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Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction.

Methods

We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients.

Results

In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P = 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P > 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv, P < 0.001). In group B (228 patients, 132 men, mean heart rate 75 ± 11 bpm), per-segment sensitivity, specificity, PPV and NPV were comparable (94 %, 95 %, 67 %, 99 % vs. 92 %, 95 %, 66 %, 99 %, P > 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv, P < 0.001). Diagnostic performance was comparable in both groups.

Conclusion

Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose.

Key Points

• 128-slice dual-source CT coronary angiography offers several different acquisition protocols.

• Randomized comparison of protocols reveals an optimal protocol selection strategy.

• Appropriate CTCA protocol selection lowers radiation dose, while maintaining high quality.

• CTCA protocol selection should be based on individual patient characteristics.

• A prospective sequential protocol is preferred for CTCA.

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Abbreviations

BMI:

body mass index

CAD:

coronary artery disease

CCA:

conventional coronary angiography

CI:

confidence intervals

CTCA:

computed tomography coronary angiography

DLP:

dose length product

FN:

false negative

FP:

false positive

LAD:

left anterior descending coronary artery

LCX:

left circumflex coronary artery

NPV:

negative predictive value

NS:

non-significant

PPV:

positive predictive value

QCA:

quantitative coronary angiography

RCA:

right coronary artery

TN:

true negative

TP:

true positive

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Authors and Affiliations

  1. Department of Cardiology, Erasmus Medical Center, Room Hs 207, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Lisan A. Neefjes, Alexia Rossi, Koen Nieman, Stella L. Papadopoulou, Anoeshka S. Dharampal, Carl J. Schultz, Gert-Jan R. ten Kate, Admir Dedic, Pim J. de Feyter & Nico R. Mollet

  2. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

    Lisan A. Neefjes, Alexia Rossi, Tessa S. S. Genders, Koen Nieman, Stella L. Papadopoulou, Anoeshka S. Dharampal, Annick C. Weustink, Marcel L. Dijkshoorn, Gert-Jan R. ten Kate, Admir Dedic, Marcel van Straten, Filippo Cademartiri, M. G. Myriam Hunink, Gabriël P. Krestin, Pim J. de Feyter & Nico R. Mollet

  3. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

    Tessa S. S. Genders & M. G. Myriam Hunink

  4. Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands

    Lisan A. Neefjes & Gert-Jan R. ten Kate

Authors
  1. Lisan A. Neefjes
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  2. Alexia Rossi
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  14. M. G. Myriam Hunink
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  15. Gabriël P. Krestin
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  17. Nico R. Mollet
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Corresponding author

Correspondence to Nico R. Mollet.

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Neefjes, L.A., Rossi, A., Genders, T.S.S. et al. Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols. Eur Radiol 23, 614–622 (2013). https://doi.org/10.1007/s00330-012-2663-3

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  • DOI: https://doi.org/10.1007/s00330-012-2663-3

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