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Comparative Study
. 2012 Jun 1;5(3):521-30.
doi: 10.1161/CIRCEP.111.968313. Epub 2012 May 14.

Pulmonary venous anatomy imaging with low-dose, prospectively ECG-triggered, high-pitch 128-slice dual-source computed tomography

Wai-ee Thai  1 , Bryan Wai, Kaity Lin, Teresa Cheng, E Kevin Heist, Udo Hoffmann, Jagmeet P Singh, Quynh A Truong
Affiliations
Comparative Study

Pulmonary venous anatomy imaging with low-dose, prospectively ECG-triggered, high-pitch 128-slice dual-source computed tomography

Wai-ee Thai et al. Circ Arrhythm Electrophysiol. .

Abstract

Background: The efforts to reduce radiation from cardiac computed tomography (CT) are essential. Using a prospectively triggered, high-pitch dual-source CT protocol, we aim to determine the radiation dose and image quality in patients undergoing pulmonary vein (PV) imaging.

Methods and results: In 94 patients (61±9 years; 71% male) who underwent 128-slice dual-source CT (pitch 3.4), radiation dose and image quality were assessed and compared between 69 patients with sinus rhythm and 25 patients with atrial fibrillation. Radiation dose was compared in a subset of 19 patients with prior retrospective or prospectively triggered CT PV scans without high pitch. In a subset of 18 patients with prior magnetic resonance imaging for PV assessment, PV anatomy and scan duration were compared with high-pitch CT. Using the high-pitch protocol, total effective radiation dose was 1.4 (1.3, 1.9) mSv, with no difference between sinus rhythm and atrial fibrillation (1.4 versus 1.5 mSv; P=0.22). No high-pitch CT scans were nondiagnostic or had poor image quality. Radiation dose was reduced with high-pitch (1.6 mSv) compared with standard protocols (19.3 mSv; P<0.0001). This radiation dose reduction was seen with sinus rhythm (1.5 versus 16.7 mSv; P<0.0001) but was more profound with atrial fibrillation (1.9 versus 27.7 mSv; P=0.039). There was excellent agreement of PV anatomy (κ 0.84; P<0.0001) and a shorter CT scan duration (6 minutes) compared with magnetic resonance imaging (41 minutes; P<0.0001).

Conclusions: Using a high-pitch dual-source CT protocol, PV imaging can be performed with minimal radiation dose, short scan acquisition, and excellent image quality in patients with sinus rhythm or atrial fibrillation. This protocol highlights the success of new cardiac CT technology to minimize radiation exposure, giving clinicians a new low-dose imaging alternative to assess PV anatomy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Truong receives research grant support from Ziosoft, Inc. Dr. Heist receives research grant support and/or honoraria from Biotronik, Boston Scientific, Medtronic, Sorin and St. Jude Medical, and is a consultant to Boston Scientific, Sorin and St. Jude Medical. Dr. Singh receives research grant support, honoraria and is a consultant to St. Jude Medical, Medtronic Inc., Boston Scientific Corp. and Biotronik. He is a consultant to CardioInsight, Thoratec Inc. and Biosense Webster and receives honoraria from Guidant Corp and Sorin Group.

Figures

Figure 1
Figure 1
Flow diagram of study schema and population.
Figure 2
Figure 2
A. Histogram with distribution of heart rates of the 94 patients. B. Radiation dose as classified by heart rate categories (p-value is the result of Kruskal-Wallis test). C. Proportion of the number of patient scans as classified by heart rate categories with excellent, good and moderate image quality using the high-pitch protocol. Note there were no high-pitch scans that were uninterpretable or had poor image quality.
Figure 3
Figure 3
Examples of excellent, good, and moderate image quality from the high-pitch DSCT protocol. CT oblique sagittal and corresponding 3-dimensional volume rendered images showing excellent (A, D), good (B, E), and moderate (C, F) image quality, respectively. Note the absence of breathing or slab artifacts.
Figure 4
Figure 4
Difference in total effective radiation dose between patients with the high-pitch and standard CT scan protocols, and classified by sinus rhythm and atrial fibrillation (p-values are the results of mixed effect models).
Figure 5
Figure 5
CT oblique sagittal and volume rendered images from a patient who had a previous “standard” retrospective scan on the 64-slice DSCT (A, C) and subsequently a high-pitch 128-DSCT scan (B, D). In both CT scans, the patient was in normal sinus rhythm. Note the slab artifact (arrow) in the retrospective CT scan resulting in a grading of poor image quality but not in the high-pitch scan which was graded as excellent in image quality. The radiation dose was 19.5 mSv for the retrospective scan and 1.2 mSv for the high-pitch scan.
Figure 6
Figure 6
CT oblique sagittal and volume rendered images from a patient who had a previous “standard” retrospective scan (A, C) and subsequently a high-pitch CT scan (B, D). Both CT scans were performed on the 128-slice DSCT with the patient in atrial fibrillation. Note the slab artifact (arrow) in the retrospective CT scan resulting in a grading of poor image quality but not in the high-pitch scan which was graded as excellent in image quality. The radiation dose was 25 mSv for the retrospective scan and 2.9 mSv for the high-pitch scan.
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