Yonsei Med J.  2021 Mar;62(3):200-208. 10.3349/ymj.2021.62.3.200.

Assessment of Image Quality for Selective Intracoronary Contrast-Injected CT Angiography in a Hybrid Angio-CT System: A Feasibility Study in Swine

  • 1Graduate School of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
  • 2CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
  • 3Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
  • 4Division of Cardiology, Cardiovascular Center, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
  • 5Division of Cardiology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
  • 6Cardiovascular Center, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
  • 7Division of Cardiology, Department of Internal Medicine, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 8Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
  • 9Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
  • 10Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea


To compare image quality in selective intracoronary contrast-injected computed tomography angiography (SelectiveCTA) with that in conventional intravenous contrast-injected CTA (IV-CTA).
Materials and Methods
Six pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement.
Quantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078). The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08).
Our feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium.


Computed tomography angiography; image quality enhancement; percutaneous coronary intervention; contrast media
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