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Updated: Jun 24, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection
Stephan Achenbach1, Ulrike Ropers, Axel Kuettner
1Department of Cardiology, University of Erlangen, Germany. Stephan.achenbach@ukerlangen.de
Insights
Systematic heart rate control significantly improves diagnostic accuracy for single-source CT angiography but is unnecessary for dual-source CT. Dual-source CT
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Coronary CT angiography (CTA) is susceptible to motion artifacts, necessitating heart rate reduction.
- Higher temporal resolution scanners, like dual-source CT, may overcome this limitation without heart rate control.
Purpose of the Study:
- To evaluate the impact of systematic heart rate control on the diagnostic accuracy of 64-slice single-source and dual-source CT coronary angiography.
Main Methods:
- 200 patients underwent coronary CTA using either single-source or dual-source CT.
- Patients were randomized to receive heart rate control (beta-blockade) or no premedication.
- Image quality and diagnostic accuracy were compared to invasive angiography.
Main Results:
- Heart rate control improved single-source CT evaluability (93% vs. 69%) and correct classification rates (78% vs. 57%).
- Dual-source CT showed no significant difference in evaluability (96% vs. 98%) or correct classification (87% vs. 93%) with or without heart rate control.
- Sensitivity for detecting stenosis was high in both systems, with no significant difference based on heart rate control.
Conclusions:
- Systematic heart rate control enhances image quality and diagnostic accuracy for single-source CT angiography.
- Dual-source CT angiography's superior temporal resolution makes heart rate control unnecessary for diagnostic quality.
Objectives:
The purpose of this study was to analyze the influence of a systematic approach to lower heart rate for coronary computed tomography (CT) angiography on diagnostic accuracy of 64-slice single- and dual-source CT.
Background:
Coronary CT angiography is often impaired by motion artifacts, so that routine lowering of heart rate is usually recommended. This is often conceived as a major limitation of the technique. It is expected that higher temporal resolution, such as with dual-source 64-slice CT, would allow diagnostic imaging even without systematic pre-treatment for lowering the heart rate.
Methods:
Two hundred patients with suspected coronary artery disease were first randomized to either 64-slice single-source CT (n = 100) or dual-source CT (n = 100) for contrast-enhanced coronary artery evaluation. In each group, patients were further randomized to either receive systematic heart rate control (oral and intravenous beta-blockade for a target heart rate < or =60 beats/min) or receive no premedication. Evaluability of datasets and diagnostic accuracy were compared between groups against the results obtained from invasive angiography.
Results:
Systematic pre-treatment lowered heart rate during CT coronary angiography by 10 beats/min. Heart rate control significantly improved evaluability in single-source CT (93% vs. 69% on a per-patient basis, p = 0.005), whereas it did not in dual-source CT (96% vs. 98%). In evaluable patients, sensitivity to detect the presence of at least 1 coronary stenosis by single-source CT was 86% and 79%, respectively, with and without heart rate control (p = NS). For dual-source CT, it was 100% and 95%, respectively (p = NS). The rate of correctly classified patients, defined as evaluable and correct classification as to the presence or absence of at least 1 coronary artery stenosis, was significantly improved by heart rate control in single-source CT (78% vs. 57%, p = 0.04), whereas there was no such influence in dual-source CT (87% vs. 93%).
Conclusions:
Systematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control.
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