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Updated: Aug 18, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary arteries: retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the
A F Kopp1, S Schroeder, A Kuettner
1Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. andreas.kopp@uni-tuebingen.de
Insights
Optimizing coronary CT angiography requires adapting image reconstruction timing to individual coronary arteries. A fixed time point does not yield the best results for visualizing the right, left anterior descending, and left circumflex arteries.
Area of Science:
- Cardiovascular imaging
- Medical physics
- Radiology
Background:
- Multi-detector row computed tomographic (CT) angiography is crucial for visualizing coronary arteries.
- Image quality in CT angiography is highly dependent on the cardiac phase of reconstruction.
- Retrospective gating allows for reconstruction at various points in the cardiac cycle.
Purpose of the Study:
- To determine the optimal cardiac phase for retrospective gating to reconstruct high-quality multi-detector row CT images of the three major coronary arteries.
- To evaluate if a single fixed time point in the cardiac cycle is sufficient for optimal image reconstruction across all major coronary arteries.
Main Methods:
- 50 patients underwent multi-detector row coronary CT angiography.
- Images were reconstructed at 10% intervals from 20% to 80% of the cardiac cycle.
- Two independent reviewers assessed image quality (artifacts, visibility) for specific segments of the right, left main/anterior descending, and left circumflex coronary arteries using a 5-grade scale.
Main Results:
- The left anterior descending artery showed optimal visualization at 60%-70% of the cardiac cycle (mid-diastole).
- The left circumflex artery was best visualized at 50% of the cardiac cycle.
- The optimal reconstruction window for the right coronary artery was significantly different, identified at 40% of the cardiac cycle (P < .05).
- High inter-reviewer agreement (kappa = 0.75) was observed, despite patient population variability.
Conclusions:
- Optimal image reconstruction for coronary CT angiography necessitates tailoring the window to each specific coronary artery.
- Employing a single, fixed time point for image reconstruction across all coronary arteries does not achieve optimal image quality.
- Individualized retrospective gating strategies are essential for maximizing diagnostic accuracy in coronary CT angiography.
Purpose:
To investigate how the technique of retrospective gating can be used to optimize reconstruction of multi-detector row computed tomographic (CT) images for each of the three major coronary arteries during the cardiac cycle.
Materials And Methods:
Multi-detector row coronary CT angiograms obtained in 50 patients were reconstructed at 20%-80% of the cardiac cycle in increments of 10%. Two blinded independent reviewers assessed the image quality, in terms of artifacts and visibility, obtained with three-dimensional postprocessing for segments 1-3 (right coronary artery), segments 5-8 (left main and left anterior descending coronary arteries), and segments 11 and 12 (left circumflex artery). The following grades were assigned: 1, very poor; 2, poor; 3, fair; 4, good; and 5, excellent.
Results:
The left anterior descending artery was best visualized in middiastole at 60%-70% of the cardiac cycle, and the left circumflex artery was best visualized at 50%. The optimal reconstruction window for the right coronary artery was significantly different at 40% (P < .05). Although there was good agreement (kappa = 0.75) between the two reviewers, there was a high degree of variation in the patient population.
Conclusion:
The image reconstruction window for CT angiography of the coronary arteries should be adapted to each coronary artery. The use of one fixed time point in the cardiac cycle for image reconstruction does not provide optimal image quality.
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