Optimal Systolic and Diastolic Reconstruction Windows for Coronary CT Angiography Using Dual-Source CT

Seifarth, Harald; Wienbeck, Susanne; Püsken, Michael; Juergens, Kai Uwe; Maintz, David; Vahlhaus, Christian; Heindel, Walter; Fischbach, Roman

doi:10.2214/ajr.07.2711

Cited by 95 publications

(75 citation statements)

References 28 publications

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“…When we specifically investigated optimal reconstruction intervals for assessment of all coronary artery segments in relation to different HRs, we have come across a similar pattern with prior studies (17), with optimal reconstruction intervals shifting to end-systole with increasing HRs. Relative coronary artery motion during the cardiac phase could be considered the main determinant of coronary segment visibility on CTA.…”

Section: Discussionsupporting

confidence: 60%

Optimal reconstruction interval in dual source CT coronary angiography: a single-center experience in 285 patients

Akgöz

Akata²,

Hazırolan³

et al. 2014

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEWe aimed to evaluate the visibility of coronary arteries and bypass-grafts in patients who underwent dual source computed tomography (DSCT) angiography without heart rate (HR) control and to determine optimal intervals for image reconstruction. MATERIALS AND METHODSA total of 285 consecutive cases who underwent coronary (n=255) and bypass-graft (n=30) DSCT angiography at our institution were identified retrospectively. Patients with atrial fibrillation were excluded. Ten datasets in 10% increments were reconstructed in all patients. On each dataset, the visibility of coronary arteries was evaluated using the 15-segment American Heart Association classification by two radiologists in consensus. RESULTSMean HR was 76±16.3 bpm, (range, 46-127 bpm). All coronary segments could be visualized in 277 patients (97.19%). On a segment-basis, 4265 of 4275 (99.77%) coronary artery segments were visible. All segments of 56 bypass-grafts in 30 patients were visible (100%). Total mean segment visibility scores of all coronary arteries were highest at 70%, 40%, and 30% intervals for all HRs. The optimal reconstruction intervals to visualize the segments of all three coronary arteries in descending order were 70%, 60%, 80%, and 30% intervals in patients with a mean HR <70 bpm; 40%, 70%, and 30% intervals in patients with a mean HR 70-100 bpm; and 40%, 50%, and 30% in patients with a mean HR >100 bpm. CONCLUSIONWithout beta-blocker administration, DSCT coronary angiography offers excellent visibility of vascular segments using both end-systolic and mid-late diastolic reconstructions at HRs up to 100 bpm, and only end-systolic reconstructions at HRs over 100 bpm. Improvements in computed tomography (CT) scanning technology throughout the last decade have resulted in widespread acceptance of contrast-enhanced multidetector CT (MDCT) coronary angiography as a reliable modality for noninvasive evaluation of the coronary arteries (1). Having a high negative predictive value, MDCT coronary angiography is considered particularly beneficial in patients with low to intermediate pretest probability for coronary artery disease (CAD) by reliably excluding coronary artery stenosis and therefore, preventing unnecessary invasive angiography (2, 3).Small dimensions and continuous rapid motions of coronary arteries make their visualization by CT challenging. Thus, excellent spatial and temporal resolution is required for adequate imaging of coronary arteries. Initial reports using a 4-detector row MDCT were promising in selected patients with low heart rates (HRs) (4−6); however, image quality was not sufficient for assessment in up to 29% of the coronary segments. With the introduction of 16-and 64-row MDCT, major improvements of image quality were achieved, with adequate visualization of up to 97% of coronary segments (7−9). Since, image quality deteriorates with increasing HRs even with 64-slice MDCT scanners (10, 11), it has been common in clinical practice to use HR-modulating beta-blockers to achieve better diagnosti...

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Section: Discussionsupporting

confidence: 60%

Optimal reconstruction interval in dual source CT coronary angiography: a single-center experience in 285 patients

Akgöz

Akata²,

Hazırolan³

et al. 2014

Diagn Interv Radiol

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“…Similarly, a shift of optimal image quality from diastolic to systolic reconstruction intervals in patients with high HRs is reported for 64-detector single-source as well as 64-detector dual-source retrospectively ECG-gated CTCA [12][13][14][15][16][17][18]. Using retrospectively ECG-gated DSCT, Adler et al [17] found the optimal systolic phase of image reconstruction to be between 35% and 50% of the RR interval in patients with HR>65 bpm and Araoz et al [16] reported that optimal image sharpness of the coronary arteries is achieved at 65-70% of the RR interval in patients with HR≤70 bpm and at 35-40% of the RR interval in patients with HR>70 bpm.…”

Section: Discussionmentioning

confidence: 60%

“…The optimal timing of image acquisition to minimise coronary arterial motion artefacts-especially of the mid to distal right coronary artery (RCA)-may shift to systolic intervals in patients with high HRs as diastolic diastasis shortens and eventually disappears with increasing HRs [9,10]. It has been demonstrated with 16-and 64-detector single-source as well as dual-source CT that the best results regarding coronary artery image quality are achieved at middiastolic intervals in patients with low HRs and at systolic intervals in patients with high HRs [11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

