Update for the Performance of CT Coronary Angiography – Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine

Abstract

Background Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure. Method The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience. Results and Conclusion According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI). Key Points: Citation Format

Enhancing Radiation Dose Efficiency in Prospective ECG-Triggered Coronary CT Angiography Using Calcium-Scoring CT

“…A test-bolus preceded CCTA to determine the time delay until maximal aortic contrast enhancement; accordingly, a region of interest was placed in the aortic root, and consecutive image acquisition started 10 s after intravenous injection of 10 mL of iodinated contrast material (Iomeprol, 400 mg/dL) followed by 60 mL using a dual-syringe power injector. The time to attenuation peak was measured, and 4 s were added to the time until peak in sequential scan mode and 5 s in high-pitch spiral scan mode to determine the CCTA scan delay [ 18 ].…”

“…For CCTA, 60-72 mL of contrast material (Imeron 400, Bracco imaging, 400 mg iodine/mL, injection rate: 6 mL/s) was injected, followed by a 60 mL saline flush (injection rate: 6 mL/s). A patient-specific simple score, calculated based on our institutional standards of procedure for CCTA acquisition [ 18 ], was used to determine the specific prospective ECG-triggered scan protocol (either high-pitch spiral CCTA or sequential CCTA). This acquisition score considers the patient’s heart rate, heart rate variability, body composition, and pretest probability of obstructive CAD [ 7 , 19 ].…”

“…When a sequential scan was applied, images were reconstructed in the automatically determined best diastolic or, if applicable, best systolic phase and in a multiphase dataset with 5% steps R-R interval [ 18 ]. All CCTA images were reconstructed using a vascular convolution kernel (Bv48), a slice thickness of 0.6 mm, and an increment of 0.4 mm.…”

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

“…Der Standard für die Triggerung des Scans ist ein Bolustracking (Schwellenwert 120–180 HE), wobei die Positionierung der Region of Interest (ROI) vom Scannertyp abhängt. Alternativ kann eine Testbolusstrategie verwendet werden 60 .…”

Calcium Scoring with Prospective ECG-Triggered coronary CT Angiography: A Path to Reduce Radiation Dose

“…A sequential diastolic scan was acquired in obese patients or patients with a heart rate > 65 bpm. Additionally, systolic ECG-padding was performed in case of increased heart rate or increased heart rate variability [17].…”