title: Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses.
abstract: OBJECTIVE
  "Flash Spiral" imaging is a new prospective ECG-triggered spiral scan mode that uses a very high-pitch for coronary computed tomography angiography (CTA). This enables complete image acquisition within one cardiac cycle with a very low radiation exposure. The aim of this study was to investigate the diagnostic accuracy, image quality, and effective radiation dose of prospectively ECG-triggered high-pitch spiral method (Flash spiral mode) of coronary CTA using dual-source technology for the evaluation of coronary artery stenoses.
  
  
  METHODS
  The study included 186 consecutive patients (115men, 71women; mean age: 53.37 years) who underwent coronary CTA. Coronary CTA was performed with a 128×2-slice dual-source CT (Somatom Definition Flash, Siemens, Germany) using a prospectively ECG-triggered high-pitch spiral mode. Patients were divided into three groups according to heart rate (≤65bpm, 66-75bpm, ≥76bpm) and body mass index (BMI) (20-24kg/m(2), 25-29kg/m(2), 30-34kg/m(2)) values. The correlation between heart rates, image quality and BMI values are investigated. A four-point scale (1=excellent, 4=poor/non-diagnostic) was used to rank the comparative image quality. Effective radiation doses were calculated. Also the correlation between radiation dose, sex and BMI values were investigated. In addition, diagnostic accuracy of CTA for detection of significant (≥50%) coronary artery stenoses was compared with invasive coronary angiography findings of 612vessel segments in 38patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were calculated.
  
  
  RESULTS
  A total of 2976coronary artery segments were present. Of all coronary artery segments, 2381 (80%) had an image quality score of 1, and 1.5% segments were rated as "poor/non-diagnostic". When the correlation between heart rate and image quality is investigated, there was a significant difference between ≤65bpm and ≥76bpm groups. However, there was no significant difference between ≤65bpm and 66-75bpm groups. The mean effective dose was found as 1.3mSv (min: 0.5, max: 2.4mSv). The correlation between effective radiation dose and BMI was moderate. However, the correlation between gender and radiation dose was significant. Sensitivity, specificity, negative predictive value and accuracy of coronary CTA on a per-vessel segment were 90.1%, 97.4%, 98.6%, and 96.5%, respectively.
  
  
  CONCLUSIONS
  Prospectively ECG-triggered high-pitch spiral mode coronary CTA provides high image quality and diagnostic accuracy, with very low radiation dose for evaluation and exclusion of coronary artery stenoses.
authors.affiliation: Selcuk University, The Central Campus, Medical Faculty, Department of Radiology, 42075 Konya, Turkey. Electronic address: koplaymustafa@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Koplay
authors.affiliation: Selcuk University, The Central Campus, Medical Faculty, Department of Radiology, 42075 Konya, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Erdogan
authors.affiliation: Selcuk University, Medical Faculty, Department of Cardiology, 42075 Konya, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Avci
authors.affiliation: Selcuk University, The Central Campus, Medical Faculty, Department of Radiology, 42075 Konya, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Sivri
authors.affiliation: Selcuk University, Medical Faculty, Department of Cardiology, 42075 Konya, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Demir
authors.affiliation: Selcuk University, The Central Campus, Medical Faculty, Department of Radiology, 42075 Konya, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Guler
authors.affiliation: Necmettin Erbakan University, Meram Medical Faculty, Department of Public Health and Medical Statistics, 42060 Konya, Turkey.
authors.forename: L S
authors.initials: LS
authors.lastname: Demir
authors.affiliation: Selcuk University, The Central Campus, Medical Faculty, Department of Radiology, 42075 Konya, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Paksoy
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Coronary angiography; Dual source CT; High-pitch spiral acquisition; Image quality; Radiation dose