Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy

Dewey, Marc; Zimmermann, Elke; Deissenrieder, Florian; Laule, Michael; Dübel, Hans-Peter; Schlattmann, Peter; Knebel, Fabian; Rutsch, Wolfgang; Hamm, Bernd

doi:10.1161/circulationaha.109.859280

Cited by 313 publications

(199 citation statements)

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“…4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. [8][9][10][11][12] With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion.…”

Section: Ultidetector Computed Tomography (Mdct) Is Wellmentioning

confidence: 99%

“…The diagnostic accuracy of 64-slice CCTA Role of Cardiac MDCT of CCTA for exclusion of anatomically significant CAD ( Table 1). [8][9][10][11][12] In a systematic review of the accuracy of DSCT for detection of arterial stenosis in some or all difficult-toimage patients, the pooled, per-patient estimates of sensitivity were 97.7% and 97.7% for patients with arrhythmias and high heart rates, respectively. 15 The corresponding pooled estimates of specificity were 81.7% and 86.3%.…”

Section: Diagnosis Of Cadmentioning

confidence: 99%

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Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Sato

Aonuma

2015

Circ J

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712SATO A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp for detecting coronary artery stenosis has been compared with ICA. Several studies have demonstrated the ability of CCTA to detect anatomically significant CAD with high negative predictive value (NPV). The CORE 64 study demonstrated that the patient-based diagnostic accuracy of quantitative CCTA for detecting stenoses ≥50% according to ICA revealed an area under the curve (AUC) of 0.93, with sensitivity of 85%, specificity of 90%, positive predictive value (PPV) of 91%, and NPV of 83%. 7 The 64-slice CCTA is accurate in identifying coronary stenoses and characterizing disease severity in symptomatic patients who have coronary artery calcium scores (CACS) <600. Given its PPV of 91% and NPV of 83%, 64-slice CCTA cannot replace conventional ICA. The substudy of CORE 64 showed that the AUC for diagnostic accuracy was similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, whereas the NPV was different (0.90, 0.83, and 0.50, respectively). For excluding obstructive CAD, CCTA was less effective in patients with calcium score ≥600 and high pretest probability for obstructive CAD. 13 In the CONFIRM study, the prevalence of observed CAD with either ≥50% diameter stenosis (CAD50) or 70% diameter stenosis (CAD70) was substantially lower than predicted by guideline probabilities in the overall population (18% vs. 51% for CAD50, 10% vs.ultidetector computed tomography (MDCT) is well established for more precise evaluation of coronary stenosis relative to electron-beam CT. 1-3 Multicenter studies have confirmed the accuracy of 64-slice MDCT for directly visualizing and detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). 4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. 8-12 With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion. Diagnosis of CAD Role of Cardiac Multidetector Computed Tomography Beyond Coronary AngiographyAkira Sato, MD; Kazutaka Aonuma, MD, PhDCardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinica...

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Section: Ultidetector Computed Tomography (Mdct) Is Wellmentioning

confidence: 99%

Section: Diagnosis Of Cadmentioning

confidence: 99%

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Sato

Aonuma

2015

Circ J

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“…The image quality tested was limited to patients with a heart rate between 65-75 bpm, and the effect of higher heart rate remains to be studied. The diagnostic accuracy of the second generation 320-detector row CT compared to invasive angiography will need further evaluation but studies from first generation scanner showed highly comparable results (3,7,21).…”

Section: Limitationsmentioning

confidence: 99%

“…Recently it has been shown to be a useful modality to assess patients with low to intermediate risk of suspected acute coronary syndromes presenting to the emergency department (4,5). To minimize radiation exposure, recent advances include the advent use of wide-detector scanners such as the 320 detector row scanner which has a 16 cm cranial-caudal coverage (6) and allows for acquisition of the whole coronary artery tree in one gantry rotation over less than one heartbeat (3,7).…”

Section: Introductionmentioning

confidence: 99%

Superior CT Coronary Angiography Image Quality at Lower Radiation Exposure with Second Generation 320-Detector-Row CT in Patients with Elevated Heart Rate – A Comparison with First Generation 320-Detector-Row CT

