Dual-source versus 64-section CT coronary angiography at lower heart rates: comparison of accuracy and radiation dose
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Published on: July 3, 2014
Stephan Baumüller1, Sebastian Leschka, Lotus Desbiolles
1Institute of Diagnostic Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
Purpose:
To compare the diagnostic performance and radiation doses of dual-source and 64-section computed tomographic (CT) coronary angiography for the diagnosis of significant coronary stenoses in patients with heart rates of 65 beats/min or less.
Materials And Methods:
This retrospective study had local ethics committee approval; all patients gave written informed consent. Two hundred patients with heart rates of 65 beats/min or less were enrolled; 100 underwent dual-source and 100 underwent 64-section CT coronary angiography. Two blinded observers independently assessed image quality of all coronary segments by using a four-point scale and searched for significant (>50%) stenoses in each segment. Catheter angiography was used as the reference standard. Image noise was measured in the ascending aorta. Radiation doses were calculated.
Results:
No significant differences were found regarding sex, age, body weight, cardiovascular risk profile, prevalence of stenosis, mean and variability of heart rate, Agatston score, and image noise (all P > .1) between patients in both CT coronary angiography groups. No significant difference was found in the rate of nonassessable coronary segments between dual-source (1.0%, 14 of 1405) and 64-section CT coronary angiography (1.8%, 25 of 1387; P = .08). Motion artifacts occurred significantly more often in 64-section (21 of 25) versus dual-source (five of 14, P = .004) CT coronary angiography. Segment-based accuracy and specificity were significantly higher for dual-source versus 64-section CT coronary angiography. There was no significant difference in accuracy parameters at the per-vessel and per-patient analyses. No significant difference (P = .13) was found between the effective doses of dual-source (mean +/- standard deviation, 10.9 mSv +/- 1.1) and 64-section CT (10.4 mSv +/- 1.7) coronary angiography.
Conclusion:
In patients with heart rates of 65 beats/min or less, the higher temporal resolution of dual-source CT coronary angiography results in improved accuracy and specificity for the diagnosis of significant stenoses on a per-segment level at a similar radiation dose, but provides a comparable diagnostic accuracy on a patient-based level as does 64-section coronary angiography.
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