Can You Reliably Achieve Diagnostic Image Quality in Morbidly Obese Patients Undergoing Computed Tomography Coronary Angiography?

Abstract

There is concern about computed tomography coronary angiography (CTCA) image quality with the increasing numbers of obese and morbidly obese patients presenting with chest pain syndrome. This study evaluated the CTCA image quality in obese and morbidly obese patients in Counties Manukau, using a dual source scanner. Scan reports were prospectively collected using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) CT database between 1 January 2022 and 31 December 2022. Image quality was subjectively graded by the reporting cardiologist as good, average, or suboptimal at the time of scan. Coronary Artery Disease Reporting and Data System (CAD-RADS) score N (non-diagnostic) due to suboptimal image quality was collected. Patients were divided into three body mass index groups: 1) normal/overweight <30 kg/m2; 2) obese 30–40 kg/m2; 3) morbidly obese > 40 kg/m2. A total of 1,137 CTCA were performed. A total of 575 patients were normal/overweight and image quality was suboptimal in 10 (1.7%), average in 78 (13.6%), and good in 487 patients (84.7%); two patients had CAD-RADS-N due to suboptimal image quality. A total of 544 patients were obese and image quality was suboptimal in 16 (3.6%), average in 106 (23.9%), and good in 321 patients (72.5%); three patients had CAD-RADS-N due to suboptimal image quality. A total of 119 patients were morbidly obese and image quality was suboptimal in 10 (8.4%), average in 57 (47.9%), and good in 52 patients (43.7%); three patients had CAD-RADS-N due to suboptimal image quality. Although proportionately more morbidly obese patients were likely to have suboptimal CTCA image quality, diagnostic scans were obtained in almost all patients.