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Erschienen in: European Radiology 9/2009

01.09.2009 | Cardiac

Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques

verfasst von: Elisabeth Arnoldi, Thorsten R. Johnson, Carsten Rist, Bernd J. Wintersperger, Wieland H. Sommer, Alexander Becker, Christoph R. Becker, Maximilian F. Reiser, Konstantin Nikolaou

Erschienen in: European Radiology | Ausgabe 9/2009

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Abstract

The goal of our study was to compare a prospective triggering (PT) CT technique with retrospectively gated (RG) CT techniques in coronary computed tomographic angiograms (CCTA) with respect to image quality and radiation dose. Sixty consecutive patients were enrolled. CCTAs using the RG technique were obtained with a dual-source 64-slice CT system in 40 patients, using ECG-triggered tube current modulation, with either a broad pulsing window at 30–80% of the RR interval (group RGb, 20 patients, heart rate > 70 bpm) or a small pulsing window at 70% (group RGs, 20 patients, heart rate < 70 bpm). The other 20 patients underwent CCTA using the PT technique on a 128-slice CT system (group PT, heart rate < 70 bpm). All images were evaluated by two observers for quality on a three-point scale, with 1 being excellent and 3 being insufficient. The effective radiation dose was calculated for each patient. The average image quality score was 1.5 ± 0.6 for PT, 1.35 ± 0.5 for RGs and 1.65 ± 0.5 for RGb. The mean effective dose for RGb was 9 ± 4 mSv, for RGs 7 ± 3 mSv and for PT 3 ± 1 mSv. This represents a 57% dose reduction for PT compared with RGs and a 67% dose reduction for PT compared with RGb. In conclusion, in selected patients CCTA with the PT technique offers adequate image quality with a significantly lower radiation dose compared with CCTA using RG techniques.
Literatur
1.
Zurück zum Zitat Busch S, Johnson TR, Nikolaou K et al (2007) Visual and automatic grading of coronary artery stenoses with 64-slice CT angiography in reference to invasive angiography. Eur Radiol 17:1445–1451PubMedCrossRef Busch S, Johnson TR, Nikolaou K et al (2007) Visual and automatic grading of coronary artery stenoses with 64-slice CT angiography in reference to invasive angiography. Eur Radiol 17:1445–1451PubMedCrossRef
2.
Zurück zum Zitat Johnson TR, Nikolaou K, Busch S et al (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691PubMedCrossRef Johnson TR, Nikolaou K, Busch S et al (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691PubMedCrossRef
3.
Zurück zum Zitat Leber AW, Johnson T, Becker A et al (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28:2354–2360PubMedCrossRef Leber AW, Johnson T, Becker A et al (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28:2354–2360PubMedCrossRef
4.
Zurück zum Zitat Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487PubMedCrossRef Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487PubMedCrossRef
5.
Zurück zum Zitat Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef
6.
Zurück zum Zitat Nikolaou K, Knez A, Rist C et al (2006) Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. AJR Am J Roentgenol 187:111–117PubMedCrossRef Nikolaou K, Knez A, Rist C et al (2006) Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. AJR Am J Roentgenol 187:111–117PubMedCrossRef
7.
Zurück zum Zitat Nikolaou K, Rist C, Wintersperger BJ et al (2006) Clinical value of MDCT in the diagnosis of coronary artery disease in patients with a low pretest likelihood of significant disease. AJR Am J Roentgenol 186:1659–1668PubMedCrossRef Nikolaou K, Rist C, Wintersperger BJ et al (2006) Clinical value of MDCT in the diagnosis of coronary artery disease in patients with a low pretest likelihood of significant disease. AJR Am J Roentgenol 186:1659–1668PubMedCrossRef
8.
Zurück zum Zitat Brenner DJ, Hall EJ (2007) Computed tomography-an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRef Brenner DJ, Hall EJ (2007) Computed tomography-an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRef
9.
Zurück zum Zitat Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323PubMedCrossRef Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323PubMedCrossRef
10.
