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Prospectively versus retrospectively ECG-gated 256-slice coronary CTA

Philips CT Clinical Science Philips Healthcare • USA

Image quality and radiation dose over expanded heart rates

Hou Y, Yue Y, Guo W, Feng G, Yu T, Li G, Vembar M, Olszewski ME, Guo Q.

Department of Radiology, Shengjing Hospital of China, Medical University, Liaoning Province, People's Republic of China.

*Published online December 14, 2010 in the International Journal of Cardiovascular Imaging.

To compare image quality and radiation dose estimates for coronary computed tomography angiography (CCTA) obtained with a prospectively gated transaxial (PGT) CT technique and a retrospectively gated helical (RGH) CT technique using a 256-slice multidetector CT (MDCT) scanner and establish an upper limit of heart rate to achieve reliable diagnostic image quality using PGT. 200 patients (135 males, 65 females) with suspected coronary artery disease (CAD) underwent CCTA on a 256-slice MDCT scanner. The PGT patients were enrolled prospectively from January to June, 2009. For each PGT patient, we found the paired ones in retrospective-gating patients database and randomly selected one patient in these match cases and built up the RGH group. Image quality for all coronary segments was assessed and compared between the two groups using a 4-point scale (1: non-diagnostic; 4: excellent). Effective radiation doses were also compared. The average heart rate ± standard deviation (HR ± SD) between the two groups was not significantly different (PGT: 64.6 ± 12.9 bpm, range 45-97 bpm; RGH: 66.7 ± 10.9 bpm, range 48-97 bpm, P = 0.22). A receiver-operating characteristic (ROC) analysis determined a cutoff HR of 75 bpm up to which diagnostic image quality could be achieved using the PGT technique (P < 0.001). There were no significant differences in assessable coronary segments between the two groups for HR ≤ 75 bpm (PGT: 99.9% [961 of 962 segments]; RGH: 99.8% [1038 of 1040 segments]; P = 1.0). At HR > 75 bpm, the performance of the PGT technique was affected, resulting in a moderate reduction of percentage assessable coronary segments using this approach (PGT: 95.5% [323 of 338 segments]; RGH: 98.5% [261 of 265 segments]; P = 0.04). The mean estimated effective radiation dose for the PGT group was 3.0 ± 0.7 mSv, representing reduction of 73% compared to that of the RGH group (11.1 ± 1.6 mSv) (P < 0.001). Prospectively-gated axial coronary computed tomography using a 256-slice multidetector CT scanner with a 270 ms tube rotation time enables a significant reduction in effective radiation dose while simultaneously providing image quality comparable to the retrospectively gated helical technique. Our experience demonstrates the applicability of this technique over a wider range of heart rates (up to 75 bpm) than previously reported.
For more information about this publication, check out the PubMed listing for this article.

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Nov 14, 2011

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Cardiac, coronary angiography, coronary artery disease, dose, Extended Brilliance Workspace 4.0, image quality, prospective, prospective gating, retrospective

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