Dual-Source versus 64-Section CT Coronary Angiography at Lower Heart Rates: Comparison of Accuracy and Radiation Dose

• Published in: Radiology Vol. 253; no. 1; pp. 56 - 64
• Main Authors: BAUMÜLLER, Stephan, LESCHKA, Sebastian, DESBIOLLES, Lotus, STOLZMANN, Paul, SCHEFFEL, Hans, SEIFERT, Burkhardt, MARINCEK, Borut, ALKADHI, Hatem
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Radiological Society of North America 01.10.2009
• Subjects: Adult; Aged; Aged, 80 and over; Applied radiobiology (equipment, dosimetry...); Biological and medical sciences; Biological effects of radiation; Cardiovascular system; Chi-Square Distribution; Contrast Media; Coronary Angiography - methods; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Electrocardiography; Female; Fundamental and applied biological sciences. Psychology; Heart Rate - physiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Iohexol - analogs & derivatives; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Radiation Dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Statistics, Nonparametric; Tissues, organs and organisms biophysics; Tomography, X-Ray Computed; Heart rate; Nuclear medicine; Radiation dose; Accuracy; Radiobiology; Radiodiagnosis; Radiology; Medical imagery; Computerized axial tomography; Dosimetry; Coronary arteriography; Comparative study
• ISSN: 0033-8419; 1527-1315
• DOI: 10.1148/radiol.2531090065

To compare the diagnostic performance and radiation doses of dual-source and 64-section computed tomographic (CT) coronary angiography for the diagnosis of significant coronary stenoses in patients with heart rates of 65 beats/min or less. This retrospective study had local ethics committee approval; all patients gave written informed consent. Two hundred patients with heart rates of 65 beats/min or less were enrolled; 100 underwent dual-source and 100 underwent 64-section CT coronary angiography. Two blinded observers independently assessed image quality of all coronary segments by using a four-point scale and searched for significant (>50%) stenoses in each segment. Catheter angiography was used as the reference standard. Image noise was measured in the ascending aorta. Radiation doses were calculated. No significant differences were found regarding sex, age, body weight, cardiovascular risk profile, prevalence of stenosis, mean and variability of heart rate, Agatston score, and image noise (all P > .1) between patients in both CT coronary angiography groups. No significant difference was found in the rate of nonassessable coronary segments between dual-source (1.0%, 14 of 1405) and 64-section CT coronary angiography (1.8%, 25 of 1387; P = .08). Motion artifacts occurred significantly more often in 64-section (21 of 25) versus dual-source (five of 14, P = .004) CT coronary angiography. Segment-based accuracy and specificity were significantly higher for dual-source versus 64-section CT coronary angiography. There was no significant difference in accuracy parameters at the per-vessel and per-patient analyses. No significant difference (P = .13) was found between the effective doses of dual-source (mean +/- standard deviation, 10.9 mSv +/- 1.1) and 64-section CT (10.4 mSv +/- 1.7) coronary angiography. In patients with heart rates of 65 beats/min or less, the higher temporal resolution of dual-source CT coronary angiography results in improved accuracy and specificity for the diagnosis of significant stenoses on a per-segment level at a similar radiation dose, but provides a comparable diagnostic accuracy on a patient-based level as does 64-section coronary angiography.