title: Influence of trigger type, tube voltage and heart rate on calcified plaque imaging in dual source cardiac computed tomography: phantom study.
abstract: BACKGROUND
  To investigate the impact of high pitch cardiac CT vs. retrospective ECG gated CT on the quantification of calcified vessel stenoses, with assessment of the influence of tube voltage, reconstruction kernel and heart rate.
  
  
  METHODS
  A 4D cardiac movement phantom equipped with three different plaque phantoms (12.5%, 25% and 50% stenosis at different calcification levels), was scanned with a 128-row dual source CT scanner, applying different trigger types (gated vs. prospectively triggered high pitch), tube voltages (100-120 kV) and heart rates (50-90 beats per minute, bpm). Images were reconstructed using different standard (B26f, B46f, B70f) and iterative (I26f, I70f) convolution kernels. Absolute and relative plaque sizes were measured and statistically compared. Radiation dose associated with the different methods (gated vs. high pitch, 100 kV vs. 120 kV) were compared.
  
  
  RESULTS
  Compared to the known diameters of the phantom plaques and vessels both CT-examination techniques overestimated the degrees of stenoses. Using the high pitch CT-protocol plaques appeared larger (0.09 ± 0.31 mm, 2 ± 8 percent points, PP) in comparison to the ECG-gated CT-scans. Reducing tube voltage had a similar effect, resulting in higher grading of the same stenoses by 3 ± 8 PP. In turn, sharper convolution kernels lead to a lower grading of stenoses (differences of up to 5%). Pairwise comparison of B26f and I26f, B46f and B70f, and B70f and I70f showed differences of 0-1 ± 6-8 PP of the plaque depiction. Motion artifacts were present only at 90 bpm high pitch experiments. High-pitch protocols were associated with significantly lower radiation doses compared with the ECG-gated protocols (258.0 mGy vs. 2829.8 mGy CTDIvol, p ≤ 0.0001).
  
  
  CONCLUSIONS
  Prospectively triggered high-pitch cardiac CT led to an overestimation of plaque diameter and degree of stenoses in a coronary phantom. This overestimation is only slight and probably negligible in a clinical situation. Even at higher heart rates high pitch CT-scanning allowed reliable measurements of plaque and vessel diameters with only slight differences compared ECG-gated protocols, although motion artifacts were present at 90 bpm using the high pitch protocols.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Pauwelsstr, 30, 52074 Aachen, Germany. tpenzkofer@ukaachen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Penzkofer
authors.forename: Eva
authors.initials: E
authors.lastname: Donandt
authors.forename: Peter
authors.initials: P
authors.lastname: Isfort
authors.forename: Thomas
authors.initials: T
authors.lastname: Allmendinger
authors.forename: Christiane K
authors.initials: CK
authors.lastname: Kuhl
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mahnken
authors.forename: Philipp
authors.initials: P
authors.lastname: Bruners
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D004562:Electrocardiography / Q000379:methods*; D056973:Four-Dimensional Computed Tomography / Q000295:instrumentation / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D061205:Vascular Calcification / Q000000981:diagnostic imaging*