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Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols
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Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols
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Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols
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Journal Article
Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols
2013
Overview
Objectives
To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction.
Methods
We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients.
Results
In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %,
P
= 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %,
P
> 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv,
P
< 0.001). In group B (228 patients, 132 men, mean heart rate 75 ± 11 bpm), per-segment sensitivity, specificity, PPV and NPV were comparable (94 %, 95 %, 67 %, 99 % vs. 92 %, 95 %, 66 %, 99 %,
P
> 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv,
P
< 0.001). Diagnostic performance was comparable in both groups.
Conclusion
Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose.
Key Points
•
128-slice dual-source CT coronary angiography offers several different acquisition protocols.
•
Randomized comparison of protocols reveals an optimal protocol selection strategy.
•
Appropriate CTCA protocol selection lowers radiation dose, while maintaining high quality.
•
CTCA protocol selection should be based on individual patient characteristics.
•
A prospective sequential protocol is preferred for CTCA.
Publisher
Springer-Verlag,Springer Nature B.V
Subject
/ Coronary Angiography - methods
/ Coronary Angiography - statistics & numerical data
/ Coronary Artery Disease - diagnostic imaging
/ Coronary Artery Disease - epidemiology
/ Female
/ Humans
/ Imaging
/ Male
/ Medicine
/ Radiographic Image Interpretation, Computer-Assisted - methods
/ Radiography, Dual-Energy Scanned Projection - methods
/ Tomography, X-Ray Computed - methods
