title: Comparison of diagnostic accuracy and radiation dose between prospective triggering and retrospective gated coronary angiography by dual-source computed tomography.
abstract: The purpose of this study was to evaluate and compare the diagnostic accuracy and radiation dose of dual-source computed tomographic (DSCT) coronary angiography for assessment of coronary artery disease using prospective electrocardiographic triggering and retrospective electrocardiographically (ECG) gated spiral scans. One hundred sixteen patients who had undergone dual-source computed tomography and conventional coronary angiography were enrolled in this study. Fifty-four patients were scanned using retrospective ECG-gated protocols (group 1) and 62 patients using prospective ECG-triggered protocols (group 2). Diagnostic accuracy, image quality, and effective dose were compared between groups 1 and 2. Conventional coronary angiography was used as the reference standard. In total 1,709 (98.2%) coronary segments in the 116 patients were assessable with adequate image quality. Sensitivities and specificities of diagnosing coronary heart disease (≥50% stenosis) in a patient-based analysis of DSCT data were 93.3% and 88.9% in group 1 and 96.4% and 85.7% in group 2, respectively (p=0.973 and 0.761). In vessel-based analysis, sensitivities and specificities were 77.4% and 94.1% in group 1 and 79.6% and 92.3% in group 2 (p=0.983 and 0.985). Overall averaged image quality scores (using 1- to 4-point scale) in groups 1 and 2 were 3.3 ± 0.4 and 3.5 ± 0.9, respectively (p=0.268). Prevalence of good (score 3.0) and excellent (score 4.0) image qualities of coronary vessels were 95.4% in group 1 and 92.4% in group 2 (p = 0.861). Effective doses were 8.82 ± 3.50 mSv (range 3.92 to 15.36) in group 1 and 2.95 ± 1.39 mSv (range 0.99 to 6.06) in group 2 (p<0.001). In conclusion, DSCT prospective ECG-triggered coronary angiography has equivalent image quality and diagnostic value compared to that of retrospective ECG-gated scans. Radiation dose was significantly decreased using prospective electrocardiographic triggering.
authors.affiliation: Department of Radiology, Division of Coronary Heart Disease, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China. blu@vip.sina.com
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
authors.forename: Jin-Guo
authors.initials: JG
authors.lastname: Lu
authors.forename: Ming-Li
authors.initials: ML
authors.lastname: Sun
authors.forename: Zhi-Hui
authors.initials: ZH
authors.lastname: Hou
authors.forename: Xiong-Biao
authors.initials: XB
authors.lastname: Chen
authors.forename: Xiang
authors.initials: X
authors.lastname: Tang
authors.forename: Run-Ze
authors.initials: RZ
authors.lastname: Wu
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.forename: Shu-Bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Yue-Jin
authors.initials: YJ
authors.lastname: Yang
authors.forename: Shi-Liang
authors.initials: SL
authors.lastname: Jiang
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed