Chinese Medical Sciences Journal ›› 2012, Vol. 27 ›› Issue (4): 213-219.doi: 10.1016/S1001-9294(13)60004-8

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Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison with Catheter Coronary Angiography

Kai Sun1*, Rui-juan Han2, Li-fang Cui1, Rui-ping Zhao2, Li-jun Ma1, Li-jun Wang1, Li-gang Li3, Chang-yong Li4   

  1. 1Department of Radiology; 2Department of Cardiology, Baotou Central Hospital, Baotou 014040, China; 3CT BM Clinic Marketing, Siemens Healthcare, Beijing 100102, China; 4Department of Physiology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
  • Received:2012-05-30 Online:2013-01-07 Published:2013-01-07
  • Contact: *Corresponding author Tel: 86-13654844693, E-mail: Henrysk@163.com E-mail:Henrysk@163.com
  • About author:*Corresponding author Tel: 86-13654844693, E-mail: Henrysk@163.com
  • Supported by:

    △Supported by the Ministry of Science and Technology of Inner Mongolia, China (20110504).

Abstract:

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.

Key words: dual-source computed tomography, coronary angiography, high pitch, prospectively electrocardiogram-triggered spiral mode, high heart rate, diagnostic accuracy

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