Zurück zum Zitat Alkadhi H, Stolzmann P, Scheffel H et al (2008) Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters. Eur J Radiol 68(3):385–391PubMedCrossRef Alkadhi H, Stolzmann P, Scheffel H et al (2008) Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters. Eur J Radiol 68(3):385–391PubMedCrossRef
11.
Zurück zum Zitat Stolzmann P, Scheffel H, Schertler T et al (2008) Radiation dose estimates in dual-source computed tomography coronary angiography. Eur Radiol 18:592–599PubMedCrossRef Stolzmann P, Scheffel H, Schertler T et al (2008) Radiation dose estimates in dual-source computed tomography coronary angiography. Eur Radiol 18:592–599PubMedCrossRef
12.
Zurück zum Zitat Hausleiter J, Meyer T, Hadamitzky M et al (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113:1305–1310PubMedCrossRef Hausleiter J, Meyer T, Hadamitzky M et al (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113:1305–1310PubMedCrossRef
13.
Zurück zum Zitat Coles DR, Smail MA, Negus IS et al (2006) Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 47:1840–1845PubMedCrossRef Coles DR, Smail MA, Negus IS et al (2006) Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 47:1840–1845PubMedCrossRef
14.
Zurück zum Zitat Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791PubMedCrossRef Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791PubMedCrossRef
15.
Zurück zum Zitat Husmann L, Valenta I, Gaemperli O et al (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197PubMedCrossRef Husmann L, Valenta I, Gaemperli O et al (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197PubMedCrossRef
16.
Zurück zum Zitat Earls JP, Berman EL, Urban BA et al (2008) Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology 246:742–753PubMedCrossRef Earls JP, Berman EL, Urban BA et al (2008) Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology 246:742–753PubMedCrossRef
17.
Zurück zum Zitat Hirai N, Horiguchi J, Fujioka C et al (2008) Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology 248:424–430PubMedCrossRef Hirai N, Horiguchi J, Fujioka C et al (2008) Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology 248:424–430PubMedCrossRef
18.
Zurück zum Zitat Shuman WP, Branch KR, May JM et al (2008) Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 248:431–437PubMedCrossRef Shuman WP, Branch KR, May JM et al (2008) Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 248:431–437PubMedCrossRef
19.
Zurück zum Zitat Scheffel H, Alkadhi H, Leschka S et al (2008) Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 94:1132–1137PubMedCrossRef Scheffel H, Alkadhi H, Leschka S et al (2008) Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 94:1132–1137PubMedCrossRef
20.
Zurück zum Zitat Herzog BA, Husmann L, Burkhard N et al (2008) Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience. Eur Heart J 29:3037–3042PubMedCrossRef Herzog BA, Husmann L, Burkhard N et al (2008) Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience. Eur Heart J 29:3037–3042PubMedCrossRef
21.
Zurück zum Zitat Klass O, Jeltsch M, Feuerlein S et al (2008) Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique. Eur Radiol 19(4):829–836PubMedCrossRef Klass O, Jeltsch M, Feuerlein S et al (2008) Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique. Eur Radiol 19(4):829–836PubMedCrossRef
22.
Zurück zum Zitat Nakaura T, Awai K, Yauaga Y et al (2008) Contrast injection protocols for coronary computed tomography angiography using a 64-detector scanner: comparison between patient weight-adjusted- and fixed iodine-dose protocols. Invest Radiol 43:512–519PubMedCrossRef Nakaura T, Awai K, Yauaga Y et al (2008) Contrast injection protocols for coronary computed tomography angiography using a 64-detector scanner: comparison between patient weight-adjusted- and fixed iodine-dose protocols. Invest Radiol 43:512–519PubMedCrossRef
23.
Zurück zum Zitat Flohr TG, Stierstorfer K, Ulzheimer S et al (2005) Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot. Med Phys 32:2536–2547PubMedCrossRef Flohr TG, Stierstorfer K, Ulzheimer S et al (2005) Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot. Med Phys 32:2536–2547PubMedCrossRef
24.
