Korean J Radiol.  2011 Jun;12(3):308-318. 10.3348/kjr.2011.12.3.308.

The Diagnostic Accuracy, Image Quality and Radiation Dose of 64-Slice Dual-Source CT in Daily Practice: a Single Institution's Experience

• Moon JH
• Park EA
• Lee W
• Yin YH
• Chung JW
• Park JH
• Lee HY
• Kang HJ
• Kim HS

• KMID: 1122328
• DOI: http://doi.org/10.3348/kjr.2011.12.3.308

Abstract

OBJECTIVE
We wanted to evaluate the image quality, diagnostic accuracy and radiation exposure of 64-slice dual-source CT (DSCT) coronary angiography according to the heart rate in symptomatic patients during daily clinical practice.
MATERIALS AND METHODS
We performed a retrospective search for the DSCT coronary angiography reports of 729 consecutive symptomatic patients. For the 131 patients who underwent invasive coronary angiography, the image quality, the diagnostic performance (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] for detecting significant stenosis > or = 50% diameter) and the radiation exposure were evaluated. These values were compared between the groups with differing heart rates (HR): mean HR < 65 or > or = 65 and HR variability (HRV) < 15 or > or = 15.
RESULTS
Among the 729 patients, the CT reports showed no stenosis or insignificant coronary artery stenosis in 72%, significant stenosis in 26% and non-diagnostic in 2%. For the 131 patients who underwent invasive coronary angiography, 95% of the patients and 97% of the segments were evaluable, and the overall per-patient/per-segment sensitivity, the perpatient/per-segment specificity, the per-patient/per-segment PPV and the per-patient/per-segment NPV were 100%/90%, 71%/98%, 95%/88% and 100%/97%, respectively. The image quality was better in the HR < 65 group than in the HR > or = 65 group (p = 0.001), but there was no difference in diagnostic performance between the two groups. The mean effective radiation doses were lower in the HR < 65 or HRV < 15 group (p < 0.0001): 5.5 versus 6.7 mSv for the mean HR groups and 5.3 versus 9.3 mSv for the HRV groups.
CONCLUSION
Dual-source CT coronary angiography is a highly accurate modality in the clinical setting. Better image quality and a significant radiation reduction are being rendered in the lower HR group.

Keyword

Dual-source computed tomography; Coronary arteries; Coronary stenosis; Coronary angiography

MeSH Terms

Adult
Aged
Aged, 80 and over
Artifacts
Contrast Media/diagnostic use
Coronary Angiography/*methods
Coronary Stenosis/*radiography
Female
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Predictive Value of Tests
Quality Assurance, Health Care
Radiation Dosage
Radiographic Image Interpretation, Computer-Assisted/methods
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Flow chart for routine work-up for 729 patients who underwent 64-slice dual-source CT coronary angiography. Treadmill test or myocardial single photon emission CT (SPECT) was performed within one month before or after dual-source CT coronary angiography. Invasive coronary angiography was performed within three months after dual-source CT coronary angiography.

• 

  Fig. 2 Coronary angiography in 65-year-old male with mean heart rate of 48 beats per minute (bpm) and his heart rate variability was 15 bpm. Volume CT dose index (CTDIvol) and effective dose were 21.1 mGy and 5.4 mSv, respectively. CT volume-rendered reconstruction (A, B) and conventional angiogram (D) show significant stenosis of right coronary artery (arrows). Mild degree of severe stair-step artifacts (white arrowheads) was observed on volume-rendered reconstruction (A) and curved multiplanar reconstruction (C). Of note, severe stenosis of posterior descending coronary artery (black arrowhead) was also seen on volume-rendered reconstruction (B). Conventional angiogram (D) taken on same day does not show stenosis of posterior descending artery (arrowhead). This is false positive case.

• 

  Fig. 3 Coronary angiography in 54-year-old male with mean heart rate of 63 beats per minute (bpm) and his heart rate variability was 5 bpm. Volume CT dose index (CTDIvol) and effective dose were 18.0 mGy and 4.5 mSv, respectively. CT volume-rendered reconstruction (A, B) and conventional angiogram (D, E) show significant stenosis of proximal left anterior descending artery (black arrows) and diagonal branch (white arrows). Radiologist well detected these lesions and they were mentioned on radiologic report. At same time, total segmental occlusion of distal left circumflex artery (arrowheads) was noted (B, E). Mixed plaque occluding lumen of left circumflex artery (white arrowheads) was well depicted on curved multiplanar reconstruction (F). However, in clinical practice, there was no mention of this on radiologic report. Unenhanced left circumflex artery (white arrowhead) is slightly enlarged and it may have been missed since it looks like cardiac vein on axial transverse image (C).

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