Comparison of coronary CT angiography (CCTA) for patients

with high heart rates using a 512-slice new-generation MDCT

and a 128-slice CT: image quality and radiation dose

Poster No.: B-0175

Congress: ECR 2015
Type: Scientific Paper
Authors: L. Macron, J.-L. Sablayrolles, J. Feignoux; Saint Denis/FR
Keywords: Cardiac, Vascular, CT, CT-Angiography, Dosimetry, Comparative
studies, Dosimetric comparison
DOI: 10.1594/ecr2015/B-0175

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Page 1 of 7
Purpose

Coronary Computed Tomography Angiography (CCTA) is well established in the

evaluation of suspected coronary artery diseases [1] for low to intermediate risk patients
[4]. CCTA is also used for the post monitoring of a bypass or the pre-assessment of
the lesions (morphological features, extra-luminal component and extent of the plaque)
prior to complex angioplasty or stent placement. However, radiation dose and diagnostic
image quality are of concern, especially for challenging patients with high or arrhythmic
heart rates. High heart rates introduce motion artefacts in the images and make it
difficult to find an appropriate phase of the cardiac cycle that is suitable for the analysis
of all coronary segments. Despite the wide use of oral or intravenous heart lowering
medication, CCTA remains challenging for patients who are contra-indicated or non-
responding to beta blockers.The latest 512-slice MDCT (Revolution CT, General Electric)
offers a novel technique based on a whole heart single beat acquisition that could allow
a significant increase in CCTA feasibility, accuracy and reproducibility; specifically for
this challenging population, as well as drastic dose reductions.Therefore, the purpose
of this study is to evaluate the benefits regarding image quality and radiation dose of
this new generation 512-slice CT scanners for CCTA in patients with a high heart rate in
comparison with the previous 128-slice generation.

Methods and materials

58 patients with a heart rate (HR) above 65 bpm during their CCTA were retrospectively
included. 29 were scanned on 128-slice MDCT (group A) and 29 underwent the exam
on 512-slice MDCT (Revolution CT, General Electric) (group B). Subjective image
quality and importance of motion and step artifacts were evaluated by two experienced
readers using respectively a 5-point scale (5: excellent, 4: good, 3: average, 2: bad,
1: very bad) and a 3-point scale (3, no artifact, 2: present but no interference with
diagnosis, 1: interference with diagnosis). Percentage of assessable coronary segments
was calculated. Besides, objective image quality was measured through the estimation
of the contrast to noise ratio. Mean effective dose (ED) was also calculated: (ED = #.DLP;
# = 0.014mSv x mGy-1 x cm-1).

Results

The mean HR was 73.3 ± 6.9 bpm and 75.7 ± 9.9 bpm for group A and B respectively
(p<0.001). In group A, 16% of coronary segments were not assessable, with motion
artefacts rated at 1.93±0.74 and step artefacts at 2.27±0.69. For group B, no step artefact
was encountered (due to a larger detector which enables the coverage of the whole

Page 2 of 7
heart and a single beat acquisition) and motion artefacts were less frequently observed
(2.41±0.62; p<0.001). That resulted in a significant drop for non-assessable coronary
segments to 3% (p<0.001) Fig. 1 on page 3. Moreover, it is shown (in table 1) that
segments from the right coronary artery are totally assessable in group B vs 85% for
group A. Besides, for those coming from the left anterior descending artery, 97% were
diagnostic in comparison of 83% obtained with the 128-slice MDCT and for the circumflex
artery respectively 99% vs 81% for group B and A. As a result, even with quite the same
increase in diagnostic segments (up to 18%) for all the main coronaries, the right coronary
artery presents the best outcome in terms of image quality Table 1 on page 5.

In addition, for group B, ED was reduced by 81% (2.7±2.4 mSv vs. 14.2±4.4 mSv,
p<0.001) Fig. 2 on page 3 and CNR increased by 32% Fig. 3 on page 4.

Fig. 4 on page 4 shows clinical images of two patients with high heart rate who
underwent a CCTA one on the 128-slice MDCT and the other on the Revolution CT.

Images for this section:

Fig. 1: Cohort of patients and assessable coronary segments.

Page 3 of 7
Fig. 2: Comparison of ED between 128-slice CT and 512-slice CT (Revolution CT).

Fig. 3: Comparison of Contrast to Noise Ratio between 128-slice CT and 512-slice CT

(Revolution CT).

Page 4 of 7
Fig. 4: Clinical images of two patients (one from group A and the other from group B)
highlighting the impact of motion and step artefacts.

Table 1: Percentage of assessable segments from each main coronary artery.

Page 5 of 7
Conclusion

New generation 512-MDCT allows performing pure arterial CCTA on high heart rate
patients with the one beat acquisition. This type of acquisition limits venous contamination
thus increasing the contrast to noise ratio. A remarkable improvement in image quality,
diagnosis accuracy and reduction of radiation dose were also measured in this study;
thanks to a prospectively ECG-gated One Beat axial acquisition protocol that utilizes
160mm of high-definition coverage with 0.28s rotation speed. Therefore, these promising
results open the door to a wider use of this examination.

Personal information

Laurent Macron, MD.

Department of Radiology, Centre Cardiologique du Nord, Saint Denis, FR.

Jean-Louis Sablayrolles, MD.

Department of Radiology, Centre Cardiologique du Nord, Saint Denis, FR.

Jacques Feignoux, MD.

Department of Radiology, Centre Cardiologique du Nord, Saint Denis, FR.

References

1. Leipsic J, Labounty TM, Heilbron B et al. Adaptive statistical iterative reconstruction:

assessment of image noise and image quality in coronary CT angiography. AJR Am J
Roentgenol 2010;195:649-654

2. Raff GL, Abidov A, Achenbach S, et al. Society of Cardiovascular Computed

Tomography. SCCT guidelines for the interpretation and reporting of coronary computed
tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3:122-36.

3. Matt D, Scheffel H, Leschka S, et al. Dual-source CT coronary angiography:

image quality, mean heart rate, and heart rate variability. AJR Am J Roentgenol.
2007;189:567-73.

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4. Montalescot G, Sechtem U, Achenbach S et al.2013 ESC guidelines on the
management of stable coronary artery disease: The Task Force on the management
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