title: Low-dose coronary computed tomography angiography using prospective ECG-triggering compared to invasive coronary angiography.
abstract: To assess the diagnostic accuracy of prospective ECG-triggering 64-slice multidetector computed tomography (MDCT) coronary angiography for evaluation of coronary artery disease (CAD). Forty-two patients (31 males, 11 females, mean age 64 years) underwent cardiac CT and invasive coronary angiography (ICA). Patients with a heart rate of <65 beats/min with stable heart rhythm were included in the study sample. We used a prospective ECG-triggering protocol. Luminal narrowing over 50% was considered to be significant according to a modified 17-segment AHA model, using invasive coronary angiography (ICA) as the standard of reference. The mean radiation dose was 3.5 mSv ± 0.3 (range, 3.3-4.2 mSv), and 542 of 549 segments (98.7%) in the 42 patients were diagnostic. In contrast, 119 of 542 segments (22%) were diagnosed as significant by ICA. The sensitivity, specificity, accuracy, PPV and NPV were 95.0, 96.2, 96, 85.8 and 98.8%, respectively. False positive results were affected by densely calcified plaques, whereas false negatives were caused by motion artifact with poor vessel attenuation at the distal segments or near the bifurcation area of the coronary arteries. Prospective ECG-triggering MDCT is a useful method for evaluating CAD in patients with a lower heart rate with low radiation dose.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Phil Ki
authors.initials: PK
authors.lastname: Min
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.forename: Byung Kwon
authors.initials: BK
authors.lastname: Lee
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000368:Aged; D016477:Artifacts; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D055424:Cardiac-Gated Imaging Techniques; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D015203:Reproducibility of Results; D056910:Republic of Korea; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed