title: Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study.
abstract: In this study, we sought to evaluate the image quality and effective radiation dose of prospectively ECG-triggered adaptive systolic (PTA-systolic) dual-source CTA versus prospectively triggered adaptive diastolic (PTA-diastolic) dual-source CTA in patients of unselected heart rate and rhythm. This retrospective cohort study consisted of 41 PTA-systolic and 41 matched PTA-diastolic CTA patients whom underwent clinically indicated 128-slice dual source CTA between December 2010 to June 2012. Image quality and motion artifact score (both on a Likert scale 1-4 with 4 being the best), effective dose, and CTDIvol were compared. The effect of heart rate (HR) and heart rate variability [HRV] on image motion artifact score and CTDIvol was analyzed with Pearson's correlation coefficient. All 82 exams were considered diagnostic with 0 non-diagnostic segments. PTA-systolic CTA patients had a higher maximum HR, wider HRV, were less likely to be in sinus rhythm, and received less beta-blocker vs. PTA-diastolic CTA patients. No difference in effective dose was observed (PTA-systolic vs. PTA-diastolic CTA: 2.9 vs. 2.2 mSv, p = 0.26). Image quality score (3.3 vs. 3.5, p < 0.05) and motion artifact score (3.5 vs. 3.8, p < 0.05) were lower in PTA-systolic CTAs than in PTA-diastolic CTAs. For PTA-systolic CTAs, an increase in HR was not associated with a negative impact on motion artifact score nor CTDIvol. For PTA-diastolic CTA, an increase in HR was associated with increased motion artifacts and CTDIvol. HRV demonstrated no correlation with motion artifact and CTDIvol for both PTA-systolic and PTA-diastolic CTAs. In conclusion, both PTA-diastolic CTA and PTA-systolic CTA yielded diagnostic examinations at unselected heart rates and rhythms with similar effective radiation, but PTA-systolic CTA resulted in more consistent radiation exposure and image quality across a wide range of rates and rhythms.
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. amlee@partners.org
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lee
authors.forename: Jonathan
authors.initials: J
authors.lastname: Beaudoin
authors.forename: Leif-Christopher
authors.initials: LC
authors.lastname: Engel
authors.forename: Manavjot S
authors.initials: MS
authors.lastname: Sidhu
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000503:physiopathology; D016477:Artifacts; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013599:Systole