Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation

Eisentopf J, Achenbach S, Ulzheimer S, Layritz C, Wüst W, May M, Lell M, Ropers D, Klinghammer L, Daniel W, Pflederer T (2013)

Publication Type: Journal article

Publication year: 2013

Journal

Book Volume: 6

Pages Range: 458-465

Journal Issue: 4

DOI: 10.1016/j.jcmg.2012.10.023

Abstract

Objectives: The purpose of this study was to evaluate the image quality and diagnostic accuracy of very low-dose, dual-source computed tomography (DSCT) angiography for the evaluation of coronary stents. Background: Iterative reconstruction (IR) leads to substantial reduction of image noise and hence permits the use of very low-dose data acquisition protocols in coronary computed tomography angiography. Methods: Fifty symptomatic patients with 87 coronary stents (diameter 3.0 ± 0.4 mm) underwent coronary DSCT angiography (heart rate, 60 ± 6 beats/min; prospectively electrocardiography-triggered axial acquisition; 80 kV, 165 mA, 2 × 128 × 0.6-mm collimation; 60 ml of contrast at 6 ml/s) before invasive coronary angiography. DSCT images were reconstructed using both standard filtered back projection and a raw data-based IR algorithm (SAFIRE, Siemens Healthcare, Forchheim, Germany). Subjective image quality (4-point scale from 0 [nondiagnostic] to 3 [excellent image quality]), image noise, contrast-to-noise ratio as well as the presence of in-stent stenosis >50% were independently determined by 2 observers. Results: The median dose-length product was 23.0 (22.0; 23.0) mGy · cm (median estimated effective dose of 0.32 [0.31; 0.32] mSv). IR led to significantly improved image quality compared with filtered back projection (image quality score, 1.8 ± 0.6 vs. 1.5 ± 0.5, p < 0.05; image noise, 70 Hounsfield units [62; 80 Hounsfield units] vs. 96 Hounsfield units [82; 113 Hounsfield units], p < 0.001; contrast-to-noise ratio, 11.0 [9.6; 12.4] vs. 8.0 [6.2; 9.3], p < 0.001). To detect significant coronary stenosis in filtered back projection reconstructions, the sensitivity, specificity, positive predictive value, and negative predictive value were 97% (32 of 33), 53% (9 of 17), 80% (32 of 40), and 90% (9 of 10) per patient, respectively; 89% (43 of 48), 79% (120 of 152), 57% (42 of 74), and 96% (121 of 126) per vessel, respectively; and 85% (12 of 14), 69% (51 of 73), 32% (11 of 34), and 96% (51 of 53) per stent, respectively. In reconstructions obtained by IR, the corresponding values were 100% (33 of 33), 65% (11 of 17), 85% (33 of 39), and 100% (11 of 11) per patient, respectively; 96% (46 of 48), 84% (129 of 152), 66% (47 of 71), and 98% (127 of 129) per vessel, respectively; and 100% (14 of 14), 75% (55 of 73), 44% (14 of 32), and 100% (55 of 55) per stent, respectively. These differences were not significant. Conclusions: In selected patients, prospectively electrocardiography-triggered image acquisition with 80-kV tube voltage and low current in combination with IR permits the evaluation of patients with implanted coronary artery stents with reasonable diagnostic accuracy at very low radiation exposure. © 2013 American College of Cardiology Foundation.

Authors with CRIS profile

Involved external institutions

Siemens AG, Healthcare Sector Germany (DE)

How to cite

APA:

Eisentopf, J., Achenbach, S., Ulzheimer, S., Layritz, C., Wüst, W., May, M.,... Pflederer, T. (2013). Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation. Journal of the American College of Cardiology : Cardiovascular imaging, 6(4), 458-465. https://doi.org/10.1016/j.jcmg.2012.10.023

MLA:

Eisentopf, Jasmin, et al. "Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation." Journal of the American College of Cardiology : Cardiovascular imaging 6.4 (2013): 458-465.

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