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. 2025 Aug;32(4):551-558.
doi: 10.1007/s10140-025-02351-4. Epub 2025 May 28.

Wide-Detector CT-Based optimized triple Rule-Out CT angiography for emergency chest pain: reducing contrast and radiation without compromising diagnostic quality

Qiuhua Zhang  1 , Kun Wang  2 , Hong Ren  3
Affiliations

Wide-Detector CT-Based optimized triple Rule-Out CT angiography for emergency chest pain: reducing contrast and radiation without compromising diagnostic quality

Qiuhua Zhang et al. Emerg Radiol. 2025 Aug.

Abstract

Background: The triple rule-out computed tomography angiography (TRO-CTA) has recently emerged as a technique that noninvasively evaluates the coronary arteries (CAs), the pulmonary arteries (PAs) and the thoracic aorta (TA).

Objective: To evaluate the feasibility of an optimized scanning protocol to reduce the volume of iodine contrast media (ICM), injection rate, and radiation dose in patients undergoing TRO-CTA.

Methods: Patients undergoing TRO-CTA were assigned to either group A or group B using a 16 cm wide-detector CT. Patients in group A were imaged with a traditional triple scanning protocol with a sequence of the PA, CAs, and TA. Patients in group B were imaged using the modified protocol with scanning sequence of PA, TA, and CAs, ICM of 55 ml, and injection rate of 4.5 mL/s. The image quality and effective radiation dose (ED) were compared.

Results: There were no significant differences in basic information between groups A and B. Other than the left PA, RA, and RV, there were no significant differences in the CT attenuation values of relevant vascular structures between groups A and B. There were no significant differences in CNR values between the two groups except the LAD-D and LCX. The image quality scores were comparable between groups A and B except the CAs. However, there were significant differences between the two groups in ICM (p < 0.05), scanning time (p < 0.001) and ED (p = 0. 023).

Conclusions: The optimized TRO-CTA scanning protocol can achieve less ICM and lower ED while maintaining image quality.

Keywords: Image quality; Iodine contrast media; Radiation dose; Tomography; Triple rule-out.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study followed the tenets of the Declaration of Helsinki and was approved by the Ethical Committee of Zhejiang University School of Medicine Sir Run Run Shaw Hospital. Conflict of interest: The authors declare that there are no conflicts of interest among the authors involved in this study.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrolment
Fig. 2
Fig. 2
60-year-old woman with chief complaint of chest pain (heart rate: 68 bpm). Images were acquired with the optimized TRO-CTA scanning scheme. Curved multiplanar reformat CT images show the left anterior descending artery (a), right coronary artery (b), left circumflex artery (c) and the thoracic aorta (e). The maximum intensity projection (MIP) images (d) show the pulmonary artery
See this image and copyright information in PMC

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