Feasibility of Low-Dose Contrast Medium High Pitch CT Angiography for the Combined Evaluation of Coronary, Head and Neck Arteries

Zhiwei Wang,Yu Chen,Zhengyu Jin,Huadan Xue,Shuo Li,Yining Wang,Jian Cao,Lingyan Kong,Zhuoli Zhang

doi:10.1371/journal.pone.0090268

Abstract

PurposeTo evaluate the image quality and radiation dose of combined heart, head, and neck CT angiography (CTA) using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol, compared with single coronary CTA.Materials and Methods151 consecutive patients were prospectively included and randomly divided into three groups. Group 1 (n = 47) underwent combined heart, neck, and head CTA using prospectively ECG-triggered high-pitch spiral (Flash) scan protocol with a single-phase intravenous injection of iodinated contrast and saline flush; Group 2 (n = 51) underwent single coronary CTA with Flash scan protocol; and Group 3 (n = 53) underwent single coronary CTA with prospective sequence scan protocol. All patients were examined on a dual source CT (Definition FLASH). The image quality was determined for each CT study.ResultsPatients of scanning protocol Group 1, 2, and 3 showed no significant differences in age, sex, heart rates, and BMI. Evaluation of coronary artery image quality showed comparable results in the three scanning protocol groups on a per patient-based analysis. In group 1, image quality was found to be sufficient to be diagnostic in all arterial segments of carotid arteries. The mean dose-length product (DLP) for group 1 was 256.3±24.5 mGy×cm and was significantly higher in comparison with group 2 (93.4±19.9 mGy×cm; p < 0.001). However, there was no significant difference of DLP between group 1 and group 3 (254.1±69.9 mGy×cm).ConclusionsThe combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose.

Highlights

Cardio-cerebral vascular disease is the leading cause of mortality worldwide [1,2]
There was no significant difference of dose-length product (DLP) between group 1 and group 3 (254.1669.9 mGy6cm)
The combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose

Summary

Introduction

Atherosclerosis is a common pathogenesis, a diffuse process that affects multiple vessels including the carotid and coronary arteries [3]. The coexistence rate of these two diseases has been reported at multiple imaging modalities, including digital subtraction angiography (DSA), Doppler ultrasonography (US), and multi-detector CT angiography (CTA) [3,4,5,6]. CTA has emerged as a reliable tool in the evaluation of atherosclerotic disease and has been shown to have a high concordance with histology when characterizing carotid artery plaque [7,8]. CTA has evolved into the modality of choice for anatomic evaluation of the coronary arteries with high sensitivity for the detection of significant coronary artery stenosis [9,10,11,12,13,14]. In retrospective electrocardiogram (ECG)-gated spiral acquisition mode, radiation doses up to 12 mSv have been reported for coronary

Methods

Results

Conclusion