Pulmonary Venous Anatomy Imaging With Low-Dose, Prospectively ECG-Triggered, High-Pitch 128-Slice Dual-Source Computed Tomography

Abstract

Background Efforts to reduce radiation from cardiac computed tomography (CT) are essential. Using a prospectively triggered, high-pitch dual source CT (DSCT) protocol, we aim to determine the radiation dose and image quality (IQ) in patients undergoing pulmonary vein (PV) imaging. Methods and Results In 94 patients (61±9 years, 71% male) who underwent 128-slice DSCT (pitch 3.4), radiation dose and IQ were assessed and compared between 69 patients in sinus rhythm (SR) and 25 in atrial fibrillation (AF). Radiation dose was compared in a subset of 19 patients with prior retrospective or prospectively triggered CT PV scans without high-pitch. In a subset of 18 patients with prior magnetic resonance imaging (MRI) for PV assessment, PV anatomy and scan duration were compared to high-pitch CT. Using the high-pitch protocol, total effective radiation dose was 1.4 [1.3, 1.9] mSv, with no difference between SR and AF (1.4 vs 1.5 mSv, p=0.22). No high-pitch CT scans were non-diagnostic or had poor IQ. Radiation dose was reduced with high-pitch (1.6 mSv) compared to standard protocols (19.3 mSv, p<0.0001). This radiation dose reduction was seen with SR (1.5 vs 16.7 mSv, p<0.0001) but was more profound with AF (1.9 vs 27.7 mSv, p=0.039). There was excellent agreement of PV anatomy (kappa 0.84, p<0.0001), and a shorter CT scan duration (6 minutes) compared to MRI (41 minutes, p<0.0001). Conclusions Using a high-pitch DSCT protocol, PV imaging can be performed with minimal radiation dose, short scan acquisition, and excellent IQ in patients with SR or AF. This protocol highlights the success of new cardiac CT technology to minimize radiation exposure, giving clinicians a new low-dose imaging alternative to assess PV anatomy.

The Clinical Value of Nongated Dual‐Source Computed Tomography in Atrial Fibrillation Catheter Ablation

“…MRI is another tool for imaging PV and LA anatomy that does not require ionizing radiation. However, approximately 40–50 minutes is required to perform PV and LA MRI . In contrast, the mean scan duration of our novel protocol was just 0.35 seconds.…”

“…The clinical advantages of ECG‐gated 128 dual‐source CT (DSCT) have been reported in several studies . For example, 128‐slice DSCT provides improved temporal resolution (75 milliseconds) because of a gantry rotation time of 280 milliseconds compared with single‐source MDCT .…”

Diagnosis of Structural Deterioration in an Aortic Bioprosthetic Valve by Multidetector Row Computed Tomography: Report of a Case

“…The latest dual-source CT scanner had no effect on atrial fibrillation. 12,15) Direct planimetric measurement of an AVA has been successfully performed using ECG-gated MDCT, 7,8) and good correlation of planimetric AVA with Dopplerderived AVA using TTE and TEE 7,8) has been indicated. Although blooming artifacts due to cusp calcification are well documented as a serious factor causing difficulty in direct planimetry of an AVA, restricted cusp opening was clearly observed during the systolic phase and planimetric measurement of the AVA was easily performed using 256-slice CT in the present patient.…”

Filling defects of the left atrial appendage on multidetector computed tomography: their disappearance following catheter ablation of atrial fibrillation and the detection of LAA thrombi by MDCT

“…In the previous study employing a dualsource 128-slice dual source CT scanner, the effective dose for coronary CT angiography was 1.4 mSv [29]. Furthermore, the 128-slice dual source system reduced the radiation dose to which a patient is exposed in the evaluation if the LA and PV anatomy to 1.4 mSv [30]. Although the effective dose of MDCT in the present study was similar to previous reports, the possibility of complication arising from radiation exposure should be considered.…”