Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: Development of selection criteria and initial experience

Gutstein, Ariel; Wolak, Arik; Lee, Cynthia; Dey, Damini; Ohba, Muneo; Suzuki, Yasuyuki; Cheng, Victor; Gransar, Heidi; Suzuki, Shoji; Friedman, John; Thomson, Louise E.; Hayes, Sean; Pimentel, Raymond; Paz, William; Slomka, Piotr; Berman, Daniel S.

doi:10.1016/j.jcct.2007.12.015

« Previous Next »Journal of Cardiovascular Computed Tomography
Volume 2, Issue 2 , Pages 81-90, March 2008

Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: Development of selection criteria and initial experience

Ariel Gutstein, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- Corresponding author.
Arik Wolak, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Cynthia Lee, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Damini Dey, PhD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- David-Geffen School of Medicine, University of California-Los Angeles, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Muneo Ohba, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Yasuyuki Suzuki, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Victor Cheng, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Heidi Gransar, MS
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Shoji Suzuki, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
John Friedman, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- David-Geffen School of Medicine, University of California-Los Angeles, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Louise E. Thomson, MD, MBchB, FRACP
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- David-Geffen School of Medicine, University of California-Los Angeles, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Sean Hayes, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Raymond Pimentel, (RT)(R)(CT)
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
William Paz
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Piotr Slomka, PhD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- David-Geffen School of Medicine, University of California-Los Angeles, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
Daniel S. Berman, MD
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA
- David-Geffen School of Medicine, University of California-Los Angeles, 8700 Beverly Boulevard, Suite 1258, Los Angeles, CA 90048, USA

Received 19 October 2007; accepted 28 December 2007. published online 15 January 2008.

Background

Prospectively gated coronary computed tomographic angiography (CCTA) with dual-source CT allows substantial reduction of radiation exposure but requires prospective single-phase selection and assessment of likelihood of adequate image quality.

Objective

We developed and tested the model for predicting success of prospectively gated CCTA.

Methods

Retrospectively gated CCTA was acquired with dual-source CT in 162 patients. Two cardiologists assessed by consensus whether diagnostic quality images could have been obtained in a single predefined phase, 70% of R-R interval (70P), thereby identifying patients in whom a prospectively gated scan at 70P would have been successful. Logistic regression models were built with and without a coronary calcium scan. The obtained criteria were applied on 42 additional patients.

Results

By logistic regression, heart rate before CCTA of ≥70 beats/min, maximal heart rate variation before CCTA of ≥10 beats/min, coronary calcium score ≥ 400 U, and body mass index (in kg/m²) ≥ 30 were independent predictors of unsuccessful prospectively gated CCTA using 70P. Excluding coronary calcium score from the model, these same variables in addition to age > 65 years were found to be predictors of unsuccessful prospectively gated CCTA. Applying this model to 42 additional patients, using prospective gating, only 5 segments in 4 patients were nondiagnostic. Mean radiation dose for prospectively gated CCTA was 2.2 ± 0.8 mSv.

Conclusion

Prospectively gated CCTA with dual-source CT can be successfully implemented with consideration of prescan heart rate, heart rate variability, body mass index, and coronary calcium score.

Keywords: Age, BMI, body mass index, CCS, coronary calcium score, Computed tomography angiography, Dual-source CT, Effective radiation dose, Heart rate, Heart rate variation, Prospective gating, Retrospective gating