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High-definition computed tomography for coronary artery stents: image quality and radiation doses for low voltage (100 kVp) and standard voltage (120 kVp) ECG-triggered scanning

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Abstract

The noninvasive assessment of coronary stents by coronary CT angiography (CCTA) is an attractive method. However, the radiation dose associated with CCTA remains a concern for patients. The purpose of this study is to compare the radiation doses and image qualities of CCTA performed using tube voltages of 100 or 120 kVp for the evaluation of coronary stents. After receiving institutional review board approval, 53 consecutive patients with previously implanted stents (101 stents) underwent 64-slice CCTA. Patients were divided into three different protocol groups, namely, prospective ECG triggering at 100 kVp, prospective ECG triggering at 120 kVp, or retrospective gating at 100 kVp. Two reviewers qualitatively scored the quality of the resulting images for coronary stents and determined levels of artificial lumen narrowing (ALN), stent lumen attenuation increase ratio (SAIR), image noise, and radiation dose parameters. No significant differences were found between the three protocol groups concerning qualitative image quality or SAIR. Coronary lumen attenuation and in-stent attenuation of 100 kVp prospective CCTA (P-CCTA) were higher than in the 120 kVp P-CCTA protocol (all Ps < 0.001). Mean ALN was significantly lower for 100 kVp P-CCTA than for 100 kVp retrospective CCTA (R-CCTA, P = 0.007). The mean effective radiation dose was significantly lower (P < 0.001) for 100 kVp P-CCTA (3.3 ± 0.4 mSv) than for the other two protocols (100 kVp R-CCTA 6.7 ± 1.0 mSv, 120 kVp P-CCTA 4.6 ± 1.2 mSv). We conclude that the use of 100 kVp P-CCTA can reduce radiation doses for patients while maintaining the imaging quality of 100 kVp R-CCTA and 120 kVp P-CCTA for the evaluation of coronary stents.

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References

  1. Pugliese F, Weustink AC, Van Mieghem C, Alberghina F, Otsuka M, Meijboom WB, van Pelt N, Mollet NR, Cademartiri F, Krestin GP, Hunink MG, de Feyter PJ (2008) Dual source coronary computed tomography angiography for detecting in-stent restenosis. Heart 94(7):848–854

    Article  CAS  PubMed  Google Scholar 

  2. Mahnken AH (2012) CT imaging of coronary stents: past, present, and future. ISRN Cardiol 2012:139823

    Article  PubMed Central  PubMed  Google Scholar 

  3. Fuchs TA, Stehli J, Fiechter M, Dougoud S, Sah BR, Gebhard C, Bull S, Gaemperli O, Kaufmann PA (2013) First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography. Int J Cardiovasc Imaging 29(6):1409–1416

    Article  PubMed  Google Scholar 

  4. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, McCollough C, Martinoff S, Kastrati A, Schomig A, Achenbach S (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301(5):500–507

    Article  CAS  PubMed  Google Scholar 

  5. Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, Shaw LJ, Hausleiter J; Society of Cardiovascular Computed Tomography (2011) SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 5(4):198–224

  6. Earls JP, Leipsic J (2010) Cardiac computed tomography technology and dose-reduction strategies. Radiol Clin North Am 48(4):657–674

    Article  PubMed  Google Scholar 

  7. Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, Kastrati A, Schomig A (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113(10):1305–1310

    Article  PubMed  Google Scholar 

  8. Qin J, Liu LY, Meng XC, Zhang JS, Dong YX, Fang Y, Shan H (2011) Prospective versus retrospective ECG gating for 320-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Clin Imaging 35(3):193–197

    Article  PubMed  Google Scholar 

  9. Zhao L, Zhang Z, Fan Z, Yang L, Du J (2011) Prospective versus retrospective ECG gating for dual source CT of the coronary stent: comparison of image quality, accuracy, and radiation dose. Eur J Radiol 77(3):436–442

    Article  PubMed  Google Scholar 

  10. Hsieh J, Londt J, Vass M, Li J, Tang X, Okerlund D (2006) Step-and-shoot data acquisition and reconstruction for cardiac X-ray computed tomography. Med Phys 33(11):4236–4248

    Article  PubMed  Google Scholar 

  11. Mahnken AH, Buecker A, Wildberger JE, Ruebben A, Stanzel S, Vogt F, Gunther RW, Blindt R (2004) Coronary artery stents in multislice computed tomography: in vitro artifact evaluation. Invest Radiol 39(1):27–33

    Article  PubMed  Google Scholar 

  12. Gebhard C, Fiechter M, Fuchs TA, Stehli J, Muller E, Stahli BE, Gebhard CE, Ghadri JR, Klaeser B, Gaemperli O, Kaufmann PA (2013) Coronary artery stents: influence of adaptive statistical iterative reconstruction on image quality using 64-HDCT. Eur Heart J Cardiovasc Imaging 14(10):969–977

    Article  PubMed  Google Scholar 

  13. Das KM, El-Menyar AA, Salam AM, Singh R, Dabdoob WA, Albinali HA, Al Suwaidi J (2007) Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment. Radiology 245(2):424–432

    Article  CAS  PubMed  Google Scholar 

  14. Yang WJ, Pan ZL, Zhang H, Pang LF, Guo Y, Chen KM (2011) Evaluation of coronary artery in-stent restenosis with prospectively ECG-triggered axial CT angiography versus retrospective technique: a phantom study. Radiol Med 116(2):189–196

