Abstract
Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1 January 2015 to 31 December 2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.
Highlights
Accepted: 23 September 2021The excellent negative predictive value of coronary computed tomography angiography (CCTA) has put it in the spotlight as a non-invasive test for coronary artery disease (CAD)
While the improvements in dose-reduction are certainly paramount, one should stress that clinical decision making based on CCTA results calls for reliable image quality and that a non-diagnostic scan may lead to further radiation exposure by alternative modalities such as invasive coronary angiography or Sesta-MIBI myocardial perfusion scan
To clarify the potential of high-pitch scanning as a go-to method in a broader patient collective, i.e., including those with elevated heart rates and extrasystoles, we investigated radiation exposure and image quality among two examination algorithms that aimed to achieve CCTAs of diagnostic quality for each patient, namely a high-pitch spiral first (HPSF) approach and non-high-pitch spiral first (NHPSF) approach
Summary
Accepted: 23 September 2021The excellent negative predictive value of coronary computed tomography angiography (CCTA) has put it in the spotlight as a non-invasive test for coronary artery disease (CAD). While the improvements in dose-reduction are certainly paramount, one should stress that clinical decision making based on CCTA results calls for reliable image quality and that a non-diagnostic scan may lead to further radiation exposure by alternative modalities such as invasive coronary angiography or Sesta-MIBI myocardial perfusion scan. In this setting, the potentially artefact-compromised data in high-pitch scans especially in patients with extrasystoles or elevated heart rates has often raised concerns about its robustness in a broad patient collective. Moving coronary arteries make it difficult to achieve this goal; a common concept to improve image quality is to widen the Published: 24 September 2021
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