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Updated: Jan 12, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
A single-session CT angiography protocol for extracoronary vascular abnormality screening in spontaneous coronary
Jacqueline M Visina1,2, Aaron W Aday3,4, Nowrin Haque3,5
1Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
A new single-session computed tomography angiography (CTA) protocol significantly reduces radiation and contrast exposure for patients with spontaneous coronary artery dissection (SCAD). This efficient imaging method effectively detects extracoronary vascular abnormalities (EVAs) without compromising diagnostic accuracy.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Vascular Medicine
Background:
- Extracoronary vascular abnormalities (EVAs) are frequently observed in patients diagnosed with spontaneous coronary artery dissection (SCAD).
- Current expert recommendations advocate for comprehensive head-to-pelvis imaging, but a standardized protocol is lacking, hindering consistent clinical application.
- This study addresses the need for an optimized imaging approach to minimize patient exposure.
Purpose of the Study:
- To implement and evaluate a high-fidelity, single-session, head-to-pelvis computed tomography angiography (CTA) protocol for patients with SCAD.
- To compare radiation dose and contrast volume against a multi-session CTA (MS-CTA) approach.
- To assess the efficacy of the single-session CTA (SS-CTA) protocol in detecting EVAs.
Main Methods:
- A cohort of 97 consecutive SCAD patients underwent the SS-CTA protocol.
- A comparison group of 63 SCAD patients received MS-CTA.
- Primary outcomes measured were total radiation dose and contrast volume; secondary outcome was EVA prevalence.
Main Results:
- The SS-CTA protocol demonstrated a 24% reduction in radiation dose and a 21% reduction in contrast volume compared to MS-CTA.
- No significant difference was observed in the prevalence of detected EVAs between the two protocols (55.7% vs 57.1%).
- Baseline characteristics and SCAD presentation were similar between groups.
Conclusions:
- A single-acquisition CTA protocol is effective for detecting EVAs in SCAD patients, significantly reducing radiation and contrast exposure.
- The SS-CTA protocol offers a valuable, lower-exposure imaging solution for SCAD patients who may need repeated scans.
- Further research is warranted to assess the impact of wider SS-CTA protocol adoption on adherence to clinical guidelines.
Introduction:
Extracoronary vascular abnormalities (EVAs) are common in patients with spontaneous coronary artery dissection (SCAD), and expert consensus statements recommend evaluation with head-to-pelvis cross-sectional imaging. Lack of a universal imaging protocol remains a barrier to consistent implementation of this recommendation. We sought to implement a high-fidelity, single-session, head-to-pelvis computed tomography angiography (CTA) protocol that minimizes radiation and contrast exposure compared to multisession CTA.
Methods:
A total of 97 consecutive patients with SCAD were evaluated with a single-session CTA (SS-CTA protocol). The comparison group consisted of 63 consecutive patients who underwent asynchronous CTA of different body segments (MS-CTA). The primary outcome was total radiation dose and contrast volume in each imaging protocol. The secondary outcome was prevalence of EVAs.
Results:
There was no difference in baseline characteristics, SCAD presentation, or management between groups. The SS-CTA protocol had a 24% lower radiation dose (1873 ± 676 mGy-cm vs 2452 ± 1099 mGy-cm, p < 0.001) and a 21% lower contrast volume (161.2 ± 48.7 mL vs 203.8 ± 68.4 mL, p < 0.001) compared to the MS-CTA protocol. There was no significant difference in the prevalence of EVAs detected between imaging groups (55.7% vs 57.1%, p = 0.854).
Conclusion:
This study demonstrates the effectiveness of a single-acquisition CTA protocol for EVA detection in patients with SCAD. The SS-CTA protocol minimized radiation and contrast exposure for a patient population that may require frequent imaging over the lifespan. Further studies are needed to determine whether expanded availability of this protocol would improve adherence to expert consensus recommendations.
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