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Accuracy of Coronary CT Angiography Using a Submillisievert Fraction of Radiation Exposure: Comparison With Invasive Coronary Angiography


Stehli, Julia; Fuchs, Tobias A; Bull, Sacha; Clerc, Olivier F; Possner, Mathias; Buechel, Ronny R; Gaemperli, Oliver; Kaufmann, Philipp A (2014). Accuracy of Coronary CT Angiography Using a Submillisievert Fraction of Radiation Exposure: Comparison With Invasive Coronary Angiography. Journal of the American College of Cardiology, 64(8):772-780.

Abstract

BACKGROUND: Coronary computed tomography angiography (CTA) is increasingly being used for evaluation of coronary artery disease (CAD). As a result of the widely reported potential of carcinogenic risk from x-ray based examinations, many strategies have been developed for dose reduction with CTA.
OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of CTA acquired with a submillisievert fraction of effective radiation dose reconstructed with a model-based iterative reconstruction (MBIR) using invasive coronary angiography (ICA) as a standard of reference.
METHODS: In 36 patients (body mass index range 17 to 39 kg/m(2)) undergoing ICA for CAD evaluation, a CTA was acquired using very low tube voltage (80 to 100 kV) and current (150 to 210 mA) and was reconstructed with MBIR. CAD (defined as ≥50% luminal narrowing) was assessed on CTA and on ICA.
RESULTS: CTA resulted in an estimated radiation dose exposure of 0.29 ± 0.12 mSv (range 0.16 to 0.53 mSv), yielding 96.9% (436 of 450) interpretable segments. On an intention-to-diagnose basis, no segment was excluded, and vessels with at least 1 nonevaluable segment and no further finding were classified as false positive. This resulted in a sensitivity, specificity, positive, and negative predictive value and accuracy of 100%, 74%, 77%, 100%, and 86% per patient and 85%, 86%, 56%, 96%, and 85% per vessel, respectively.
CONCLUSIONS: The use of MBIR reconstruction allows accurate noninvasive diagnosis of CAD with CTA at a submillisievert fraction of effective radiation dose comparable with a chest x-ray in 2 views.

Abstract

BACKGROUND: Coronary computed tomography angiography (CTA) is increasingly being used for evaluation of coronary artery disease (CAD). As a result of the widely reported potential of carcinogenic risk from x-ray based examinations, many strategies have been developed for dose reduction with CTA.
OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of CTA acquired with a submillisievert fraction of effective radiation dose reconstructed with a model-based iterative reconstruction (MBIR) using invasive coronary angiography (ICA) as a standard of reference.
METHODS: In 36 patients (body mass index range 17 to 39 kg/m(2)) undergoing ICA for CAD evaluation, a CTA was acquired using very low tube voltage (80 to 100 kV) and current (150 to 210 mA) and was reconstructed with MBIR. CAD (defined as ≥50% luminal narrowing) was assessed on CTA and on ICA.
RESULTS: CTA resulted in an estimated radiation dose exposure of 0.29 ± 0.12 mSv (range 0.16 to 0.53 mSv), yielding 96.9% (436 of 450) interpretable segments. On an intention-to-diagnose basis, no segment was excluded, and vessels with at least 1 nonevaluable segment and no further finding were classified as false positive. This resulted in a sensitivity, specificity, positive, and negative predictive value and accuracy of 100%, 74%, 77%, 100%, and 86% per patient and 85%, 86%, 56%, 96%, and 85% per vessel, respectively.
CONCLUSIONS: The use of MBIR reconstruction allows accurate noninvasive diagnosis of CAD with CTA at a submillisievert fraction of effective radiation dose comparable with a chest x-ray in 2 views.

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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
Dewey Decimal Classification:610 Medicine & health
Date:26 August 2014
Deposited On:01 Oct 2014 15:44
Last Modified:08 Dec 2017 07:17
Publisher:Elsevier
ISSN:0735-1097
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.jacc.2014.04.079
PubMed ID:25145520

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