Zurück zum Zitat Scanlon PJ, Faxon DP, Audet AM et al (1999) ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 33:1756–1824PubMedCrossRef Scanlon PJ, Faxon DP, Audet AM et al (1999) ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 33:1756–1824PubMedCrossRef
25.
Zurück zum Zitat Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 228:15–21PubMedCrossRef Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 228:15–21PubMedCrossRef
26.
Zurück zum Zitat Leschka S, Scheffel H, Desbiolles L et al (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol 42:543–549PubMedCrossRef Leschka S, Scheffel H, Desbiolles L et al (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol 42:543–549PubMedCrossRef
27.
Zurück zum Zitat Wintersperger BJ, Nikolaou K, von Ziegler F et al (2006) Image quality, motion artifacts, and reconstruction timing of 64-slice coronary computed tomography angiography with 0.33-second rotation speed. Invest Radiol 41:436–442PubMedCrossRef Wintersperger BJ, Nikolaou K, von Ziegler F et al (2006) Image quality, motion artifacts, and reconstruction timing of 64-slice coronary computed tomography angiography with 0.33-second rotation speed. Invest Radiol 41:436–442PubMedCrossRef
28.
Zurück zum Zitat Stolzmann P, Scheffel H, Trindade PT et al (2008) Left ventricular and left atrial dimensions and volumes: comparison between dual-source CT and echocardiography. Invest Radiol 43:284–289PubMedCrossRef Stolzmann P, Scheffel H, Trindade PT et al (2008) Left ventricular and left atrial dimensions and volumes: comparison between dual-source CT and echocardiography. Invest Radiol 43:284–289PubMedCrossRef
29.
Zurück zum Zitat Alkadhi H, Desbiolles L, Husmann L et al (2007) Aortic regurgitation: assessment with 64-section CT. Radiology 245:111–121PubMedCrossRef Alkadhi H, Desbiolles L, Husmann L et al (2007) Aortic regurgitation: assessment with 64-section CT. Radiology 245:111–121PubMedCrossRef
30.
Zurück zum Zitat Alkadhi H, Wildermuth S, Plass A et al (2006) Aortic stenosis: comparative evaluation of 16-detector row CT and echocardiography. Radiology 240:47–55PubMedCrossRef Alkadhi H, Wildermuth S, Plass A et al (2006) Aortic stenosis: comparative evaluation of 16-detector row CT and echocardiography. Radiology 240:47–55PubMedCrossRef
31.
Zurück zum Zitat Jakobs TF, Becker CR, Ohnesorge B et al (2002) Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol 12:1081–1086PubMedCrossRef Jakobs TF, Becker CR, Ohnesorge B et al (2002) Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol 12:1081–1086PubMedCrossRef
32.
Zurück zum Zitat Abada HT, Larchez C, Daoud B et al (2006) MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose. AJR Am J Roentgenol 186:S387–390PubMedCrossRef Abada HT, Larchez C, Daoud B et al (2006) MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose. AJR Am J Roentgenol 186:S387–390PubMedCrossRef
33.
Zurück zum Zitat Hermann F, Martinoff S, Meyer T et al (2008) Reduction of radiation dose estimates in cardiac 64-slice CT angiography in patients after coronary artery bypass graft surgery. Invest Radiol 43:253–260PubMedCrossRef Hermann F, Martinoff S, Meyer T et al (2008) Reduction of radiation dose estimates in cardiac 64-slice CT angiography in patients after coronary artery bypass graft surgery. Invest Radiol 43:253–260PubMedCrossRef
34.
Zurück zum Zitat Deetjen A, Mollmann S, Conradi G et al (2007) Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography. Heart 93:1040–1043PubMedCrossRef Deetjen A, Mollmann S, Conradi G et al (2007) Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography. Heart 93:1040–1043PubMedCrossRef
35.
Zurück zum Zitat Achenbach S, Anders K, Kalender WA (2008) Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 18:1188–1198PubMedCrossRef Achenbach S, Anders K, Kalender WA (2008) Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 18:1188–1198PubMedCrossRef
Metadaten
Titel
Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques
verfasst von
Elisabeth Arnoldi
Thorsten R. Johnson
Carsten Rist
Bernd J. Wintersperger
Wieland H. Sommer
Alexander Becker
Christoph R. Becker
Maximilian F. Reiser
Konstantin Nikolaou
Publikationsdatum
01.09.2009
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 9/2009
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1411-9

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