Skip to main content
Log in

Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients.

Methods

We retrospectively analyzed 76 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography. Prospectively ECG-triggered acquisition was performed with automated tube voltage selection (ATVS). Patients were dichotomized based on body mass index in groups A (<30 kg/m2, n = 37) and B (≥30 kg/m2, n = 39) and based on tube voltage in groups C (<120 kV, n = 46) and D (120 kV, n = 30). Coronary arteries were assessed for significant stenoses (≥50 % luminal narrowing) and diagnostic accuracy was calculated.

Results

Per-patient overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 96.9 %, 95.5 %, 93.9 %, 97.7 % and 96.1 %, respectively. Sensitivity and NPV were lower in groups B and D compared to groups A and C, but no statistically significant differences were observed (group A vs. B: sensitivity, 100.0 % vs. 93.3 %, p = 0.9493; NPV, 100 % vs. 95.5 %, p = 0.9812; group C vs. D: sensitivity, 100.0 % vs. 92.3 %, p = 0.8462; NPV, 100.0 % vs. 94.1 %, p = 0.8285).

Conclusion

CCTA using 3rd-generation DSCT and (ATVS) provides high diagnostic accuracy in both non-obese and obese patients.

Key Points

Coronary CTA provides high diagnostic accuracy in non-obese and obese patients.

Diagnostic accuracy between obese and non-obese patients showed no significant difference.

<120 kV studies were performed in 44 % of obese patients.

Current radiation dose-saving approaches can be applied independent of body habitus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CCTA:

Coronary CT angiography

ICA:

Invasive coronary angiography

CAD:

Coronary artery disease

PPV:

Positive predictive value

DSCT:

Dual-source CT

ATVS:

Automated tube voltage selection

BMI:

Body-mass index

ROI:

Region of interest

HU:

Hounsfield unit

LM:

Left main

LAD:

Left anterior descending

CX:

Circumflex artery

RCA:

Right coronary artery

SD:

Standard deviation

SNR:

Signal-to-noise ratio

CNR:

Contrast-to-noise ratio

CTDIvol :

Volume CT dose index

DLP:

Dose-length product

ED:

Effective dose

SSDE:

Size-specific dose estimates

NPV:

Negative predictive value

References

  1. Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791

    Article  PubMed  Google Scholar 

  2. Stein PD, Beemath A, Kayali F, Skaf E, Sanchez J, Olson RE (2006) Multidetector computed tomography for the diagnosis of coronary artery disease: a systematic review. Am J Med 119:203–216

    Article  PubMed  Google Scholar 

  3. Menke J, Unterberg-Buchwald C, Staab W, Sohns JM, Seif Amir Hosseini A, Schwarz A (2013) Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: meta-analysis of diagnostic accuracy, image quality, and radiation dose. Am Heart J 165:154–163, e3

    Article  PubMed  Google Scholar 

  4. Layritz C, Schmid J, Achenbach S et al (2014) Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. Eur Heart J Cardiovasc Imaging 15:1238–1245

    Article  PubMed  Google Scholar 

  5. Stehli J, Fuchs TA, Bull S et al (2014) Accuracy of coronary CT angiography using a submillisievert fraction of radiation exposure: comparison with invasive coronary angiography. J Am Coll Cardiol 64:772–780

    Article  PubMed  Google Scholar 

  6. Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557

    Article  PubMed  Google Scholar 

  7. Meinel FG, Canstein C, Schoepf UJ et al (2014) Image quality and radiation dose of low tube voltage 3rd generation dual-source coronary CT angiography in obese patients: a phantom study. Eur Radiol 24:1643–1650

    Article  PubMed  Google Scholar 

  8. Geyer LL, Glenn GR, De Cecco CN et al (2015) CT evaluation of small-diameter coronary artery stents: effect of an integrated circuit detector with iterative reconstruction. Radiology 273:706–714

    Article  Google Scholar 

  9. Hell MM, Bittner D, Schuhbaeck A et al (2014) Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. J Cardiovasc Comput Tomogr 8:418–425

    Article  PubMed  Google Scholar 

  10. Geyer LL, Schoepf UJ, Meinel FG et al (2015) State of the art: iterative CT reconstruction techniques. Radiology 276:339–357

    Article  PubMed  Google Scholar 

  11. Winklehner A, Gordic S, Lauk E et al (2015) Automated attenuation-based tube voltage selection for body CTA: performance evaluation of 192-slice dual-source CT. Eur Radiol 25:2346–2353

    Article  PubMed  Google Scholar 

  12. Goetti R, Winklehner A, Gordic S et al (2012) Automated attenuation-based kilovoltage selection: preliminary observations in patients after endovascular aneurysm repair of the abdominal aorta. AJR Am J Roentgenol 199:W380–W385

    Article  PubMed  Google Scholar 

  13. Layritz C, Muschiol G, Flohr T et al (2013) Automated attenuation-based selection of tube voltage and tube current for coronary CT angiography: reduction of radiation exposure versus a BMI-based strategy with an expert investigator. J Cardiovasc Comput Tomogr 7:303–310

