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.
Shapiro
Michael D
MD
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Dodd
Jonathan D
JD
Kalva
Sanjeeva
S
Wittram
Conrad
C
Hsu
Joe
J
Nasir
Khurram
K
Liu
Bob
B
Nagurney
John T
JT
Kalra
Mannudeep K
MK
Nichols
John H
JH
Cury
Ricardo C
RC
Abbara
Suhny
S
Tawakol
Ahmed
A
Brady
Thomas J
TJ
Hoffmann
Udo
U
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