title: Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries.
abstract: OBJECTIVE
  To explore the feasibility and diagnostic accuracy of a combined one-step high-pitch dual-source computed tomography angiography (CTA) technique for evaluation of coronary and carotid-cerebrovascular arteries.
  
  
  METHODS
  85 symptomatic patients suspected of coronary artery and cerebrovascular disease referred for simultaneous coronary and carotid-cerebrovascular CTA were included. Additional invasive angiography of the coronary and cerebral arteries was performed within 30 days in 23 and 13 patients, respectively. The objective parameters of image quality, the mean CT attenuations, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. The subjective image quality of vessels was also assessed by 2 independent radiologists blinded to the patients' medical history and scan protocols. The diagnostic performance of CTA including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection or exclusion of significant artery stenosis was calculated using the chi-squared test of contingency and correlated with the results of invasive angiography representing the standard of reference.
  
  
  RESULTS
  Image quality was rated excellent (score 1) in 95.3% (1074/1127), good (score 2) in 3.3% (37/1127), adequate (score 3) in 1.0% (11/1127), and non-diagnostic (score 4) in 0.4% (5/1127) of coronary segments. Image quality of carotid and cerebral vessels was rated mostly excellent (score 1, 95.12% [78/82]; score 2, 3.66% [3/82]; score 3, 1.22% [1/82]). The sensitivity, specificity, PPV and NPV for the detection of coronary stenosis were 92.2% (81.1-97.7%), 95.2% (91.7-97.5%), 79.6% (67.1-89.1%) and 98.3% (95.8-99.5%), respectively. For the detection of carotid and cerebral artery stenosis, CTA demonstrated a sensitivity of 92.8% (80.5-98.4%), a specificity of 93.5% (88.3-96.8%), a PPV of 79.6% (65.6-89.7%) and a NPV of 97.9% (94.1-99.5%). The effective radiation dose was 1.42±0.44mSv (range, 0.88-3.35mSv).
  
  
  CONCLUSIONS
  Dual-source CT with a one-step high-pitch scan protocol for combined coronary and carotid-cerebrovascular CTA provides good image quality and a high diagnostic accuracy for the simultaneous evaluation of coronary, carotid and cerebral artery stenosis and may be a useful examination with relatively low radiation exposure in patients with suspected coronary and carotid-cerebrovascular disease.
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. Electronic address: cjr.likuncheng@vip.163.com.
authors.forename: Kuncheng
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Ruijuan
authors.initials: R
authors.lastname: Han
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Wenhuan
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Xiangying
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Neurology Baotou Central Hospital, Inner Mongolia, Baotou 014040, China.
authors.forename: Guorong
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Neurology Baotou Central Hospital, Inner Mongolia, Baotou 014040, China.
authors.forename: Yuechun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Radiology, Baotou Central Hospital, Inner Mongolia, Baotou 014040, China.
authors.forename: Maorong
authors.initials: M
authors.lastname: Zhou
authors.affiliation: CT BM Clinic Marketing, Siemens Healthcare, Beijing 100102, China.
authors.forename: Ligang
authors.initials: L
authors.lastname: Li
authors.affiliation: CT BM Clinic Marketing, Siemens Healthcare, Beijing 100102, China.
authors.forename: Endt
authors.initials: E
authors.lastname: Heidrun
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Cerebrovascular angiography; Coronary angiography; High-pitch dual-source CT