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Preliminary study of prospective ECG-gated 320-detector CT coronary angiography in patients with ventricular premature beats.

Zhang T, Bai J, Wang W, Wang D, Shen B - PLoS ONE (2012)

Bottom Line: In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively.The two groups had no significant difference in image quality score (P>0.05).For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.

ABSTRACT

Background: To study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats (VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose.

Methods: 110 patients were divided into a VPB group (60 cases) and a control group (50 cases) using CTCA. All the patients then underwent coronary angiography (CAG) within one month. CAG served as a reference standard through which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTCA in diagnosing significant coronary artery stenosis (luminal stenosis ≥50%) could be analyzed. The two radiologists with more than 3 years' experience in cardiac CT each finished the image analysis after consultation. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups.

Methodology/principal findings: At the coronary artery segment level, sensitivity, specificity, PPV, and NPV in the premature beat group were 92.55%, 98.21%, 88.51%, and 98.72% respectively. In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively. Between the two groups, specificity, sensitivity PPV, NPV was no significant difference. The two groups had no significant difference in image quality score (P>0.05). Heart rate (77.20±12.07 bpm) and radiation dose (14.62±1.37 mSv) in the premature beat group were higher than heart rate (58.72±4.73 bpm) and radiation dose (3.08±2.35 mSv) in the control group. In theVPB group, the radiation dose (34.55±7.12 mSv) for S-field scanning was significantly higher than the radiation dose (15.10±1.12 mSv) for M-field scanning.

Conclusions/significance: With prospective ECG-gated scanning for VPB, the diagnostic accuracy of coronary artery stenosis is very high. Scanning field adjustment can reduce radiation dose while maintaining good image quality. For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.

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Related in: MedlinePlus

A male patient, 58-years-old, with an image quality score of 4.Figure A includes VR and CPR images, and Figure B includes an MIP image and a CPR straightened image used when measuring degree and range of luminal stenosis. The images show multiple soft plaques and calcified plaques at the right coronary and moderate stenosis at distal lumen (indicated by the superimposed arrow). Figure C is an example of coronary angiography, which demonstrates that it is in accordance with the results of CTCA. Figure D is an example of the ECG taken when data was acquired. Figure E show the ECG-edit later.
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pone-0038430-g002: A male patient, 58-years-old, with an image quality score of 4.Figure A includes VR and CPR images, and Figure B includes an MIP image and a CPR straightened image used when measuring degree and range of luminal stenosis. The images show multiple soft plaques and calcified plaques at the right coronary and moderate stenosis at distal lumen (indicated by the superimposed arrow). Figure C is an example of coronary angiography, which demonstrates that it is in accordance with the results of CTCA. Figure D is an example of the ECG taken when data was acquired. Figure E show the ECG-edit later.

Mentions: It can be seen from the results that sensitivity, specificity, PPV, and NPV in both groups are high, and there is no significant differences between the two groups. CTCA can accurately diagnosis CAD, and is particularly effective in excluding CAD. With the increasing strength of post-processing technology, we can observe the position, degree, and range of lesions from all angles and directions. After straightening the coronary artery at the lesion site, we can more accurately observe the degree and range of stenosis. We can also more accurately guide the selection of stent positioning in clinical settings (Figure 2). Before stent positioning, CAG is not sensitive enough to detect mild stenosis caused by small plaques. Because of this limitation, if the range of stent positioning is not sufficient, incidence of restenosis will be significantly higher. Therefore, multi-detector spiral CT has been the first choice for clinical diagnosis and treatment of CAD.


Preliminary study of prospective ECG-gated 320-detector CT coronary angiography in patients with ventricular premature beats.

Zhang T, Bai J, Wang W, Wang D, Shen B - PLoS ONE (2012)

A male patient, 58-years-old, with an image quality score of 4.Figure A includes VR and CPR images, and Figure B includes an MIP image and a CPR straightened image used when measuring degree and range of luminal stenosis. The images show multiple soft plaques and calcified plaques at the right coronary and moderate stenosis at distal lumen (indicated by the superimposed arrow). Figure C is an example of coronary angiography, which demonstrates that it is in accordance with the results of CTCA. Figure D is an example of the ECG taken when data was acquired. Figure E show the ECG-edit later.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368870&req=5

pone-0038430-g002: A male patient, 58-years-old, with an image quality score of 4.Figure A includes VR and CPR images, and Figure B includes an MIP image and a CPR straightened image used when measuring degree and range of luminal stenosis. The images show multiple soft plaques and calcified plaques at the right coronary and moderate stenosis at distal lumen (indicated by the superimposed arrow). Figure C is an example of coronary angiography, which demonstrates that it is in accordance with the results of CTCA. Figure D is an example of the ECG taken when data was acquired. Figure E show the ECG-edit later.
Mentions: It can be seen from the results that sensitivity, specificity, PPV, and NPV in both groups are high, and there is no significant differences between the two groups. CTCA can accurately diagnosis CAD, and is particularly effective in excluding CAD. With the increasing strength of post-processing technology, we can observe the position, degree, and range of lesions from all angles and directions. After straightening the coronary artery at the lesion site, we can more accurately observe the degree and range of stenosis. We can also more accurately guide the selection of stent positioning in clinical settings (Figure 2). Before stent positioning, CAG is not sensitive enough to detect mild stenosis caused by small plaques. Because of this limitation, if the range of stent positioning is not sufficient, incidence of restenosis will be significantly higher. Therefore, multi-detector spiral CT has been the first choice for clinical diagnosis and treatment of CAD.

Bottom Line: In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively.The two groups had no significant difference in image quality score (P>0.05).For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.

ABSTRACT

Background: To study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats (VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose.

Methods: 110 patients were divided into a VPB group (60 cases) and a control group (50 cases) using CTCA. All the patients then underwent coronary angiography (CAG) within one month. CAG served as a reference standard through which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTCA in diagnosing significant coronary artery stenosis (luminal stenosis ≥50%) could be analyzed. The two radiologists with more than 3 years' experience in cardiac CT each finished the image analysis after consultation. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups.

Methodology/principal findings: At the coronary artery segment level, sensitivity, specificity, PPV, and NPV in the premature beat group were 92.55%, 98.21%, 88.51%, and 98.72% respectively. In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively. Between the two groups, specificity, sensitivity PPV, NPV was no significant difference. The two groups had no significant difference in image quality score (P>0.05). Heart rate (77.20±12.07 bpm) and radiation dose (14.62±1.37 mSv) in the premature beat group were higher than heart rate (58.72±4.73 bpm) and radiation dose (3.08±2.35 mSv) in the control group. In theVPB group, the radiation dose (34.55±7.12 mSv) for S-field scanning was significantly higher than the radiation dose (15.10±1.12 mSv) for M-field scanning.

Conclusions/significance: With prospective ECG-gated scanning for VPB, the diagnostic accuracy of coronary artery stenosis is very high. Scanning field adjustment can reduce radiation dose while maintaining good image quality. For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality.

Show MeSH
Related in: MedlinePlus