Noninvasive Visualization of Coronary Arteries Using Contrast-Enhanced Multidetector CT: Influence of Heart Rate on Image Quality and Stenosis Detection

• Published in: American journal of roentgenology (1976) Vol. 179; no. 4; pp. 911 - 916
• Main Authors: Giesler, Tom, Baum, Ulrich, Ropers, Dieter, Ulzheimer, Stefan, Wenkel, Evelyn, Mennicke, Maria, Bautz, Werner, Kalender, Willi A, Daniel, Werner G, Achenbach, Stephan
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.10.2002; American Roentgen Ray Society
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular system; Contrast Media; Coronary Angiography; Coronary Disease - diagnostic imaging; Electrocardiography; Female; Heart Rate; Humans; Image Processing, Computer-Assisted; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Human; Motion; Visualization; Radiodiagnosis; Coronary artery; Stenosis; Cardiovascular disease; Artefact; Coronary heart disease; Arterial disease; Vascular disease; Image quality; Heart rate; Image analysis; Accuracy; Medical imagery; Computerized axial tomography; Diagnosis; Technique; Contrast media
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.179.4.1790911

Although multidetector CT (MDCT) with retrospectively ECG-gated image reconstruction has been shown to permit noninvasive visualization of the coronary arteries, the 125-250 msec required for image acquisition frequently causes motion artifacts. We investigated the influence of a patient's heart rate on the presence of motion artifacts and on accuracy of stenosis detection on contrast-enhanced MDCT. In 100 patients, MDCT was performed, and ECG-gated cross-sectional images were retrospectively reconstructed. From the 10 data sets obtained for each patient (reconstructed at 0-90% of the cardiac cycle in increments of 10%), we chose the best data set for every coronary artery. The images of the arteries were evaluated for occurrence of artifacts and the presence of high-grade stenosis (diameter reduction exceeding 70%) or occlusions. MDCT results were compared with coronary angiographic findings. Of the 400 coronary arteries, 115 (29%) could not be evaluated because of motion artifacts (n = 84) or other reasons (n = 31). Overall, 51 (49%) of 104 stenoses were revealed on MDCT. For detecting stenosis in those arteries that we could evaluate, MDCT had a sensitivity of 91% (51 of 56 stenoses detected) and a specificity of 89%. As the heart rate increased, the number of arteries that could be evaluated decreased, and overall sensitivity for stenosis detection decreased from 62% (heart rate < or = 70 beats per minute) to 33% (heart rate > 70 beats per minute). MDCT can reveal coronary stenoses, but the usefulness of MDCT as an aid in accurately evaluating stenoses decreases as a patient's heart rate increases.