Abstract
We aimed to evaluate the accuracy of coronary computed tomography angiography (CCTA) with a low-radiation protocol and iterative model reconstruction (IMR), in comparison with invasive coronary angiography (ICA). Sixty-one patients (45 males; mean age, 61.9 ± 9.2 years) with suspected coronary artery disease who underwent CCTA and ICA were retrospectively enrolled. CCTA was performed with low tube voltage (80 or 100 kVp), low tube current (100–200 mAs), prospective ECG triggering, and IMR using a 64-slice computed tomography scanner. Coronary artery disease was defined as luminal narrowing of >50%, as assessed using CCTA and ICA. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, and accuracy of CCTA were examined. The mean radiation dose of CCTA was 1.05 ± 0.36 mSv. No non-diagnostic segment was noted. The sensitivity, specificity, PPV, NPV, and accuracy of CCTA were 86.4%, 96.1%, 80.3%, 97.5%, and 94.6% on a per segment basis, 93.1%, 94.7%, 88.3%, 97.0%, and 94.2% on a per vessel basis, and 100%, 83.3%, 93.5%, 100%, and 95.1% on a per patient basis, respectively. In conclusion, a low-radiation CCTA protocol with IMR may be useful for diagnosing coronary artery disease, as it reduces the radiation dose while maintaining diagnostic accuracy.
Highlights
Coronary computed tomographic angiography (CCTA) is a useful, non-invasive diagnostic imaging modality for the detection of coronary artery disease (CAD)
We aimed to assess the accuracy of coronary computed tomography angiography (CCTA) using low tube voltage, the iterative model reconstruction (IMR) technique, prospective ECG triggering, and a radiation dose of approximately 1 mSv, in comparison with invasive coronary angiography (ICA), in patients with suspected CAD
Compared with the reference standard ICA, the present study showed that CCTA had high diagnostic performance in ruling out CAD, along with a marked dose reduction at a 1 mSv fraction of effective radiation
Summary
Coronary computed tomographic angiography (CCTA) is a useful, non-invasive diagnostic imaging modality for the detection of coronary artery disease (CAD). The diagnostic performance of prospectively ECG-triggered CCTA with lowered radiation exposure by decreasing the scanning duration showed a high negative predictive value (NPV), when using stenosis by invasive coronary angiography (ICA) as the reference in patients with low-to-intermediate probability for CAD6. A few recent studies have evaluated the diagnostic performance and clinical feasibility of CCTA for CAD using low tube voltage and the model-based iterative reconstruction algorithm (MBIR), which is not yet commercially available because of the extended reconstruction time; these studies have showed relatively low specificity[9,10]. We aimed to assess the accuracy of CCTA using low tube voltage, the IMR technique, prospective ECG triggering, and a radiation dose of approximately 1 mSv, in comparison with ICA, in patients with suspected CAD. We evaluated the diagnostic accuracy on a per-segment, per-vessel, and per-patient basis, and determined its impact and the factors underlying misdiagnosis on CT images
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