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Published on: August 28, 2018
Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT: influence of heart rate on
Tom Giesler1, Ulrich Baum, Dieter Ropers
1Department of Internal Medicine II, Universität Erlangen-Nuernberg, Ulmenweg 18, D-91054 Erlangen, Germany.
Insights
Higher heart rates increase motion artifacts in multidetector CT (MDCT) coronary angiography, reducing diagnostic accuracy for detecting coronary artery stenosis. This impacts the reliability of MDCT for evaluating coronary artery disease.
Area of Science:
- Cardiovascular imaging
- Medical diagnostics
- Radiology
Background:
- Multidetector CT (MDCT) with ECG-gating allows noninvasive coronary artery visualization.
- Image acquisition times (125-250 msec) can lead to motion artifacts, especially at higher heart rates.
Purpose of the Study:
- To investigate the impact of patient heart rate on motion artifacts.
- To assess the influence of heart rate on the accuracy of coronary artery stenosis detection using MDCT.
Main Methods:
- 100 patients underwent MDCT with retrospective ECG-gated image reconstruction.
- Coronary arteries were evaluated for motion artifacts and high-grade stenosis (>70% diameter reduction).
- MDCT findings were compared with coronary angiography results.
Main Results:
- 29% of 400 coronary arteries were unevaluable due to motion artifacts.
- MDCT detected 49% of stenoses, with 91% sensitivity and 89% specificity in evaluable arteries.
- Increased heart rate correlated with decreased evaluability and lower stenosis detection sensitivity (62% at ≤70 bpm vs. 33% at >70 bpm).
Conclusions:
- MDCT is effective for visualizing coronary stenoses.
- Increasing heart rate significantly degrades MDCT image quality due to motion artifacts.
- The diagnostic accuracy of MDCT for coronary stenosis detection diminishes as heart rate rises.
Objective:
Although multidetector CT (MDCT) with retrospectively ECG-gated image reconstruction has been shown to permit noninvasive visualization of the coronary arteries, the 125-250 msec required for image acquisition frequently causes motion artifacts. We investigated the influence of a patient's heart rate on the presence of motion artifacts and on accuracy of stenosis detection on contrast-enhanced MDCT.
Materials And Methods:
In 100 patients, MDCT was performed, and ECG-gated cross-sectional images were retrospectively reconstructed. From the 10 data sets obtained for each patient (reconstructed at 0-90% of the cardiac cycle in increments of 10%), we chose the best data set for every coronary artery. The images of the arteries were evaluated for occurrence of artifacts and the presence of high-grade stenosis (diameter reduction exceeding 70%) or occlusions. MDCT results were compared with coronary angiographic findings.
Results:
Of the 400 coronary arteries, 115 (29%) could not be evaluated because of motion artifacts (n = 84) or other reasons (n = 31). Overall, 51 (49%) of 104 stenoses were revealed on MDCT. For detecting stenosis in those arteries that we could evaluate, MDCT had a sensitivity of 91% (51 of 56 stenoses detected) and a specificity of 89%. As the heart rate increased, the number of arteries that could be evaluated decreased, and overall sensitivity for stenosis detection decreased from 62% (heart rate < or = 70 beats per minute) to 33% (heart rate > 70 beats per minute).
Conclusion:
MDCT can reveal coronary stenoses, but the usefulness of MDCT as an aid in accurately evaluating stenoses decreases as a patient's heart rate increases.
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