title: Pulmonary venous anatomy imaging with low-dose, prospectively ECG-triggered, high-pitch 128-slice dual-source computed tomography.
abstract: BACKGROUND
  The efforts to reduce radiation from cardiac computed tomography (CT) are essential. Using a prospectively triggered, high-pitch dual-source CT protocol, we aim to determine the radiation dose and image quality in patients undergoing pulmonary vein (PV) imaging.
  
  
  RESULTS
  In 94 patients (61±9 years; 71% male) who underwent 128-slice dual-source CT (pitch 3.4), radiation dose and image quality were assessed and compared between 69 patients with sinus rhythm and 25 patients with atrial fibrillation. Radiation dose was compared in a subset of 19 patients with prior retrospective or prospectively triggered CT PV scans without high pitch. In a subset of 18 patients with prior magnetic resonance imaging for PV assessment, PV anatomy and scan duration were compared with high-pitch CT. Using the high-pitch protocol, total effective radiation dose was 1.4 (1.3, 1.9) mSv, with no difference between sinus rhythm and atrial fibrillation (1.4 versus 1.5 mSv; P=0.22). No high-pitch CT scans were nondiagnostic or had poor image quality. Radiation dose was reduced with high-pitch (1.6 mSv) compared with standard protocols (19.3 mSv; P<0.0001). This radiation dose reduction was seen with sinus rhythm (1.5 versus 16.7 mSv; P<0.0001) but was more profound with atrial fibrillation (1.9 versus 27.7 mSv; P=0.039). There was excellent agreement of PV anatomy (κ 0.84; P<0.0001) and a shorter CT scan duration (6 minutes) compared with magnetic resonance imaging (41 minutes; P<0.0001).
  
  
  CONCLUSIONS
  Using a high-pitch dual-source CT protocol, PV imaging can be performed with minimal radiation dose, short scan acquisition, and excellent image quality in patients with sinus rhythm or atrial fibrillation. This protocol highlights the success of new cardiac CT technology to minimize radiation exposure, giving clinicians a new low-dose imaging alternative to assess PV anatomy.
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Wai-ee
authors.initials: WE
authors.lastname: Thai
authors.forename: Bryan
authors.initials: B
authors.lastname: Wai
authors.forename: Kaity
authors.initials: K
authors.lastname: Lin
authors.forename: Teresa
authors.initials: T
authors.lastname: Cheng
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D036542:Tomography, Spiral Computed / Q000379:methods*