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First Head-to-Head Comparison of Effective Radiation Dose from Low-Dose CT with Prospective ECG-Triggering versus Invasive Coronary Angiography


Herzog, B A; Wyss, C A; Husmann, L; Gaemperli, O; Valenta, I; Treyer, V; Landmesser, U; Kaufmann, P A (2009). First Head-to-Head Comparison of Effective Radiation Dose from Low-Dose CT with Prospective ECG-Triggering versus Invasive Coronary Angiography. Heart, 95(20):1656-1661.

Abstract

BACKGROUND: Reduction of radiation burden of multidetector CT coronary angiography (CTCA) has remained an important task. OBJECTIVES: To compare effective radiation dose of low-dose 64-slice CTCA using prospective ECG-triggering versus diagnostic invasive coronary angiography (CA). METHODS: Forty-two patients referred for elective invasive CA due to suspected coronary artery disease (CAD) were prospectively enrolled to undergo a low-dose CTCA without calcium scoring within the same day prior to CA. Dose-area product of diagnostic invasive CA and dose-length product of CTCA were measured, converted into effective radiation dose and compared using Man-Whitney-U tests. In addition, accuracy of CTCA to detect CAD (coronary artery narrowing >/= 50%) was assessed using invasive CA as standard of reference. On an intention-to-diagnose-base all non-evaluative vessels were included in the analysis and censored as positive. RESULTS: The estimated mean effective radiation dose was 8.5 +/- 4.4mSv (range: 1.4 - 20.5mSV) for diagnostic invasive CA, and 2.1 +/- 0.7mSv (range: 1.0 - 3.3mSv) for CTCA (P<0.001). Nineteen patients (42.9%) had no CAD by invasive CA. Forty (95.2 %) patients have been correctly classified as having CAD (23/23) or no CAD (17/19). Over 97 % (551/567) of segments were evaluable. Vessel-based analysis revealed sensitivity, specificity, positive and negative predictive value of 94.2 % (CI: 0.8-1.0), 94.8% (CI: 0.9-1.0), 89.0% (CI: 0.8-1.0), 97.4% (CI: 0.9-1.0), and an accuracy of 94.6%. CONCLUSIONS: Low dose CTCA allows evaluation of CAD with high accuracy, but significantly less effective radiation dose to patients compared to diagnostic invasive CA.

BACKGROUND: Reduction of radiation burden of multidetector CT coronary angiography (CTCA) has remained an important task. OBJECTIVES: To compare effective radiation dose of low-dose 64-slice CTCA using prospective ECG-triggering versus diagnostic invasive coronary angiography (CA). METHODS: Forty-two patients referred for elective invasive CA due to suspected coronary artery disease (CAD) were prospectively enrolled to undergo a low-dose CTCA without calcium scoring within the same day prior to CA. Dose-area product of diagnostic invasive CA and dose-length product of CTCA were measured, converted into effective radiation dose and compared using Man-Whitney-U tests. In addition, accuracy of CTCA to detect CAD (coronary artery narrowing >/= 50%) was assessed using invasive CA as standard of reference. On an intention-to-diagnose-base all non-evaluative vessels were included in the analysis and censored as positive. RESULTS: The estimated mean effective radiation dose was 8.5 +/- 4.4mSv (range: 1.4 - 20.5mSV) for diagnostic invasive CA, and 2.1 +/- 0.7mSv (range: 1.0 - 3.3mSv) for CTCA (P<0.001). Nineteen patients (42.9%) had no CAD by invasive CA. Forty (95.2 %) patients have been correctly classified as having CAD (23/23) or no CAD (17/19). Over 97 % (551/567) of segments were evaluable. Vessel-based analysis revealed sensitivity, specificity, positive and negative predictive value of 94.2 % (CI: 0.8-1.0), 94.8% (CI: 0.9-1.0), 89.0% (CI: 0.8-1.0), 97.4% (CI: 0.9-1.0), and an accuracy of 94.6%. CONCLUSIONS: Low dose CTCA allows evaluation of CAD with high accuracy, but significantly less effective radiation dose to patients compared to diagnostic invasive CA.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:October 2009
Deposited On:18 Aug 2009 12:26
Last Modified:05 Apr 2016 13:19
Publisher:BMJ Publishing Group
ISSN:1355-6037
Publisher DOI:10.1136/hrt.2008.162420
PubMed ID:19581273
Permanent URL: http://doi.org/10.5167/uzh-20258

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