at 100 kVp with hybrid iterative reconstruction (IR), and to evaluate the feasibility of a low-dose radiation protocol with IMR. Thirty subjects who underwent prospective electrocardiogram-gating CCTA at 80 kVp, 150 mAs, and IMR (Group A), and 30 subjects with 100 kVp, 150 mAs, and hybrid IR (Group B) were retrospectively enrolled after sample-size calculation. A BMI of less than 25 kg/m2 was required for inclusion. The attenuation value and image noise of CCTA were measured and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated at the proximal right coronary artery and left main coronary artery. The image noise was analyzed using a non-inferiority test. The CCTA images were qualitatively evaluated using a four-point scale. The radiation dose was significantly lower in Group A than Group B (0.69 ± 0.08 mSv vs. 1.39 ± 0.15 mSv, p < 0.001). The attenuation values were higher in Group A than Group B (p < 0.001). The SNR and CNR in Group A were higher than those of Group B. The image noise of Group A was non-inferior to that of Group B. Qualitative image quality of Group A was better than that of Group B (3.6 vs. 3.4, p = 0.017). CCTA at 80 kVp with IMR could reduce the radiation dose by about 50%, with non-inferior image noise and image quality than those of CCTA at 100 kVp with hybrid IR.

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“…In addition, state-of-the-art CT scanners offer special acquisition modes as high volume axial modes or high-pitch spiral dual source protocols. In combination with advanced reconstruction algorithms radiation doses below 1.0 mSv for CCTA can be reached [37,38].…”

Section: Cct Image Acquisitionmentioning

confidence: 99%

The role of MRI and CT for diagnosis and work-up in suspected ACS

2016

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This article describes the role of cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) in the diagnostic work-up of patients with suspected acute coronary syndrome (ACS). Recent studies on the principles, diagnostic targets, clinical utility, accuracy, prognostic relevance and implications for clinical decision-making are discussed and current state-ofthe-art and novel approaches are presented. The authors recognize that in ACS, time is of the essence and therefore put a special emphasis on the feasibility of tomographic cardiac imaging in realistic clinical settings.

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The feasibility of sub-millisievert coronary CT angiography with low tube voltage, prospective ECG gating, and a knowledge-based iterative model reconstruction algorithm

Cited by 25 publications

References 22 publications

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Coronary Computed Tomographic Angiography at 80 kVp and Knowledge-Based Iterative Model Reconstruction Is Non-Inferior to that at 100 kVp with Iterative Reconstruction

The role of MRI and CT for diagnosis and work-up in suspected ACS

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