Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience

Leschka, Sebastian ; Stolzmann, Paul ; Desbiolles, Lotus ; Baumueller, Stephan ; Goetti, Robert ; Schertler, Thomas ; Scheffel, Hans ; Plass, Andre ; Falk, Volkmar ; Feuchtner, Gudrun ; Marincek, Borut ; Alkadhi, Hatem

In: European Radiology, 2009, vol. 19, no. 12, p. 2896-2903

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    Summary
    Objectives: The objective was to prospectively investigate the diagnostic accuracy of high-pitch (HP) dual-source computed tomography coronary angiography (CTCA) compared with catheter coronary angiography (CCA) for the diagnosis of significant coronary stenoses. Methods: Thirty-five patients (seven women; mean age 62 ± 8years) underwent both CTCA and CCA. CTCA was performed with a second-generation dual-source CT system permitting data acquisition at an HP of 3.4. Patients with heart rates >60bpm were excluded from study enrolment. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a four-point scale (1: excellent to 4: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). CCA served as the standard of reference. Radiation dose values were calculated using the dose-length product. Results: Diagnostic image quality was found in 99% of all segments (455/459). Non-diagnostic image quality occurred in a single patient with a sudden increase in heart rate immediately before and during CTCA. Taking segments with non-evaluative image quality as positive for disease, the sensitivity, specificity and positive and negative predictive values were 94, 96, 80 and 99% per segment and 100, 91, 88 and 100% per patient. The effective radiation dose was on average 0.9 ± 0.1mSv. Conclusion: In patients with heart rates ≤60bpm, CTCA using the HP mode of the dual-source CT system is associated with high diagnostic accuracy for the assessment of coronary artery stenoses at sub-milliSievert doses