Noninvasive Visualization of Coronary Arteries Using Contrast-Enhanced  Multidetector CT: Influence of Heart Rate on Image Quality and Stenosis  Detection

Giesler, Tom; Baum, Ulrich; Ropers, Dieter; Ulzheimer, Stefan; Wenkel, Evelyn; Mennicke, Maria; Bautz, W.; Kalender, Willi A.; Daniel, Werner G.; Achenbach, Stephan

doi:10.2214/ajr.179.4.1790911

Cited by 280 publications

(172 citation statements)

References 20 publications

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“…Secondly, the occurrence of motion artefacts at elevated heart rates is a common problem, which most frequently affects the right coronary artery because of its extensive motion during the cardiac cycle. A low heart rate during scanning has therefore been an essential requirement to obtain a data set suitable for quantitative analysis, [32][33][34] which so far has required a consistent heart rate lowering protocol using oral or intravenous administration of β-blockers. [1][2][3][4]13,[35][36][37][38] Hence, the mean heart rate during scanning in studies using 64-slice MDCT is considerably below 65 bpm.…”

Section: Discussionmentioning

confidence: 99%

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

Rixe

Rolf

Conradi

et al. 2009

Circ J

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Background Computed tomography (CT) enables detection of coronary artery stenoses, but its use is limited by deficient evaluation at elevated heart rates. The accuracy of dual-source CT (DSCT) for the detection of coronary artery disease (CAD) was assessed in 76 patients at high probability of CAD without heart rate control and compared with quantitative coronary angiography (QCA). Methods and ResultsThe 76 patients (47 males, mean age 65.5±10 years) underwent DSCT without preceding heart rate control. Data sets were evaluated by 2 observers in consensus with respect to stenoses >50% decreased diameter. QCA served as the standard of reference. Mean heart rate during scanning was 68±9 beats per min, and the average Agatston score was 337±560. Of 1,160 coronary artery segments, all but 3 were visualized artefactfree; 58 coronary stenoses were correctly detected by CT angiography. In the segment-based analysis, sensitivity was 98.3%, specificity 99.2% and accuracy 99%; patient based analysis revealed a sensitivity of 100%, specificity of 83.3% and overall accuracy of 92.1%. Conclusions Even at elevated heart rates, DSCT can reliably detect coronary artery stenoses and the results correlate well with those for invasive coronary angiography. (Circ J 2009; 73: 316 -322)

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Section: Discussionmentioning

confidence: 99%

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

Rixe

Rolf

Conradi

et al. 2009

Circ J

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“…As at the beginning of the MSCT era, coronary imaging was limited to the proximal vessel sgts, 15 continuous modifications of hardware and scan protocol, for example, lowering of the heart rate by application of betablockers, 8,9 has led to a significant stabilization and improvement of image quality. 16 Important determinants are temporal and spatial resolution.…”

Section: Discussionmentioning

confidence: 99%

“…To reduce motion artefacts caused by elevated heart rate 8,9 additional b-blockade with 50-100 mg metoprolol per os (p.o.) was performed within 30 min prior to the CT scan in pts with heart rates 465/min.…”

Section: Methodsmentioning

confidence: 99%

Image quality and diagnostic accuracy of 16-slice multidetector computed tomography for the detection of coronary artery disease in obese patients

et al. 2005

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Background: Cardiac multislice spiral computed tomography (MSCT) scanners permit visualization of the coronary arteries with an overall good sensitivity (sens) and specificity (spec). However, in obese patients (pts), who are at higher risk to develop coronary artery disease (CAD), image quality of MSCT is supposed to be limited. At present, there are no data whether the accuracy of MSCT depends on the body mass index (BMI). Thus, we compared the catheter-controlled MSCT results from normal weight and obese pts in a cohort of 117 pts with regard to sens, spec, positive predictive value (PPV), negative predictive value (NPV) and image quality. 3 pts (group I 1, group II 2) had to be excluded from analysis due to technical problems. Group I had significantly less risk factors (Po0.001) and image quality was significantly better than in group II and III (Po0.05). Group II and III did not differ with regard to risk factors or image quality. Conclusions: Overweight and obesity have an impact on MSCT image quality but did not hamper the diagnostic accuracy. Thus, MSCT is a noninvasive method to detect or rule out CAD also in pts with higher BMI. These retrospective data have to be confirmed in larger prospective trials.

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“…[1][2][3][4][5][6] With single-source 64-slice CTA, most investigators recommend lowering the patient's heart rate to G65 beats per minute (bpm) to achieve stable image quality. [7][8][9][10] In this range, diagnostic image quality can be obtained for all coronary arteries at a single reconstruction interval at mid-diastole.…”

Section: Introductionmentioning

confidence: 99%

Is It Possible to Predict Heart Rate and Range during Enhanced Cardiac CT Scan from Previous Non-enhanced Cardiac CT?

et al. 2010

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The effect of heart rate and variation during cardiac computed tomography (CT) on the examination quality. The purpose of this study is to investigate whether it is possible to predict heart rate and range during enhanced cardiac computed CT scan from previous non-enhanced cardiac CT scan. Electrocardiograph (ECG) files from 112 patients on three types of cardiac 64-slice CT (nonenhanced, prospective ECG-triggered and retrospective ECG-gated enhanced scans) were recorded. The mean heart rate, range (defined as difference between maximal and minimal heart rates) and the range ratio (defined as maximal heart rate divided by minimal heart rate) during the scans were compared. Scan time was 4.8, 4.6, and 7.3 s on non-enhanced, prospective ECG-triggered and retrospective ECG-gated scans, respectively (pG0.0001). The heart rates were not significantly different (60±9 beats per minute (bpm), 60±9 and 61±10 bpm; p=0.64). Heart rate on the enhanced scan markedly correlated with that of the non-enhanced scan (r=0.78 and 0.74). In contrast, the ranges of heart rate were 2±5, 4±8, and 8± 21 bpm, with different range ratios (1.04, 1.07, and 1.14; pG0.0001). Correlation of heart rate ranges between nonenhanced scan versus prospective ECG-triggered scan was low (r=0.27) and that between non-enhanced scan versus retrospective ECG-gated scan negligible (r= −0.027).Heart rate on enhanced cardiac CT, in most cases, can be predicted from a non-enhanced scan. Heart rate range on enhanced cardiac CT, however, is hard to predict from the non-enhanced scan.

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Noninvasive Visualization of Coronary Arteries Using Contrast-Enhanced Multidetector CT: Influence of Heart Rate on Image Quality and Stenosis Detection

Abstract: MDCT can reveal coronary stenoses, but the usefulness of MDCT as an aid in accurately evaluating stenoses decreases as a patient's heart rate increases.

Cited by 280 publications

References 20 publications

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

Image quality and diagnostic accuracy of 16-slice multidetector computed tomography for the detection of coronary artery disease in obese patients

Is It Possible to Predict Heart Rate and Range during Enhanced Cardiac CT Scan from Previous Non-enhanced Cardiac CT?

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