Soh

Wong

et al. 2013

Heart, Lung and Circulation

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Background: This study aims to compare the image quality of second generation versus first generation 320-computed tomography coronary angiography (CTCA) in patients with heart rate ≥65 bpm as it has not been specifically reported.Methods: Consecutive patients who underwent CTCA using second-generation-320-detector-row-CT were prospectively enrolled. A total of 50 patients with elevated (≥65 bpm) heart rate and 50 patients with controlled (<65 bpm) heart rate were included. Age and gender matched patients who were scanned with the first-generation-320-detector-row-CT were retrospectively identified. Image quality in each coronary artery segment was assessed by two blinded CT angiographers using the five-point Likert scale.Results: In the elevated heart rate cohorts, while there was no significant difference in heart rate during scan-acquisition (66 vs. 69 bpm, P=0.308), or body mass index (28.5 vs. 29.6, P=0.464), the second generation scanner was associated with better image quality (3.94±0.6 vs. 3.45±0.8, P=0.001), and with lower radiation (2.8 vs. 4.3 mSv, P=0.009). There was no difference in scan image quality for the controlled heart rate cohorts. Conclusions:The second generation CT scanner provides better image quality at lower radiation dose in patients with elevated heart rate (≥65 bpm) compared to first generation CT scanner.

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“…These artifacts can only be eliminated by avoiding the step portion in the ''step-and-shoot'' techniques and can be accomplished by imaging in a single heartbeat as recently suggested using either 320-row coronary CT angiography [11,12] or highpitch prospective spiral acquisition [13,14]. However, the scanners required for these two approaches (320-row CT and fast dual-source 64-row CT) are not as widely available as standard 64-row CT scanners.…”

Section: Cad Coronary Artery Disease Ct Computed Tomography Ecg Electmentioning

confidence: 99%

Prospective helical acquisition for coronary CT angiography

Dewey

2009

Int J Cardiovasc Imaging

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Abbreviations CAD Coronary artery disease CT Computed tomography ECG ElectrocardiogramNoninvasive detection of coronary artery disease (CAD) using computed tomography (CT) with multiple detector rows has high sensitivity and negative predictive value [1,2] and is thus considered an appropriate clinical option to reliably rule out CAD in patients with low-to-intermediate pretest likelihood of disease [3]. However, the reported effective doses of coronary CT angiography using retrospective ECG gating are rather high, ranging from about 15 to 20 mSv [4,5]. Prospective ECG gating with acquisition of axial datasets (also called ''step-and-shoot'') is an established CT scanning technique that has been used for a long time for coronary artery calcium scoring and has recently also been employed as a very promising concept to reduce the effective dose of coronary CT angiography [6][7][8].DeFrance et al. propose prospectively ECG-gated helical (spiral) acquisitions as a very promising new prospective acquisition technique for coronary CT angiography [9]. After helical data acquisition, reconstruction provides axial datasets as for standard retrospective helical acquisitions. The authors show that prospectively ECG-gated helical acquisition has a sufficient image quality while greatly reducing effective dose (mean of 6.9 mSv, range: 2.9-10.7 mSv) compared with standard retrospectively ECG-gated helical acquisition (mean of 16.9 mSv, range: 10.1-25.7 mSv). This is achieved by avoiding exposure-intensive overscanning and increasing the pitch (from about 0.2 to 0.27) using prospective helical acquisition. However, their study lacks an important methodological feature since it would have been even more interesting to compare axial stepand-shoot acquisition and prospectively ECG-gated helical acquisition. Such a comparison is not available and would be most interesting in patients with low heart rates. A significant bias is also introduced into this study by comparing two different patient populations: patients with higher heart rates were examined using retrospectively ECG-gated helical acquisition whereas the new prospectively ECGgated technique was used in patients with low heart rates (\65 beats per minute). Of the 29 patients examined in the study using retrospective ECGgating, only 10 had heart rates below 65 beats per Editorial Comment on the article of DeFrance et al.

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Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy

Cited by 313 publications

References 50 publications

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Superior CT Coronary Angiography Image Quality at Lower Radiation Exposure with Second Generation 320-Detector-Row CT in Patients with Elevated Heart Rate – A Comparison with First Generation 320-Detector-Row CT

Prospective helical acquisition for coronary CT angiography

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