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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Predictors of image quality in high-pitch coronary CT angiography
Paul Stolzmann1, Robert P Goetti, Pal Maurovich-Horvat
1Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. pstolzmann@partners.org
Insights
High-pitch coronary CT angiography (CTA) quality depends on heart rate and motion artifacts from prior coronary artery calcification (CAC) scans. These factors predict diagnostic image quality in this lower-radiation protocol.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- High-pitch coronary CT angiography (CTA) offers reduced radiation exposure compared to traditional methods.
- Predicting diagnostic image quality in high-pitch CTA is crucial, as heart rate alone is insufficient.
- Identifying reliable predictors is essential for optimizing patient selection and scan protocols.
Purpose of the Study:
- To prospectively identify predictors of diagnostic image quality in high-pitch coronary CTA.
- To evaluate the influence of heart rate and motion artifacts on scan quality.
- To establish criteria for successful high-pitch CTA examinations.
Main Methods:
- One hundred patients underwent prospectively ECG-gated high-pitch coronary artery calcification (CAC) scoring and coronary CTA.
- Image quality of CAC and CTA was assessed by blinded readers for motion artifacts and diagnostic quality.
- Multivariate logistic regression analyzed predictors including BMI, CAD risk, Agatston score, heart rate, and CAC motion artifacts.
Main Results:
- Heart rate frequency and variability during high-pitch CTA were not significantly different from CAC scans.
- Diagnostic image quality was achieved in 97% of segments in 82% of patients.
- Heart rate (OR, 1.04) and motion artifacts on preceding CAC scans (OR, 94.55) were significant independent predictors of CTA image quality.
Conclusions:
- Heart rate and motion artifacts on preceding high-pitch CAC scans are significant predictors of high-pitch coronary CTA image quality.
- These findings aid in selecting appropriate patients for high-pitch CTA and improving protocol success rates.
- High-pitch CTA, when optimized, provides excellent diagnostic quality with reduced radiation exposure.
Objective:
High-pitch coronary CT angiography (CTA) shows an alternative coronary CTA protocol to retrospectively ECG-gated imaging that is associated with a significantly lower radiation exposure. Yet, the diagnostic quality of high-pitch coronary CTA cannot be sufficiently predicted on the basis of heart rate (HR) alone. Thus, we sought to prospectively identify the predictors of diagnostic high-pitch coronary CTA.
Subjects And Methods:
One hundred consecutive patients (16 women, 84 men; mean age, 67 ± 10 years) without restrictions in HR frequency or variability underwent prospectively ECG-gated high-pitch coronary artery calcification (CAC) scoring and coronary CTA using dual-source 128-MDCT. High-pitch CAC was graded on the basis of motion artifacts; high-pitch coronary CTA was graded on the basis of image quality by each of two independent and blinded readers. Predictors of coronary CTA image quality were assessed by multivariate logistic regression, including body mass index, risk of coronary artery disease, Agatston score, HR frequency and variability, and motion artifacts on CAC. If high-pitch coronary CTA was nondiagnostic, the examination was repeated using a retrospectively ECG-gated coronary CTA protocol.
Results:
HR frequency (66 ± 20 beats per minute [bpm]) and variability (12 ± 10 bpm) during high-pitch coronary CTA was not significantly different from that during high-pitch CAC. Interobserver agreement for image quality reading was good (k = 0.79) for CAC and excellent (k = 0.88) for coronary CTA. High-pitch CAC showed no motion artifacts in 1304 of 1396 segments (93.4%) in 78 of 100 patients. Diagnostic image quality of high-pitch coronary CTA was found in 1413 of 1457 segments (97%) in 82 of 100 patients. Multivariate logistic regression revealed HR frequency (odds ratio, 1.04; p < 0.05) and motion artifacts on preceding high-pitch CAC (odds ratio, 94.55; p < 0.001) as significant independent predictors of image quality of high-pitch coronary CTA. The mean effective radiation doses of high-pitch CAC and coronary CTA were 0.4 ± 0.1 mSv (0.3-0.5 mSv) and 1.0 ± 0.2 mSv (0.8-1.2 mSv; p < 0.001), respectively.
Conclusion:
HR frequency and motion artifacts on preceding high-pitch CAC represent significant independent predictors of image quality in high-pitch coronary CTA.
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