Korean J Radiol.  2017 Oct;18(5):763-772. 10.3348/kjr.2017.18.5.763.

High-Pitch Coronary CT Angiography at 70 kVp Adopting a Protocol of Low Injection Speed and Low Volume of Contrast Medium

• Feng R
• Tong J
• Liu X
• Zhao Y
• Zhang L

• KMID: 2427213
• DOI: http://doi.org/10.3348/kjr.2017.18.5.763

Abstract

OBJECTIVE
To evaluate the feasibility and image quality (IQ) of prospectively high-pitch coronary CT angiography (CCTA) with low contrast medium injection rate at 70 kVp.
MATERIALS AND METHODS
One hundred and four patients with suspected coronary artery disease (body mass index < 26 kg/m², sinus rhythm and heart rate < 70 beats/min) were prospectively enrolled and randomly divided into two groups. In group A and group B, 28 mL and 40 mL of 370 mgI/mL iodinated contrast media was administrated at a flow rate of 3.5 and 5 mL/s, respectively. CT values, noise, signal-to-noise ratio, contrast-to-noise ratio (CNR) of the proximal segments of coronary arteries and subjective IQ were evaluated.
RESULTS
The CT values and noise in group A were significantly lower than those in group B (434-485 Hounsfield units [HU] vs. 772-851 HU, all p < 0.001; 17.8-22.3 vs. 23.3-26.4, all p < 0.005). The CNRs of the right coronary artery and left main artery showed no statistical difference between the two groups (42.1 ± 13.8 vs. 36.8 ± 16.0, p = 0.074; 38.7 ± 10.6 vs. 38.1 ± 17.0, p = 0.819). No statistical difference was observed between the two groups in IQ scores (3.04 ± 0.75 vs. 3.0 ± 0.79, p = 0.526) and diagnostic ratio (96.1% [50/52] vs. 94.2% [49/52], p = 0.647).
CONCLUSION
Prospective high-pitch CCTA at 70 kVp with 28 mL of contrast media and injection rate of 3.5 mL/s could provide diagnostic IQ for normal-weight patients with heart rate of < 70 beats/min.

Keyword

Low tube voltage; Contrast medium; Coronary CT angiography; Iodine delivery rate; CT attenuation enhancement; Radiation reduction; Low dose contrast agent

MeSH Terms

Adult
Aged
Aged, 80 and over
Body Mass Index
*Computed Tomography Angiography
Contrast Media/*chemistry
Coronary Artery Disease/*diagnosis/diagnostic imaging
Female
Heart Rate
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Prospective Studies
Signal-To-Noise Ratio
Contrast Media

Figure

• 

  Fig. 1 Flow chart for patient enrollment. CCTA = coronary CT angiography

• 

  Fig. 2 Subjective ratings of CCTA IQ on coronary artery basis. LCX showed significant difference in IQ between two groups (p = 0.040). y-axis represent IQ score. A = group A, B = group B, IQ = image quality, LAD = left anterior descending artery, LCX = left circumflex artery, LM = left main coronary artery, RCA = right coronary artery

• 

  Fig. 3 Subjective ratings of CCTA IQ on coronary artery segment basis. x-axis represents coronary artery segments. y-axis represents IQ score. A = group A, B = group B.

• 

  Fig. 4 65-year-old woman (HR = 56 bpm, BMI = 19.9 kg/m2, ED = 0.19 mSv) with atypical chest pain underwent CCTA. All visualized coronary segments were evaluated as score 4 (excellent IQ). A. CT value of AAO was 596 HU. B. Volume-rendered reformatted image of coronary tree. C-E. Curved multiplanar reformatted images of RCA, LAD, and LCX. AAO = ascending aorta root, BMI = body mass index, bpm = beats per minute, ED = effective dose, HR = heart rate, HU = Hounsfield unit

• 

  Fig. 5 CCTA in 74-year-old man (HR = 63 bpm, BMI = 24.3 kg/m2, ED = 0.38 mSv) with chest pain for one day. A. Showed CT value of AAO was 442 HU. B. Volume-rendered. C. Curved multiplanar reformation of RCA. D. Curved multiplanar reformation showed severe stenosis in proximal segment of LAD. E. Curved multiplanar reformation of LCX showed punctuate calcification in proximal segment. IQ of CCTA study was rated as score 4 (excellent) in this patient.

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