    Article  PubMed  Google Scholar 

  14. Lurz M, Lell MM, Wuest W et al (2015) Automated tube voltage selection in thoracoabdominal computed tomography at high pitch using a third-generation dual-source scanner: image quality and radiation dose performance. Investig Radiol 50:352–360

    Article  CAS  Google Scholar 

  15. Krazinski AW, Meinel FG, Schoepf UJ et al (2014) Reduced radiation dose and improved image quality at cardiovascular CT angiography by automated attenuation-based tube voltage selection: intra-individual comparison. Eur Radiol 24:2677–2684

    Article  PubMed  Google Scholar 

  16. Spearman JV, Schoepf UJ, Rottenkolber M et al (2015) Effect of automated attenuation-based tube voltage selection on radiation dose at CT: an observational study on a global scale. Radiology 279:167–174

    Article  PubMed  Google Scholar 

  17. Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358

    Article  PubMed  Google Scholar 

  18. Alkadhi H, Stolzmann P, Scheffel H et al (2008) Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters. Eur J Radiol 68:385–391

    Article  PubMed  Google Scholar 

  19. Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–266

    Article  PubMed  Google Scholar 

  20. Christner JA, Braun NN, Jacobsen MC, Carter RE, Kofler JM, McCollough CH (2012) Size-specific dose estimates for adult patients at CT of the torso. Radiology 265:841–847

    Article  PubMed  Google Scholar 

  21. Boone JM SK, Cody DD, McCollough CH, McNitt-Gray MF, Toth TL (2011) Size-specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. Report of Am Assoc Phys Med AAPM Task Group 204. American Association of Physicists in Medicine, College Park

    Google Scholar 

  22. Fine JJ, Hopkins CB, Ruff N, Newton FC (2006) Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease. Am J Cardiol 97:173–174

    Article  PubMed  Google Scholar 

  23. Ropers D, Rixe J, Anders K et al (2006) Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348

    Article  PubMed  Google Scholar 

  24. Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323

    Article  PubMed  Google Scholar 

  25. Gordic S, Desbiolles L, Stolzmann P et al (2014) Advanced modelled iterative reconstruction for abdominal CT: qualitative and quantitative evaluation. Clin Radiol 69:e497–e504

    Article  CAS  PubMed  Google Scholar 

  26. Solomon J, Mileto A, Ramirez-Giraldo JC, Samei E (2015) Diagnostic performance of an advanced modeled iterative reconstruction algorithm for low-contrast detectability with a third-generation dual-source multidetector ct scanner: potential for radiation dose reduction in a multireader study. Radiology 275:735–745

    Article  PubMed  Google Scholar 

  27. Wang R, Schoepf UJ, Wu R et al (2012) Image quality and radiation dose of low dose coronary CT angiography in obese patients: sinogram affirmed iterative reconstruction versus filtered back projection. Eur J Radiol 81:3141–3145

    Article  PubMed  Google Scholar 

  28. Oda S, Weissman G, Vembar M, Weigold WG (2014) Iterative model reconstruction: improved image quality of low-tube-voltage prospective ECG-gated coronary CT angiography images at 256-slice CT. Eur J Radiol 83:1408–1415

    Article  PubMed  Google Scholar 

  29. Renker M, Ramachandra A, Schoepf UJ et al (2011) Iterative image reconstruction techniques: applications for cardiac CT. J Cardiovasc Comput Tomogr 5:225–230

    Article  PubMed  Google Scholar 

  30. Brodoefel H, Tsiflikas I, Burgstahler C et al (2008) Cardiac dual-source computed tomography: effect of body mass index on image quality and diagnostic accuracy. Investig Radiol 43:712–718

    Article  Google Scholar 

  31. Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382

    Article  PubMed  Google Scholar 

  32. Schuhbaeck A, Achenbach S, Layritz C et al (2013) Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction. Eur Radiol 23:597–606

    Article  PubMed  Google Scholar 

  33. Sun G, Hou YB, Zhang B et al (2015) Application of low tube voltage coronary CT angiography with low-dose iodine contrast agent in patients with a BMI of 26-30 kg/m2. Clin Radiol 70:138–145

    Article  CAS  PubMed  Google Scholar 

  34. Zhang LJ, Qi L, Wang J et al (2014) Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol 24:1537–1546

    Article  PubMed  Google Scholar 

  35. Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Prof. Dr. U. Joseph Schoepf.

The authors of this manuscript declare relationships with the following companies: Dr. Schoepf is a consultant for and receives research support from Astellas, Bayer, Bracco, GE, Medrad, and Siemens. Mr. Canstein is a Siemens employee. The other authors have no conflicts of interest to disclose.

The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained.

Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, cross sectional study, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to U. Joseph Schoepf.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mangold, S., Wichmann, J.L., Schoepf, U.J. et al. Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population. Eur Radiol 27, 2298–2308 (2017). https://doi.org/10.1007/s00330-016-4601-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4601-2

Keywords

Navigation