title: Strengths and limitations of coronary angiography with turbo high-pitch third-generation dual-source CT.
abstract: OBJECTIVE
  To define practical limitations of diagnostic image quality for recently introduced turbo high-pitch scan mode (THP) in third-generation dual-source computed tomography (CT).
  
  
  METHODS
  Two hundred and twenty-nine consecutive patients undergoing CT coronary angiography were included in this retrospective single-centre analysis. A contrast-enhanced volume dataset was acquired in THP. Image quality of coronary segments was classified as diagnostic or non-diagnostic by three blinded readers. Segments were stated as non-diagnostic if at least one of three readers could neither exclude nor confirm significant stenoses. Multivariable logistic regression was used to assess relationships between number of non-diagnostic segments and common influencing factors.
  
  
  RESULTS
  Median effective radiation dose was 0.6 (interquartile range [IQR], 0.4-0.8) mSv overall and 0.3 (IQR, 0.3-0.4) mSv in the 70 kV subgroup of this middle aged, predominantly pre-obese cohort (age: 61 [IQR, 52-67] years; body mass index [BMI]: 26 [IQR, 23-29] kg/m2) with a low-moderate median Agatston score (AS) 0 (IQR, 0-70). Diagnostic image quality was found in 98.1% of 3,678 coronary segments. AS was independently associated with diagnostic image quality (B=0.34; p=0.02), whereas heart rate, BMI, and presence of arrhythmia were not. The portion of diagnostic coronary segments decreased slightly in obese patients with heart rates >65 beats/min and dropped significantly in patients with an AS >600 (p=0.003).
  
  
  CONCLUSIONS
  THP enables CT coronary angiography with minimal radiation exposure and is most appropriate in non-obese patients with stable sinus rhythm ≤65 beats/min and a calcium score ≤600.
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany. Electronic address: marco.ochs@med.uni-heidelberg.de.
authors.forename: M M
authors.initials: MM
authors.lastname: Ochs
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Andre
authors.affiliation: Department of Cardiology, GRN Hospital Weinheim, Röntgenstraße 1, 69469 Weinheim, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Korosoglou
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fritz
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Seitz
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: Y
authors.initials: Y
authors.lastname: Bogomazov
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: C L
authors.initials: CL
authors.lastname: Schlett
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Sokiranski
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Sommer
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Gückel
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Brado
authors.affiliation: Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: H-U
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Görich
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany.
authors.forename: S J
authors.initials: SJ
authors.lastname: Buss
mesh_terms: D000368:Aged; D055424:Cardiac-Gated Imaging Techniques; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D000069079:Radiation Exposure; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol