title: Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography.
abstract: OBJECTIVE
  To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard.
  
  
  METHODS
  Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality.
  
  
  RESULTS
  At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv.
  
  
  CONCLUSIONS
  Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population.
  
  
  CONCLUSIONS
  Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China. kevinzhlj@163.com.
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.|Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.|Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Li
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Zhou
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Yan E
authors.initials: YE
authors.lastname: Zhao
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Xie
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Jian Bin
authors.initials: JB
authors.lastname: Gong
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Beijing, China. jin_zhengyu@163.com.
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China. cjr.luguangming@vip.163.com.
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000528:radiation effects; D006339:Heart Rate / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Coronary CT angiography; High-pitch acquisition; Low contrast medium; Low kilovoltage; Prospective ECG gating