Diagnostic image quality of a comprehensive high-pitch dual-spiral cardiothoracic CT protocol in patients with undifferentiated acute chest pain.

Abstract

OBJECTIVE:

To evaluate diagnostic image quality of high-pitch dual source comprehensive cardiothoracic CT protocol in patients presenting with acute undifferentiated chest pain.

MATERIALS AND METHODS:

Consecutive symptomatic subjects (n=51) with undifferentiated acute chest pain underwent ECG-synchronized high-pitch dual-spiral chest CT angiography (Definition Flash, Siemens Medical Solutions, 2 × 100 kVp or 2 × 120 kV if BMI>30, collimation: 128 × 0.6mm, pitch: 3.2). Independent investigators determined the image quality of each cardiac and pulmonary vessel segment, measured contrast-to-noise-ratio (CNR), and determined radiation exposure. In addition, the prevalence of CT findings (pulmonary embolism (PE), aortic dissection (AD) and significant coronary stenosis (≥ 50%)) was determined. Univariate and multivariate analysis were performed to determine the subpopulation with highest diagnostic quality.

RESULTS:

Among 51 subjects (66% male, average age: 63 ± 15.8), the prevalence of positive CT findings was moderate (overall: 11.7%). Overall, image quality of the pulmonary, aortic and coronary vasculature was good (1.26 ± 0.43 and CNR: 2.52) with an average radiation dose of 3.82 mSv and 3.2% of segments rated non-evaluable. The image quality was lowest in the coronary arteries (p=0.02), depending on the heart rate (r=0.52, p<0.001). In subjects with a heart rate of ≤ 65 bpm (n=30) subjective image quality and CNR of the coronary arteries were higher (1.6 ± 0.5 vs. 2.1 ± 0.5, p=0.03 and 1.21 ± 0.3 vs. 1.02 ± 0.3, p=0.05) with only 1.5% segments classified as non-evaluable.

CONCLUSION:

High-pitch dual-spiral comprehensive cardiothoracic CT provides low radiation exposure with excellent image quality at heart rates ≤ 65 bpm. In subjects with higher heart rates, image quality of the aortic and pulmonary vasculature remains excellent, while the assessment of the coronary arteries degrades substantially.

• Authors: Fabian Bamberg, Roy Marcus, Wieland Sommer, Florian Schwarz, Konstantin Nikolaou, Christoph R Becker, Maximilian F Reiser, Thorsten R C Johnson
• Journal: European journal of radiology (Eur J Radiol) Vol. 81 Issue 12 Pg. 3697-702 (Dec 2012) ISSN: 1872-7727 [Electronic] Ireland
• PMID: 21196093 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Topics

• Acute Disease
• Algorithms
• Angiography (methods)
• Chest Pain (diagnostic imaging)
• Female
• Humans
• Male
• Middle Aged
• Radiographic Image Enhancement (methods)
• Radiography, Thoracic (methods)
• Reproducibility of Results
• Sensitivity and Specificity
• Tomography, Spiral Computed (methods)