Prospective Electrocardiogram-Gated Multidetector Row Computed Tomography Coronary Angiography. Analysis of Quality Image and Radiation Dose
Creators
- 1. Diagnostico Maipu, Vicente Lopez, Buenos Aires (Argentina)
- 2. Medico Hemodinamista. Sanatorio Guemes, Ciudad Autonoma de Buenos Aires (Argentina)
- 3. Mount Sinai Medical Center, New York (United States)
Description
Multidetector row computed tomography coronary angiography (MDCT-CA) has become a useful diagnostic tool for the direct quantification of coronary stenosis, for identifying coronary anomalies and for the assessment of coronary artery bypass grafts. Despite its clinical value has been questioned due to the effective radiation dose (ERD) received by each patient, radiation exposure is similar to other studies. However, different strategies are permanently tested in order to reduce the ERD maintaining adequate and diagnostic image quality. Objectives: To determine the image quality and effective radiation dose (ERD) of prospective electrocardiogram-gated multidetector row computed tomography coronary angiography (PMDCTCA) (the x-ray beam is turned on for only a short portion of diastole) compared to retrospective ECG gating (RMDCTCA) (the x-ray beam is turned on throughout the cardiac cycle) and a preliminary approach of its diagnostic accuracy compared to digital invasive coronary angiography (CA). Material and Methods: Fifty consecutive patients with suspected coronary artery disease and sinus rhythm were evaluated with PMDCT-CA and compared to a control group who underwent RMDCTCA. Image quality was analyzed by two reviewers. Interobserver concordance and ERD were determined. The diagnostic accuracy of PMDCT-CA compared to CA to detect coronary artery stenosis > 50% was assessed in 30 patients. Results: There were no significant differences in the image quality between both groups. Agreement between the reviewers for segment image quality scores was k = 0.92. Mean ERD was 3.5 mSv for PMDCT-CA compared to 9.7 and 12.9 mSv for RMDCT-CA with and without tube current modulation, respectively. Individual analysis including all segments showed that the sensitivity, specificity, positive predictive value and negative predictive value of PMDCT-CA for the detection of coronary stenosis were 94.74%, 81.82%, 90% and 90%, respectively. Conclusion: Our initial experience demonstrated that PMDCT-CA has similar subjective image quality scores with a substantial reduction of ERD when compared to RMDCT-CA in a selected population. (authors)
Availability note (English)
Available in electronic form from: http://www.sac.org.ar/web_files/download/revista_articulos/files/v77n4a05-pdf-1673.pdfAbstract (Spanish)
Introduccion: La angiografia coronaria por tomografia computarizada multidetector (ACTCM) se ha convertido en una herramienta diagnostica util para la cuantificacion directa de la estenosis coronaria, la identificacion de anomalias coronarias y la evaluacion de bypass. Pese a que su valor clinico en ocasiones se ve cuestionado debido a la dosis de radiacion efectiva (DRE) que recibe cada paciente, esta no es mayor que la de otros estudios. No obstante, es motivo de permanente preocupacion la busqueda de diferentes estrategias para reducir la DRE sin detrimento de la calidad de imagen y de la certeza diagnostica. Objetivos: Determinar la calidad de imagen y la dosis de radiacion efectiva (DRE) de los estudios de angiografia coronaria por tomografia computarizada multidetector realizados con gatillado electrocardiografico prospectivo (ACTCM-P) (emision de radiacion sincronizada con la fase diastolica) en comparacion con la tecnica de adquisicion con gatillado retrospectivo (ACTCMR) (emision durante todo el ciclo cardiaco) y, en forma preliminar, su certeza diagnostica en relacion con la cinecoronariografia digital invasiva (CCG). Material y metodos: Cincuenta pacientes consecutivos con sospecha de enfermedad coronaria y ritmo sinusal fueron estudiados con ACTCM-P y comparados con un grupo control al que se le realizo una ACTCM-R. La calidad de imagen fue analizada por dos observadores. Se determinaron la concordancia interobservador y la DRE. En 30 pacientes se evaluo la certeza diagnostica de la ACTCM-P para la deteccion de estenosis > 50% en comparacion con la CCG. Resultados: No hubo diferencias significativas en la calidad de imagen entre los dos grupos. La concordancia interobservador fue: k = 0,92. La DRE media de la ACTCM-P fue de 3,5 mSv en comparacion con 12,9 y 9,7 mSv de la ACTCM-R sin modulacion del tubo de rayos X y con ella, respectivamente. En el analisis por paciente incluyendo todos los segmentos, la sensibilidad, la especificidad y el valor predictivo positivo y negativo de la ACTCM-P para la deteccion de estenosis fueron del 94,74%, 81,82%, 90% y 90%, respectivamente. Conclusion: Nuestra experiencia inicial demostro que la ACTCM-P brinda una reduccion sustancial de la DRE con una calidad de imagen comparable a la de la ACTCM-R en una poblacion seleccionada. (autores)Additional details
Additional titles
- Original title (Spanish)
- Angiografia coronaria por tomografia computarizada multidetector con gatillado electrocardiografico prospectivo. Analisis de la calidad de imagen y de la dosis de radiacion
Identifiers
Publishing Information
- Journal Title
- Revista Argentina de Cardiologia
- Journal Volume
- 77
- Journal Issue
- 4
- Series
- 24 refs.,4 figs.,4 tab.
- Journal Page Range
- p. 259-267
- ISSN
- 0034-7000
INIS
- Country of Publication
- Argentina
- Country of Input or Organization
- Argentina
- INIS RN
- 42032434
- Subject category
- S62: RADIOLOGY AND NUCLEAR MEDICINE; S61: RADIATION PROTECTION AND DOSIMETRY;
- Descriptors DEI
- BIOMEDICAL RADIOGRAPHY; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; COMPUTERIZED TOMOGRAPHY; ELECTROCARDIOGRAMS; IMAGES; RADIATION DOSES
- Descriptors DEC
- DIAGNOSTIC TECHNIQUES; DIAGRAMS; DISEASES; DOSES; INFORMATION; MEDICINE; NUCLEAR MEDICINE; RADIOLOGY; TOMOGRAPHY