Journal of Cardiovascular Computed Tomography
Volume 3, Issue 5 , Pages 300-309, September 2009

Dual-source computed tomography angiography image quality in patients with fast heart rates

  • Monvadi B. Srichai, MD

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
    • Department of Medicine, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
    • Corresponding Author InformationCorresponding author.
  • ,
  • Elizabeth M. Hecht, MD

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
  • ,
  • Danny Kim, MD

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
  • ,
  • James Babb, PhD

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
  • ,
  • Jessica Bod, BA

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA
  • ,
  • Jill E. Jacobs, MD

      Affiliations

    • Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA

Received 16 January 2009; accepted 20 May 2009. published online 22 June 2009.

Background

Dual-source computed tomography (DSCT) provides diagnostic quality images of the coronary arteries over a wide range of heart rates (HRs). Current dose reduction techniques, including electrocardiographic (ECG) dose modulation and prospective triggering, are optimized for use in patients with relatively slow (<70 beats/min) HRs by limiting radiation dose to the ideal phases of image acquisition.

Objective

We evaluated coronary vessel image quality (IQ) at different reconstruction phases in patients with fast HRs (>80 beats/min) to assess potential feasibility of prospective triggering techniques on DSCT.

Methods

Patients (n=101) underwent 64-slice DSCT with retrospective ECG-gating without β-blocker premedication. Image reconstructions were performed at 10% R-R wave phase intervals (0%–90%). Patients were grouped by mean HR: group A, <60 beats/min (n=22); group B, 60–80 beats/min (n=57); group C, >80 beats/min (n=22). Coronary artery IQ was assessed by 2 readers in consensus on a 5-point scale.

Results

Optimal IQ occurred at 70% phase for all arteries in groups A and B. In group C, optimal IQ occurred at 30% and 40% phases. The 70% phase achieved diagnostic IQ in 97% of group A and 86% of group B. A widened reconstruction window (30%–50%) was necessary for diagnostic IQ in a similar high proportion (84%) of group C.

Conclusion

Optimal IQ occurs during late-systolic phases for patients with fast HRs (>80 beats/min). Late-systolic phase prospective triggering is potentially feasible in these patients; however, given the widened reconstruction windows required, a higher radiation dose may be required compared with patients with slower HRs (<80 beats/min).

Keywords: Cardiac computed tomography, Coronary artery disease, Dual-source computed tomography, Prospective triggering, Retrospective gating

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 Conflict of interest: The authors report no conflicts of interest.

PII: S1934-5925(09)00263-9

doi:10.1016/j.jcct.2009.05.014

Refers to erratum:

  • Erratum , 21 December 2009

    Journal of Cardiovascular Computed Tomography January 2010 (Vol. 4, Issue 1, Page 80)

Journal of Cardiovascular Computed Tomography
Volume 3, Issue 5 , Pages 300-309, September 2009