Korean J Radiol.  2012 Dec;13(6):684-693. 10.3348/kjr.2012.13.6.684.

Prospectively Electrocardiogram-Gated High-Pitch Spiral Acquisition Mode Dual-Source CT Coronary Angiography in Patients with High Heart Rates: Comparison with Retrospective Electrocardiogram-Gated Spiral Acquisition Mode

• Sun K
• Han RJ
• Ma LJ
• Wang LJ
• Li LG
• Chen JH

• KMID: 1397498
• DOI: http://doi.org/10.3348/kjr.2012.13.6.684

Abstract

OBJECTIVE
To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode.
MATERIALS AND METHODS
Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 +/- 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed.
RESULTS
There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 +/- 0.306 [group A] vs. 1.084 +/- 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 +/- 0.16 mSv in group A and 7.1 +/- 1.05 mSv in group B (p = 0.001).
CONCLUSION
In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.

Keyword

High-pitch dual-source CT; Prospectively ECG-gated; Coronary angiography; High heart rates

MeSH Terms

Arrhythmias, Cardiac/*diagnosis
Artifacts
*Cardiac-Gated Imaging Techniques
*Coronary Angiography
*Electrocardiography
Female
*Heart Rate
Humans
Male
Middle Aged
*Tomography, Spiral Computed

Figure

• 

  Fig. 1 HP dual-source computed tomography coronary angiography in 55-year-old woman (heart rate: 99 bpm) from Group A. Electrocardiogram signal (A) demonstrates depiction of entire heart within single heart beat. Curved reformations of right coronary artery (B), left anterior descending artery (C) and left circumflex artery (D) did not show motion artifacts (score 1). Image quality was classified as excellent (i.e. score 1) in all coronary segments. RCA = right coronary artery, LCX = left circumflex artery

• 

  Fig. 2 HP dual-source computed tomography coronary angiography in 40-year-old man (heart rate: 79 bpm) from group A. Electrocardiogram signal (A) demonstrates that high-pitch spiral mode in acquisition at 20% of R-R interval falls into scan range of R wave because HR variability was too high (26 bpm). Motion artifacts occurred at right coronary artery (B, C) and left circumflex artery (D) (score 3). LCX = left circumflex artery

• 

  Fig. 3 47-year-old woman (heart rate: 70 bpm) underwent CTCA. Image is not evaluative and vessels are not differentiable due to effect of respiration using spiral mode (B, C, D). High-pitch spiral mode in acquisition at 20% of R-R interval CTCA was used, and patient had diagnostic evaluation of entire coronary artery tree (F, G, H). Electrocardiogram signal (A, E) demonstrated acquisition window of spiral mode and high-pitch spiral mode. CTCA = computed tomography coronary angiography, LAD = left anterior descending artety, LCX = left circumflex artery

• 

  Fig. 4 Most important features of cardiac cycle and optimal scan time of flash mode computed tomography coronary angiography within single heart beat.

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