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

• Published in: European radiology 2016-03, Vol.26 (3), p.797-806
• Main Authors: Zhang, Long Jiang, Wang, Yining, Schoepf, U. Joseph, Meinel, Felix G., Bayer, Richard R., Qi, Li, Cao, Jian, Zhou, Chang Sheng, Zhao, Yan E, Li, Xie, Gong, Jian Bin, Jin, Zhengyu, Lu, Guang Ming
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Aged, 80 and over; Body Mass Index; Cardiac; Cardiovascular disease; Contrast Media; Coronary Angiography - methods; Coronary Angiography - standards; Coronary Stenosis - diagnostic imaging; Diagnostic Radiology; Electrocardiography - methods; Female; Heart - radiation effects; Heart rate; Heart Rate - radiation effects; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Prospective Studies; Radiation; Radiation Dosage; Radiology; Reference Standards; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Tomography, X-Ray Computed - standards; Ultrasound; Vascular Calcification - diagnostic imaging
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3868-z

Purpose 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. Materials and 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