Abstract
BackgroundTo study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats(VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose. Methods: 110 patients were divided into a VPB group (60 cases) and a control group (50 cases) using CTCA.All the patients then underwent coronary angiography (CAG) within one month. CAG served as a reference standard through which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTCA in diagnosing significant coronary artery stenosis (luminal stenosis ≥50%) could be analyzed. The two radiologists with more than 3 years’ experience in cardiac CT each finished the image analysis after consultation. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups.Methodology/Principal FindingsAt the coronary artery segment level, sensitivity, specificity, PPV, and NPV in the premature beat group were 92.55%, 98.21%, 88.51%, and 98.72% respectively. In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively. Between the two groups, specificity, sensitivity PPV, NPV was no significant difference. The two groups had no significant difference in image quality score (P>0.05). Heart rate (77.20±12.07 bpm) and radiation dose (14.62±1.37 mSv) in the premature beat group were higher than heart rate (58.72±4.73 bpm) and radiation dose (3.08±2.35 mSv) in the control group. In theVPB group, the radiation dose (34.55±7.12 mSv) for S-field scanning was significantly higher than the radiation dose (15.10±1.12 mSv) for M-field scanning.Conclusions/SignificanceWith prospective ECG-gated scanning for VPB, the diagnostic accuracy of coronary artery stenosis is very high. Scanning field adjustment can reduce radiation dose while maintaining good image quality. For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.
Highlights
Coronary CTA is currently the first choice for non-invasive diagnosis of coronary artery disease (CAD). This method has high diagnostic accuracy [1,2], but its accuracy is influenced by heart rate, rhythm, and other factors
Data from 110 patients undergoing 320detector CT coronary angiography in our hospital from October 2009 to June 2011 were collected (72 males and 38 females, aged 38- to 86-years-old, mean age 59-years-old). These patients were divided into two groups, those with ventricular premature beats (60 cases) and those with a normal rhythm and a heart rate below 65 bpm (50 cases)
The criterion of patients with ventricular premature beat is that the acquisition range was just in time to catch ventricular premature beat during prospective ECG-gated scanning. 50 cases were detected during medium-field (M-field, FOV = 320 mm) scanning, and 10 cases were detected during small-field (S-field,FOV = 200 mm) scanning
Summary
Coronary CTA is currently the first choice for non-invasive diagnosis of coronary artery disease (CAD). This method has high diagnostic accuracy [1,2], but its accuracy is influenced by heart rate, rhythm, and other factors. The radiation dose received by the patient can be reduced. To study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats(VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups
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