High-pitch dual-source CT coronary angiography: systolic data acquisition at high heart rates

et al. 2010

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Objective To assess the effect of systolic data acquisition for electrocardiography (ECG)-triggered high-pitch computed tomography (CT) on motion artefacts of coronary arteries in patients with high heart rates (HRs). Methods Eighty consecutive patients (15 women, age 67± 14years) with HR≥70bpm underwent CT angiography of the thoracic aorta (CTA) on 128-slice dual-source CT in ECG-triggered high-pitch acquisition mode (pitch=3.2) set at 60% (group A, n=40) or 30% (group B, n=40) of the RR interval. Two blinded readers graded coronary artery image quality on a three-point scale. Radiation doses were calculated. Results Interobserver agreement in grading image quality of the 1,154 coronary segments was good (κ=0.62). HRs were similar in groups A and B (85± 13bpm vs 85±14bpm, p not significant). Significantly fewer coronary segments with non-diagnostic image quality occurred (i.e. score 3) in group B than in group A [2.8% (16/ 579) vs 8.3% (48/575), p<0.001]. Seventeen patients (42.5%) of group A and 12 patients (30.0%) of group B had at least one non-diagnostic segment. Effective radiation doses were 2.3±0.3mSv for chest CTA. Conclusion A systolic acquisition window for high-pitch dual-source CTA in patients with high HRs (≥70bpm) significantly improves coronary artery image quality at a low radiation dose.

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“…This range of the cardiac cycle was chosen because it has been shown to contain the optimal systolic and diastolic quiescent phases. 3,17 However, since the remainder of the cardiac cycle, i.e., between 80% and 20% is not reconstructed, it is possible that the start of the systolic or end of the diastolic quiescent period may lie outside the 20%-80% reconstructed interval of the cardiac cycle. This is apparent in Fig.…”

Section: A Limitationsmentioning

confidence: 99%

Characterization of cardiac quiescence from retrospective cardiac computed tomography using a correlation‐based phase‐to‐phase deviation measure

et al. 2015

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Purpose: Accurate knowledge of cardiac quiescence is crucial to the performance of many cardiac imaging modalities, including computed tomography coronary angiography (CTCA). To accurately quantify quiescence, a method for detecting the quiescent periods of the heart from retrospective cardiac computed tomography (CT) using a correlation-based, phase-to-phase deviation measure was developed. Methods: Retrospective cardiac CT data were obtained from 20 patients (11 male, 9 female, 33-74 yr) and the left main, left anterior descending, left circumflex, right coronary artery (RCA), and interventricular septum (IVS) were segmented for each phase using a semiautomated technique. Cardiac motion of individual coronary vessels as well as the IVS was calculated using phase-to-phase deviation. As an easily identifiable feature, the IVS was analyzed to assess how well it predicts vessel quiescence. Finally, the diagnostic quality of the reconstructed volumes from the quiescent phases determined using the deviation measure from the vessels in aggregate and the IVS was compared to that from quiescent phases calculated by the CT scanner. Three board-certified radiologists, fellowship-trained in cardiothoracic imaging, graded the diagnostic quality of the reconstructions using a Likert response format: 1 = excellent, 2 = good, 3 = adequate, 4 = nondiagnostic. Results: Systolic and diastolic quiescent periods were identified for each subject from the vessel motion calculated using the phase-to-phase deviation measure. The motion of the IVS was found to be similar to the aggregate vessel (AGG) motion. The diagnostic quality of the coronary vessels for the quiescent phases calculated from the aggregate vessel (P AGG ) and IVS (P IVS ) deviation signal using the proposed methods was comparable to the quiescent phases calculated by the CT scanner (P CT ). The one exception was the RCA, which improved for P AGG for 18 of the 20 subjects when compared to P CT (P CT = 2.48; P AGG = 2.07, p = 0.001). Conclusions: A method for quantifying the motion of specific coronary vessels using a correlationbased, phase-to-phase deviation measure was developed and tested on 20 patients receiving cardiac CT exams. The IVS was found to be a suitable predictor of vessel quiescence. The diagnostic quality of the quiescent phases detected by the proposed methods was comparable to those calculated by the CT scanner. The ability to quantify coronary vessel quiescence from the motion of the IVS can be used to develop new CTCA gating techniques and quantify the resulting potential improvement in CTCA image quality. C 2015 American Association of Physicists in Medicine.

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Optimal Systolic and Diastolic Reconstruction Windows for Coronary CT Angiography Using Dual-Source CT

Abstract: Using dual-source CT, the overall optimal reconstruction window is at 75% of the R-R interval in patients with low or intermediate heart rates. In patients with heart rates of > 80 bpm, systolic reconstructions often yield superior image quality compared with diastolic reconstructions.

Cited by 95 publications

References 28 publications

Optimal reconstruction interval in dual source CT coronary angiography: a single-center experience in 285 patients

Optimal reconstruction interval in dual source CT coronary angiography: a single-center experience in 285 patients

High-pitch dual-source CT coronary angiography: systolic data acquisition at high heart rates

Characterization of cardiac quiescence from retrospective cardiac computed tomography using a correlation‐based phase‐to‐phase deviation measure

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