Abstract 5802: Whole-Heart Coronary Angiography using Volume Computed Tomography in Comparison to Conventional Coronary Angiography

Abstract

This is an initial report on the use of the recently introduced whole-heart 320-slice computed tomography (CT) scanner for noninvasive coronary angiography compared with conventional coronary angiography (CCA). Whole-heart CT avoids overscanning and overranging as necessary for helical coronary CT acquisitions thereby significantly reducing the effective radiation dose. Twelve patients with suspected coronary artery disease (4 women, 8 men; mean age 64.6 ± 11 years) have undergone coronary CT angiography using a 320-slice scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation time, 120 kV, and 350 – 450 mA) prior to clinically indicated CCA. CT images were manually reconstructed in motion-free phases with 0.5-mm slice thickness and 0.25-mm slice increment. Independent blinded assessment of CT and CCA (using quantitative analysis) was performed to detect significant (at least 50%) diameter stenoses. Of the 12 patients, in 8 patients, single-heart beat CT acquisition was performed, resulting in an effective dose of 5.6 ± 1.1 mSv and an image reconstruction window length of 175 msec. In the other 4 patients, because of higher heart rates, 2 or 3 heart beats were used for acquisition, resulting in higher radiation exposure (on average 17 mSv) and the possibility to perform multisegment reconstruction with improved temporal resolution (88 and 58 msec image reconstruction windows, respectively). Per-patient sensitivity and specificity for CT compared to CCA were 100%. Per-vessel sensitivity and specificity were 88% and 95%, respectively. Intraindividual comparison of CT with CCA revealed a nonsignificantly smaller effective radiation dose (9.4 ± 7.2 mSv vs. 10.5 ± 5.3 mSv, p<0.69) but significantly smaller contrast agent amount (80 ±0 ml vs. 107.3 ± 17.8 ml, p<0.01) for 320-slice CT. Whole-heart CT significantly reduces the contrast agent amount compared to CCA while radiation exposure is reduced in patients with slow heart rates. This initial report also indicates that diagnostic accuracy of coronary CT angiography using up to 320 simultaneous detector rows remains high as compared with CCA as the reference standard.