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High-pitch non-gated scans on the second and third generation dual-source CT scanners: comparison of coronary image
Cheng Ting Lin1, Linda Chi Hang Chu1, Stefan Loy Zimmerman1
1Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287, United States of America.
Insights
Third-generation (3G) dual-source CT scanners significantly improve coronary artery image quality for high-pitch, non-electrocardiography (ECG)-gated CT angiography (CTA) compared to second-generation (2G) systems. This advancement aids in diagnosing coronary artery disease with reduced radiation exposure.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Technology
Background:
- High-pitch, non-electrocardiography (ECG)-gated CT angiography (CTA) is increasingly used for coronary artery assessment.
- Differences in image quality between second-generation (2G) and third-generation (3G) dual-source CT (DSCT) scanners for this technique require detailed examination.
Purpose of the Study:
- To compare the image quality of coronary arteries obtained using high-pitch, non-ECG-gated CTA on 2G and 3G DSCT scanners.
- To evaluate the diagnostic performance and radiation dose implications of each scanner generation.
Main Methods:
- Retrospective analysis of high-pitch, non-ECG-gated chest or chest/abdomen/pelvis CTA scans from 59 patients (3G) and 53 patients (2G).
- Independent blinded cardiac imagers assessed coronary image quality using a 4-point Likert scale and evaluated coronary artery disease (CAD).
Main Results:
- Diagnostic image quality for coronary arteries was significantly improved with the 3G scanner compared to the 2G scanner, both per-vessel (45-94% vs. 23-86%) and per-study (34% vs. 14%).
- The 3G group demonstrated statistically significant improvements in image quality for the left main, right coronary, and overall coronary arteries.
- Coronary artery disease was detected in 65% of high-pitch scans. Radiation doses (CTDIvol, DLP) were lower with 3G (7.5 mGy, 491 mGy*cm) versus 2G (14.8 mGy, 911 mGy*cm).
Conclusions:
- Third-generation dual-source CT scanners provide a higher proportion of diagnostic image quality for high-pitch, non-ECG-gated coronary CTA compared to second-generation scanners.
- Improved image quality with 3G DSCT facilitates confident diagnosis of coronary artery disease, supporting timely clinical management decisions.
Objective:
To examine differences in image quality of the coronary arteries when performing high-pitch non-electrocardiography (ECG)-gated scans on the second-generation (2G) and third-generation (3G) dual-source CT scanners.
Methods:
We retrospectively examined patients with high-pitch non-ECG-gated CT angiography (CTA) of the chest or chest/abdomen/pelvis. Outpatient scans from 59 patients in the 3G high-pitch group and 53 patients in the 2G high-pitch group were included. Two blinded cardiac imagers independently scored the coronary image quality using a 4-point Likert scale (from completely diagnostic to completely non-diagnostic) and evaluated the presence of coronary artery disease.
Results:
Diagnostic image quality of the coronaries in high-pitch CTA exams using 3G scanner was improved compared to 2G scanner, both on a per-vessel basis (45-94% versus 23-86%) and on a per-study basis (34% versus 14%). The 3G group showed a statistically significant improvement in image quality when evaluating the left main coronary, right coronary, and overall coronary arteries. Coronary artery disease was detected in 65% of high-pitch scans. Radiation doses in terms of CTDIvol and DLP were lower for 3G high-pitch scans (7.5 mGy and 491 mGy∗cm) compared to 2G high-pitch scans (14.8 mGy and 911 mGy∗cm).
Conclusions:
We found a higher proportion of diagnostic image quality of the coronary arteries in high-pitch non-ECG-gated CTA exams using a 3G dual-source CT scanner, compared to 2G. In scans with diagnostic image quality, underlying coronary artery disease may be confidently diagnosed and should prompt considerations for further management in the appropriate clinical setting.
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