    Article  PubMed  Google Scholar 

  15. Ebersberger U, Tricarico F, Schoepf UJ, Blanke P, Spears JR, Rowe GW, Halligan WT, Henzler T, Bamberg F, Leber AW, Hoffmann E, Apfaltrer P (2013) CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction. Eur Radiol 23(1):125–132

    Article  PubMed  Google Scholar 

  16. Esposito A, Colantoni C, De Cobelli F, Del Vecchio A, Palmisano A, Calandrino R, Del Maschio A (2013) Multidetector computed tomography for coronary stents imaging: high-voltage (140-kVp) prospective ECG-triggered versus standard-voltage (120-kVp) retrospective ECG-gated helical scanning. J Comput Assist Tomogr 37(3):395–401

    Article  PubMed  Google Scholar 

  17. Eisentopf J, Achenbach S, Ulzheimer S, Layritz C, Wuest W, May M, Lell M, Ropers D, Klinghammer L, Daniel WG, Pflederer T (2013) Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation. JACC Cardiovasc Imaging 6(4):458–465

    Article  PubMed  Google Scholar 

  18. Manghat N, Van Lingen R, Hewson P, Syed F, Kakani N, Cox I, Roobottom C, Morgan-Hughes G (2008) Usefulness of 64-detector row computed tomography for evaluation of intracoronary stents in symptomatic patients with suspected in-stent restenosis. Am J Cardiol 101(11):1567–1573

    Article  PubMed  Google Scholar 

  19. Krueger KD, Mitra AK, DelCore MG, Hunter WJ 3rd, Agrawal DK (2006) A comparison of stent-induced stenosis in coronary and peripheral arteries. J Clin Pathol 59(6):575–579

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Cademartiri F, Maffie E, Palumbo A, Martini C, Aldrovandi A, Ardissino D, Brambilla V, Coruzzi P, Mollet NR, Krestin GP, de Feyter PJ (2010) CT coronary angiography for the follow-up of coronary stent. Acta Biomed 81(2):87–93

    PubMed  Google Scholar 

  21. Rixe J, Achenbach S, Ropers D, Baum U, Kuettner A, Ropers U, Bautz W, Daniel WG, Anders K (2006) Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 27(21):2567–2572

    Article  PubMed  Google Scholar 

  22. Abdelkarim MJ, Ahmadi N, Gopal A, Hamirani Y, Karlsberg RP, Budoff MJ (2010) Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography. J Cardiovasc Comput Tomogr 4(1):29–37

    Article  PubMed  Google Scholar 

  23. Gilard M, Cornily JC, Rioufol G, Finet G, Pennec PY, Mansourati J, Blanc JJ, Boschat J (2005) Noninvasive assessment of left main coronary stent patency with 16-slice computed tomography. Am J Cardiol 95(1):110–112

    Article  PubMed  Google Scholar 

  24. Yang WJ, Chen KM, Pang LF, Guo Y, Li JY, Zhang H, Pan ZL (2012) High-definition computed tomography for coronary artery stent imaging: a phantom study. Korean J Radiol 13(1):20–26

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Horiguchi J, Fujioka C, Kiguchi M, Yamamoto H, Kitagawa T, Kohno S, Ito K (2009) Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT. Eur Radiol 19(10):2363–2372

    Article  PubMed  Google Scholar 

  26. Barrett JF, Keat N (2004) Artifacts in CT: recognition and avoidance. Radiographics 24(6):1679–1691

    Article  PubMed  Google Scholar 

  27. Huda W, Scalzetti EM, Levin G (2000) Technique factors and image quality as functions of patient weight at abdominal CT. Radiology 217(2):430–435

    Article  CAS  PubMed  Google Scholar 

  28. Meyer BC, Ribbe C, Kruschewski M, Wolf KJ, Albrecht T (2005) 16-row multidetector CT angiography of the aortoiliac system and lower extremity arteries: contrast enhancement and image quality using a standarized examination protocol. Rofo 177(11):1562–1570

    Article  CAS  PubMed  Google Scholar 

  29. Bischoff B, Hein F, Meyer T, Hadamitzky M, Martinoff S, Schomig A, Hausleiter J (2009) Impact of a reduced tube voltage on CT angiography and radiation dose: results of the PROTECTION I study. JACC Cardiovasc Imaging 2(8):940–946

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the 2013 Clinical Research Grant from Pusan National University Hospital.

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Authors and Affiliations

  1. Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, #1-10 Ami-Dong, Seo-Gu, Pusan, 602-739, Republic of Korea

    Ji Won Lee, Chang Won Kim, Lee Hwangbo, Jin You Kim & Yeon Joo Jeong

  2. Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, #1-10 Ami-Dong, Seo-Gu, Pusan, 602-739, Republic of Korea

    Han Cheol Lee

  3. Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

    Ming-Ting Wu

  4. Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea

    Ki Seok Choo

  5. Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

    June Hong Kim

  6. Department of Radiology, College of Medicine, Dong-A University, Pusan, Korea

    Ki-Nam Lee

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  1. Ji Won Lee
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Correspondence to Yeon Joo Jeong.

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Lee, J.W., Kim, C.W., Lee, H.C. et al. High-definition computed tomography for coronary artery stents: image quality and radiation doses for low voltage (100 kVp) and standard voltage (120 kVp) ECG-triggered scanning. Int J Cardiovasc Imaging 31 (Suppl 1), 39–49 (2015). https://doi.org/10.1007/s10554-015-0686-y

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  • DOI: https://doi.org/10.1007/s10554-015-0686-y

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