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Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience
Sebastian Leschka1, Paul Stolzmann, Lotus Desbiolles
1Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.
Insights
High-pitch dual-source CT coronary angiography (CTCA) accurately diagnoses coronary stenoses in patients with heart rates ≤60 bpm. This advanced CTCA method offers high diagnostic accuracy at low radiation doses.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary artery disease diagnosis relies on invasive catheter coronary angiography (CCA).
- Computed tomography coronary angiography (CTCA) offers a non-invasive alternative.
- Advancements in CT technology aim to improve diagnostic accuracy and reduce radiation exposure.
Purpose of the Study:
- To evaluate the diagnostic accuracy of high-pitch (HP) dual-source CT coronary angiography (CTCA).
- To compare HP-CTCA with catheter coronary angiography (CCA) for detecting significant coronary stenoses.
- To assess image quality and radiation dose of HP-CTCA.
Main Methods:
- Prospective study of 35 patients undergoing both HP-CTCA and CCA.
- HP-CTCA performed on a second-generation dual-source CT system with heart rates ≤60 bpm.
- Independent blinded observers assessed image quality and significant stenoses (diameter narrowing >50%). CCA served as the reference standard.
Main Results:
- Diagnostic image quality achieved in 99% of coronary segments.
- High diagnostic performance per segment (sensitivity 94%, specificity 96%) and per patient (sensitivity 100%, specificity 91%).
- Low effective radiation dose of 0.9 ± 0.1 mSv.
Conclusions:
- HP dual-source CTCA demonstrates high diagnostic accuracy for coronary stenoses in selected patients.
- The technique provides excellent image quality and diagnostic performance.
- Sub-milli-Sievert radiation doses are achievable with this advanced CTCA method.
Objectives:
The objective was to prospectively investigate the diagnostic accuracy of high-pitch (HP) dual-source computed tomography coronary angiography (CTCA) compared with catheter coronary angiography (CCA) for the diagnosis of significant coronary stenoses.
Methods:
Thirty-five patients (seven women; mean age 62 ± 8 years) underwent both CTCA and CCA. CTCA was performed with a second-generation dual-source CT system permitting data acquisition at an HP of 3.4. Patients with heart rates >60 bpm were excluded from study enrolment. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a four-point scale (1: excellent to 4: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). CCA served as the standard of reference. Radiation dose values were calculated using the dose-length product.
Results:
Diagnostic image quality was found in 99% of all segments (455/459). Non-diagnostic image quality occurred in a single patient with a sudden increase in heart rate immediately before and during CTCA. Taking segments with non-evaluative image quality as positive for disease, the sensitivity, specificity and positive and negative predictive values were 94, 96, 80 and 99% per segment and 100, 91, 88 and 100% per patient. The effective radiation dose was on average 0.9 ± 0.1 mSv.
Conclusion:
In patients with heart rates ≤60 bpm, CTCA using the HP mode of the dual-source CT system is associated with high diagnostic accuracy for the assessment of coronary artery stenoses at sub-milli-Sievert doses.
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