Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT
Marco M Ochs1, Fabian Aus dem Siepen2, Thomas Fritz2
1Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. marco.ochs@med.uni-heidelberg.de.
Insights
Third-generation dual-source CT (DSCT) with sequential scan mode (SSM) offers significant radiation dose savings for coronary CT angiography (CTA). This method provides robust diagnostic image quality, especially in patients with an Agatston score (AS) of 2000 or less.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Coronary CT angiography (CTA) is valuable for chest pain assessment.
- Diagnostic accuracy can be limited by high Agatston score (AS), heart rate, arrhythmia, and obesity.
- Third-generation dual-source CT (DSCT) is a newer technology for CTA.
Purpose of the Study:
- To evaluate the potential of third-generation DSCT for CTA in a real-world clinical setting.
- To compare sequential scan mode (SSM) with helical scan mode (HSM) using DSCT.
- To assess the impact of patient factors on CTA image quality and diagnostic accuracy.
Main Methods:
- Retrospective analysis of 268 patients undergoing CTA with DSCT.
- Acquisition of contrast-enhanced volume datasets in SSM (n=151) or HSM (n=117).
- Classification of coronary segments into diagnostic or non-diagnostic image quality, with a subset undergoing invasive angiography for accuracy assessment.
Main Results:
- SSM and HSM showed comparable overall diagnostic image quality (96.8% vs. 97.5%).
- Agatston score (AS) impacted image quality in SSM (p=0.0001) but not HSM, with decreased quality for AS ≥2000 in SSM (p=0.03).
- Both SSM and HSM demonstrated high diagnostic accuracy, with SSM yielding significantly lower radiation doses (2.1 mSv vs. 5.1 mSv; p=0.0001).
Conclusions:
- SSM with third-generation DSCT allows for significant radiation dose reduction.
- SSM provides robust diagnostic image quality in patients with AS ≤2000, irrespective of heart rate, rhythm, or obesity.
- Third-generation DSCT in SSM is a viable option for CTA, balancing image quality, diagnostic accuracy, and radiation dose.
Background:
The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting.
Methods:
Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA.
Results:
SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts.
Conclusion:
SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
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