Related Experiment Video
Updated: Aug 4, 2025
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Comparison of First-generation and Third-generation Dual-source Computed Tomography for Detecting Coronary Artery
Matthias Renker1,2,3, Robert Steinbach1, U Joseph Schoepf4
1Departments of Cardiology.
Insights
Third-generation dual-source computed tomography (DSCT) offers superior coronary artery evaluation before transcatheter aortic valve replacement compared to first-generation DSCT. This advanced technology provides better image quality with reduced contrast and radiation, improving diagnostic performance for coronary artery disease (CAD).
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Transcatheter aortic valve replacement (TAVI) requires accurate pre-procedural assessment of coronary arteries.
- Dual-source computed tomography (DSCT) is utilized for coronary artery disease (CAD) evaluation.
- Advancements in DSCT technology aim to improve image quality and diagnostic accuracy.
Purpose of the Study:
- To compare the image quality and diagnostic performance of first-generation (64-slice) versus third-generation (192-slice) DSCT for CAD detection.
- To evaluate the feasibility of routine coronary artery imaging prior to TAVI using different DSCT generations.
Main Methods:
- Retrospective analysis of 192 patients undergoing pre-TAVI CT angiography.
- Comparison between first-generation DSCT (n=96) and third-generation DSCT (n=96) groups.
- Assessment of subjective and objective image quality, diagnostic accuracy, sensitivity, specificity, and predictive values against invasive coronary angiography as the reference standard.
Main Results:
- Third-generation DSCT demonstrated significantly better subjective and objective image quality.
- Diagnostic accuracy, specificity, and positive/negative predictive values for CAD detection were significantly higher with third-generation DSCT.
- Third-generation DSCT utilized significantly lower contrast media volumes and radiation doses.
Conclusions:
- Third-generation DSCT is superior to first-generation DSCT for coronary artery evaluation before TAVI.
- This advanced technology enables improved diagnostic performance with reduced contrast and radiation exposure.
- Coronary CT angiography using third-generation DSCT is a feasible and effective tool for pre-TAVI assessment.
Purpose:
This study compared image quality and evaluability of coronary artery disease (CAD) in routine preparatory imaging for transcatheter aortic valve replacement using 64-slice (first-generation) to 192-slice (third-generation) dual-source computed tomography(DSCT).
Materials And Methods:
The CT data sets of 192 patients (122 women, median age 82 y) without severe renal dysfunction or known CAD were analyzed retrospectively. Half were examined using first-generation DSCT (June 2014 to February 2016) and the other half with third-generation DSCT (April 2016 to April 2017). Per protocol, contrast material (110 [110 to 120] vs. 70 [70 to 70] mL, P <0.001) and radiation dose of multiphasic retrospectively gated thoracic CT angiography (dose-length-product, 1001 [707 to 1312] vs. 727 [474 to 1369] mGy×cm, P <0.001) were significantly lower with third-generation DSCT. Significant CAD was defined as CAD-RADS ≥4 by CT. Invasive coronary angiography served as the reference standard (CAD is defined as ≥70% stenosis or fractional flow reserve ≤0.80).
Results:
In comparison with first-generation DSCT, third-generation DSCT showed significantly better subjective (3 [interquartile range 2 to 3] vs. 4 [3 to 4.25] on a 5-point scale, P <0.001) and objective image quality (signal-to-noise ratio of left coronary artery 12.8 [9.9 to 16.4] vs. 15.2 [12.4 to 19.0], P <0.001). Accuracy (72.9% vs. 91.7%, P =0.001), specificity (59.7% vs. 88.3%, P <0.001), positive (61.0% vs. 83.3%, P <0.001), and negative predictive value (91.9% vs. 98.2%, P =0.045) for detecting CAD per-patient were significantly better using third-generation DSCT, while sensitivity was similar (92.3% vs. 97.2%, P =0.129).
Conclusions:
Coronary artery evaluation with CT angiography before TAVI is feasible in selected patients. Compared with first-generation DSCT, state-of-the-art third-generation DSCT technology is superior for this purpose, allowing for less contrast medium and radiation dose while providing better image quality and improved diagnostic performance.
More Related Videos
09:57Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
09:32Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
Published on: December 9, 2021
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Imaging Studies III: Computed Tomography
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:24Cardiac Catheterization III: Left Heart Catheterization