A comprehensive electrocardiogram-gated 64-slice multidetector computed tomography imaging protocol to visualize the coronary arteries, thoracic aorta, and pulmonary vasculature in a single breath hold.
OBJECTIVE
Advances in computed tomography technology may permit the evaluation of coronary disease, aortic dissection, and pulmonary embolism with a single contrast bolus and breath hold. We sought to determine whether 64-slice computed tomography angiography (CTA) allows for simultaneous visualization of the coronary arteries, thoracic aorta, and pulmonary arteries (coronary, aorta, pulmonary [CAP]) with image quality comparable to routine CTA protocols.


METHODS
We prospectively enrolled 20 patients who underwent CAP CTA. Image quality of CAP CTA was assessed qualitatively and quantitatively and compared with dedicated coronary (n = 20) and pulmonary (n = 10) CTA data sets using matched controls.


RESULTS
The mean amount of contrast and radiation dose was 132 +/- 10 mL and 17.8 +/- 1.8 mSv, 78 +/- 9 mL and 13.7 +/- 3.4 mSv, and 135 mL and 11.9 +/- 1.5 mSv for CAP CTA, coronary CTA, and pulmonary CTA, respectively (P = 0.001). There was no difference in overall image quality (P = 0.88), presence of motion artifacts (P = 0.40), or enhancement of the proximal coronary arteries (median [interquartile range for contrast-noise ratio was 12.5 9.9-15.2 vs 13.1 10.3-16.9; P = 0.17]) or thoracic aorta (264 [113-326] vs 245 [107-295]; P = 0.34) between CAP CTA and the dedicated coronary CTA, respectively. However, contrast attenuation was higher in the pulmonary arteries with CAP CTA (363 [253-424]) versus the standard pulmonary CTA protocol (235 [182-269]; P = 0.0001).


CONCLUSIONS
: Using an individually tailored single contrast injection, CAP CTA permits simultaneous visualization of the coronary arteries, thoracic aorta, and pulmonary arteries with excellent image quality. Further research is necessary to determine whether this protocol may enhance triage of patients with undifferentiated acute chest pain.
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Michael D
MD
Shapiro
Jonathan D
JD
Dodd
Sanjeeva
S
Kalva
Conrad
C
Wittram
Joe
J
Hsu
Khurram
K
Nasir
Bob
B
Liu
John T
JT
Nagurney
Mannudeep K
MK
Kalra
John H
JH
Nichols
Ricardo C
RC
Cury
Suhny
S
Abbara
Ahmed
A
Tawakol
Thomas J
TJ
Brady
Udo
U
Hoffmann
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D016477:Artifacts; D016022:Case-Control Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods*; D015656:Respiratory Mechanics; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media