Related Experiment Video
Updated: Jun 25, 2026
High-Resolution Cardiac Positron Emission Tomography/Computed Tomography for Small Animals
Published on: December 16, 2022
Diagnostic accuracy and image quality of cardiac dual-source computed tomography in patients with arrhythmia
Ilias Tsiflikas1, Tanja Drosch, Harald Brodoefel
1Department of Diagnostic Radiology, University Hospital Tuebingen, and Department of Internal Medicine-Sports Medicine, University of Tuebingen, Germany.
Insights
Dual-source computed tomography (DSCT) shows limitations in diagnosing coronary artery disease in patients with irregular heart rhythms. High rates of "step-ladder" artifacts in DSCT hinder accurate visualization of coronary artery lesions.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Cardiac multi-detector computed tomography (MDCT) accurately visualizes coronary artery stenosis.
- MDCT has limitations in patients with heart rate irregularities.
- A new dual-source computed tomography (DSCT) scanner with 83 ms temporal resolution was evaluated.
Purpose of the Study:
- To assess the diagnostic accuracy of a new DSCT generation in patients without stable sinus rhythm.
- To evaluate DSCT's effectiveness in detecting significant coronary artery lesions (>50%) in irregular heart rhythms.
- To compare DSCT findings with invasive coronary angiography (ICA).
Main Methods:
- 44 patients without stable sinus rhythm underwent DSCT and ICA.
- Patients had suspected or known coronary artery disease (CAD).
- Coronary segments were analyzed for significant lesions, and findings were compared to ICA.
Main Results:
- Prevalence of CAD was 68%.
- 155 segments (27%) showed "step-ladder" artifacts, and 28 segments (5%) were not visualized.
- Overall accuracy for detecting significant lesions was 88% (sensitivity 73%, specificity 91%).
Conclusions:
- DSCT's diagnostic yield is hampered by "step-ladder" artifacts in patients with heart rate irregularities.
- Atrial fibrillation and other arrhythmias significantly impact DSCT image quality.
- Further advancements are needed to overcome artifact limitations in irregular heart rhythms.
Background:
Cardiac multi-detector computed tomography (MDCT) permits accurate visualization of high-grade coronary artery stenosis. However, in patients with heart rate irregularities, MDCT was found to have limitations. Thus, the aim of the present study was to evaluate the diagnostic accuracy of a new dual-source computed tomography (DSCT) scanner generation with 83 ms temporal resolution in patients without stable sinus rhythm.
Methods:
44 patients (31 men, mean age 67.5+/-9.2 years) without stable sinus rhythm and scheduled for invasive coronary angiography (ICA) because of suspected (n=17) or known coronary artery disease (CAD, n=27) were included in this study. All patients were examined with DSCT (Somatom Definition, Siemens). Besides assessment of total calcium score, all coronary segments were analyzed with regard to the presence of significant coronary artery lesions (>50%). The findings were compared to ICA in a blinded fashion.
Results:
During CT examination, heart rhythm was as follows: 25 patients (57%) atrial fibrillation, 7 patients (16%) ventricular extrasystoles (two of them with atrial fibrillation), 4 patients (9%) supraventricular extrasystoles, 10 patients (23%) sinus arrhythmia (heart rate variability>10 bpm). Mean heart rate was 69+/-14 bpm, median 65 bpm. Mean Agatston score equivalent (ASE) was 762, ranging from 0 to 4949.7 ASE. Prevalence of CAD was 68% (30/44). 155 segments (27%) showed "step-ladder" artifacts and 28 segments (5%) could not be visualized by DSCT. Only 70 segments (12%) were completely imaged without any artifacts. Based on a coronary segment model, sensitivity was 73%, specificity 91%, positive predictive value 63%, and negative predictive value 94% for the detection of significant lesions (>or=50% diameter stenosis). Overall accuracy was 88%.
Conclusions:
In patients with heart rate irregularities, including patients with atrial fibrillation and a high prevalence of coronary artery disease, the diagnostic yield of dual-source computed tomography is still hampered due to a high number of segments with "step-ladder" artifacts.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...