JOURNAL ARTICLE

Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation

Carsten Rist, Thorsten R Johnson, Jens Müller-Starck, Elisabeth Arnoldi, Tobias Saam, Alexander Becker, Alexander W Leber, Bernd J Wintersperger, Christoph R Becker, Maximilian F Reiser, Konstantin Nikolaou
Investigative Radiology 2009, 44 (3): 159-67
19151607

OBJECTIVES: Despite constant improvements in scanner technology, reliable visualization of the coronary arteries with multislice spiral CT angiography (CTA) remains a major challenge in patients with atrial fibrillation (AF). The purpose of this study was to assess the image quality of coronary CT angiograms with coronary angiography, using a dual-source CT scanner (DSCT), comparing systolic and diastolic reconstruction techniques. Additionally, we sought to evaluate the diagnostic accuracy of DSCT with coronary angiography as the standard of reference.

MATERIALS AND METHODS: Sixty-eight patients with permanent AF were imaged on a DSCT system, with a temporal resolution of 82 milliseconds. The volume and flow rate of the contrast medium were adapted to the patient's body weight. The patients were not receiving any drugs for heart rate regulation. Each dataset was reconstructed at an absolute delay determined from the R wave at 300 milliseconds (ie, systolic reconstruction), as well as at 70% of the RR-cycle (diastolic reconstruction). Twenty-one patients underwent both DSCT and coronary angiography. Two blinded independent readers assessed significant stenoses (> or =50%), and image quality in terms of visibility and artifacts (4-point rating scale: 1 = excellent, 2 = good, 3 = poor, 4 = insufficient) on a per-patient- and a per-segment-based analysis (15-segment AHA model) for both the systolic and diastolic datasets. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

RESULTS: : During 68 DSCT examinations, the mean heart rate ranged between 26 and 181 beats per minute (77 +/- 25). In the patient-based analysis, the image qualities of 64 of 68 CT angiograms (94%) were high enough to permit diagnosis, ie, 4 of 68 (6%) datasets were considered nonevaluable. Segment-based, a total of 898 of 979 coronary artery segments were rated as diagnostically evaluable (92%).In 57 of 68 evaluable patients (84%) the reconstructions in stole had fewer motion artifacts and thus showed superior image quality. The median image quality of all CT datasets was 2. In 21 patients undergoing both coronary angiography and DSCT, the overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of significant stenoses were 89% (16 of 18), 98% (260 of 265), 76% (16 of 21), and 99% (260 of 262), respectively, in the per-segment analysis (including 283 vessel segments) and 90% (9 of 10), 82% (9 of 11), 82% (9 of 11), and 90% (9 of 10), respectively, in the patient-based analysis.

CONCLUSIONS: The image quality of coronary CT angiograms obtained with a DSCT is satisfactory in most patients with AF. In the majority of patients with high and irregular heart rate, the absolute forward approach with end-systolic reconstruction 300 milliseconds after the R-peak yield a higher image quality than diastolic reconstructions. As a result of a significant improvement in temporal resolution, DSCT coronary angiography is feasible in patients with AF and can be used to exclude coronary artery disease in this patient cohort.

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