Coronary computed tomography angiography during arrhythmia: Radiation dose reduction with prospectively ECG-triggered axial and retrospectively ECG-gated helical 128-slice dual-source CT

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• 作者：Ashley M. Lee ; BS ; ^{amlee@partners.org} ; Leif-Christopher Engel ; MD ; PhD ; Baiju Shah ; MD ; Gary Liew ; MD ; Manavjot S. Sidhu ; MD ; Mannudeep Kalra ; MD ; Suhny Abbara ; MD ; Thomas J. Brady ; MD ; Udo Hoffmann ; MD ; MPH ; Brian B. Ghoshhajra ; MD ; MBA
• 关键词：Coronary computed tomography angiography ; Arrhythmia ; Radiation dose reduction
• 刊名：Journal of Cardiovascular Computed Tomography
• 出版年：2012
• 期刊代码：pca207_19345925
• 类别：med
• 出版时间：May-June, 2012
• 卷：6
• 期：3
• 页码：172-183.e2
• 文件大小：553 K

摘要

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Background

Arrhythmia during coronary computed tomography angiography (coronary CTA) acquisition increases the risk of nondiagnostic segments and high radiation exposure. An advanced arrhythmia rejection algorithm for prospectively electrocardiogram (ECG)-triggered axial scans using dual-source CT (DSCT) examinations has recently been reported.

Objective

We compared image quality and effective dose at DSCT examinations using prospectively ECG-triggered axial scanning with advanced arrhythmia rejection software (PT-AAR) versus retrospectively ECG-gated helical scanning with tube-current modulation (RG-TCM) during arrhythmia.

Methods

This was a retrospective case-control study of 90 patients (43 PT-AAR, 47 RG-TCM) with arrhythmia (defined as heart rate variability [HRV] > 10 beats/min during data acquisition) referred for physician-supervised coronary CTA between April 2010 and September 2011. A subset of 22 cases matched for body mass index, HR, HRV, and other scan parameters was identified. Subjective image quality (4-point scale) and effective dose (dose length product method) were compared.

Results

PT-AAR was associated with lower effective dose than RG-TCM (4.1 vs 12.6 mSv entire cohort and 4.3 vs 9.1 mSv matched controls; both P < 0.01). Image quality scores were excellent in both groups (3.9 PT-AAR vs 3.6 RG-TCM) and nondiagnostic segment rates were low (0.1%vs 0.6%). Significantly higher image quality scores were found with PT-AAR in the entire cohort (P < 0.05), and in matched controls with high HRV > 28 beats/min (P < 0.05).

Conclusions

In patients with variable heart rates, prospectively ECG-triggered axial DSCT with arrhythmia rejection algorithm is feasible and can decrease radiation exposure by 鈭?0%versus retrospectively ECG-gated helical DSCT, with preserved image quality.