Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT.
BACKGROUND
The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting.


METHODS
Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA.


RESULTS
SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts.


CONCLUSIONS
SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. marco.ochs@med.uni-heidelberg.de.
Marco M
MM
Ochs
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Fabian Aus dem
FAD
Siepen
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Thomas
T
Fritz
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Florian
F
Andre
Department of Cardiology and Angiology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Gitsios
G
Gitsioudis
Department of Cardiology, Angiology and Pneumology, GRN Hospital Weinheim, Röntgenstr. 1, 69469, Weinheim, Germany.
Grigorios
G
Korosoglou
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Sebastian
S
Seitz
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Yuriy
Y
Bogomazov
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69198, Heidelberg, Germany.
Christopher L
CL
Schlett
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Roman
R
Sokiranski
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Andre
A
Sommer
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Friedemann
F
Gückel
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Matthias
M
Brado
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69198, Heidelberg, Germany.
Hans-Ulrich
HU
Kauczor
Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Johannes
J
Görich
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Matthias G W
MGW
Friedrich
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Hugo A
HA
Katus
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.|Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
Sebastian J
SJ
Buss
D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011829:Radiation Dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies
CT angiography; Coronary artery disease; Dual-source CT; Image quality; Limitations