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Erschienen in: European Radiology 3/2013

01.03.2013 | Computed Tomography

Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols

verfasst von: Lisan A. Neefjes, Alexia Rossi, Tessa S. S. Genders, Koen Nieman, Stella L. Papadopoulou, Anoeshka S. Dharampal, Carl J. Schultz, Annick C. Weustink, Marcel L. Dijkshoorn, Gert-Jan R. ten Kate, Admir Dedic, Marcel van Straten, Filippo Cademartiri, M. G. Myriam Hunink, Gabriël P. Krestin, Pim J. de Feyter, Nico R. Mollet

Erschienen in: European Radiology | Ausgabe 3/2013

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Abstract

Objectives

To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction.

Methods

We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients.

Results

In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P = 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P > 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv, P < 0.001). In group B (228 patients, 132 men, mean heart rate 75 ± 11 bpm), per-segment sensitivity, specificity, PPV and NPV were comparable (94 %, 95 %, 67 %, 99 % vs. 92 %, 95 %, 66 %, 99 %, P > 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv, P < 0.001). Diagnostic performance was comparable in both groups.

Conclusion

Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose.

Key Points

128-slice dual-source CT coronary angiography offers several different acquisition protocols.
Randomized comparison of protocols reveals an optimal protocol selection strategy.
Appropriate CTCA protocol selection lowers radiation dose, while maintaining high quality.
CTCA protocol selection should be based on individual patient characteristics.
A prospective sequential protocol is preferred for CTCA.
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Metadaten
Titel
Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols
verfasst von
Lisan A. Neefjes
Alexia Rossi
Tessa S. S. Genders
Koen Nieman
Stella L. Papadopoulou
Anoeshka S. Dharampal
Carl J. Schultz
Annick C. Weustink
Marcel L. Dijkshoorn
Gert-Jan R. ten Kate
Admir Dedic
Marcel van Straten
Filippo Cademartiri
M. G. Myriam Hunink
Gabriël P. Krestin
Pim J. de Feyter
Nico R. Mollet
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 3/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2663-3

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