title: High pitch third generation dual-source CT: Coronary and cardiac visualization on routine chest CT.
abstract: BACKGROUND
  Chest CT scans are frequently performed in radiology departments but have not previously contained detailed depiction of cardiac structures.
  
  
  OBJECTIVE
  To evaluate myocardial and coronary visualization on high-pitch non-gated CT of the chest using 3rd generation dual-source computed tomography (CT).
  
  
  METHODS
  Cardiac anatomy of patients who had 3rd generation, non-gated high pitch contrast enhanced chest CT and who also had prior conventional (low pitch) chest CT as part of a chest abdomen pelvis exam was evaluated. Cardiac image features were scored by reviewers blinded to diagnosis and pitch. Paired analysis was performed.
  
  
  RESULTS
  3862 coronary segments and 2220 cardiac structures were evaluated by two readers in 222 CT scans. Most patients (97.2%) had chest CT for oncologic evaluation. The median pitch was 2.34 (IQR 2.05, 2.65) in high pitch and 0.8 (IQR 0.8, 0.8) in low pitch scans (p < 0.001). High pitch CT showed higher image visualization scores for all cardiovascular structures compared with conventional pitch scans (p < 0.0001). Coronary arteries were visualized in 9 coronary segments per exam in high pitch scans versus 2 segments for conventional pitch (p < 0.0001). Radiation exposure was lower in the high pitch group compared with the conventional pitch group (median CTDIvol 10.83 vs. 12.36 mGy and DLP 790 vs. 827 mGycm respectively, p < 0.01 for both) with comparable image noise (p = 0.43).
  
  
  CONCLUSIONS
  Myocardial structure and coronary arteries are frequently visualized on non-gated 3rd generation chest CT. These results raise the question of whether the heart and coronary arteries should be routinely interpreted on routine chest CT that is otherwise obtained for non-cardiac indications.
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Veit
authors.initials: V
authors.lastname: Sandfort
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ahlman
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Jones
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Selwaness
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Marcus
authors.initials: M
authors.lastname: Y Chen
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
authors.forename: Les
authors.initials: L
authors.lastname: R Folio
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. Electronic address: bluemked@cc.nih.gov.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D016477:Artifacts; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D013902:Radiography, Thoracic / Q000295:instrumentation / Q000379:methods*; D015203:Reproducibility of Results; D015898:Tomography Scanners, X-Ray Computed; D014057:Tomography, X-Ray Computed / Q000295:instrumentation
keywords: CT; Cardiac imaging; Incidental findings