High-pitch computed tomography coronary angiography-a new dose-saving algorithm: estimation of radiation exposure

Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies

Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.

Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography: Protocol Comparison

Purpose:

To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA).

Methods:

Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed.

Results:

Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001.

Conclusion:

The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.

Estimation and comparison of the radiation effective dose during coronary computed tomography angiography examinations on single-source 64-MDCT and dual-source 128-MDCT

GOAL

To estimate and compare the radiation dose associated with coronary computed tomography angiography (CCTA) examinations on two multi-detector CT scanners (MDCT), 64-MDCT and 128-MDCT, in daily practice.

METHODS

Scan parameters of 90 patients undergoing retrospective electrocardiographic gating spiral CCTA exam were recorded during a period on a single-source 64-MDCT and a dual-source 128-MDCT, and average scan parameters were derived that were used for dosimetry. The computed tomography dose index (CTDI) with a pencil ionisation chamber and polymethyl methacrylate body phantom with diameter of 32 cm was measured on both scanners. The dose-length product (DLP) was calculated and the DLP to effective dose conversion factor (for chest scan at 120 kV of 0.014 mSv mGy^-1 cm^-1) was used to estimate effective dose (ED).

RESULTS

Patients' heart rate, scan length, pitch factor, CTDIv, DLP and ED for 128-MDCT were 64 (5) (beats min^-1), 161 (10) (mm), 0.26, 47 (12) (mGy), 769 (212) (mGy cm) and 10.3 (3.1) (mSv), respectively [mean (one standard deviation)]. Patients' heart rate, scan length, pitch factor, CTDIv, DLP and ED for 64-MDCT were 60 (7) (beats min^-1), 172 (14) (mm), 0.2, 60 (6) (mGy), 1068 (98) (mGy cm) and 14.9 (1.4) (mSv), respectively.

CONCLUSION

Our results indicated that the CTDIv, DLP and the effective dose with 128-MDCT is significantly lower than with 64-MDCT (p < 0.05). As differences between the exposure parameter mAs on two CT scanners was not significant (p > 0.05) and the kV was constant for both scanners (120 kV), the differences resulted from a shorter scan length on the 128-MDCT and use of a higher pitch factor (0.26 and 0.2 in the 128-MDCT and 64-MDCT, respectively). Comparison with other published studies confirms the findings and indicates methods for reducing patient dose.

Utility of cardiac CT for evaluating delayed contrast enhancement in dilated cardiomyopathy

BACKGROUND

The presence of myocardial fibrosis is associated with adverse outcome in dilated cardiomyopathy (DCM). Delayed contrast-enhanced cardiac magnetic resonance (DE-CMR) currently represents the gold standard in noninvasive evaluation of myocardial scarring. However, a significant number of patients are unable to undergo DE-CMR study for various reasons. We sought to determine the diagnostic accuracy of cardiac CT (CCT) compared with CMR in the investigation of the presence of delayed contrast enhancement (DCE) in subjects with DCM.

METHODS

We prospectively enrolled 17 consecutive patients with DCM, who were initially referred to our institution because of recently manifested heart failure due to unexplained left ventricular systolic dysfunction. In all subjects, CCT and DE-CMR were performed within 1 week.

RESULTS

CCT and DE-CMR showed satisfactory agreement in detecting DCE (agreement in 82% cases, κ = 0.56) with 50% sensitivity, 100% specificity, and a positive predictive value of 100%.

CONCLUSION

CCT may be a valuable method for detecting DCE in patients with DCM. CCT thus might be considered as an alternative method to DE-CMR in the assessment of the presence and extent of myocardial fibrosis in subjects who are not suitable for DE-CMR examination.

Stress echocardiography: what is new and how does it compare with myocardial perfusion imaging and other modalities?

Cardiovascular disease is a leading cause of morbidity and mortality, and noninvasive strategies to diagnose and risk stratify patients remain paramount in the evaluative process. Stress echocardiography is a well-established, versatile, real-time imaging modality with advantages including lack of radiation exposure, portability, and affordability. Innovative techniques in stress echocardiography include myocardial contrast echocardiography, deformation imaging, three-dimensional (3D) echocardiography, and assessment of coronary flow reserve. Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) are imaging alternatives, and stress cardiac magnetic resonance imaging and coronary computed tomography (CT) angiography, including CT perfusion imaging, are emerging as newer approaches. This review will discuss recent and upcoming developments in the field of stress testing, with an emphasis on stress echocardiography while highlighting comparisons with other modalities.

Effects of a high-pitch protocol and a hybrid iterative reconstruction algorithm on image quality of cerebral subtracted 3D CT angiography

PURPOSE

To evaluate the image quality and the radiation dose of 3D-computed tomography angiography (3D-CTA) with a high-pitch protocol and a hybrid iterative reconstruction (HIR).

MATERIALS AND METHODS

This was a prospective study and thirty patients were scanned at a 0.51-helical pitch with filtered back-projection (FBP, protocol-A), and 30 patients were scanned at a 0.91-helical pitch with FBP and HIR (protocol-B and C). The mean volume CT dose index (CTDI(vol)), image noise, and mean cerebral arterial and venous attenuation were compared between the three protocols. Two readers assessed image noise, arterial contrast and venous overlap.

RESULTS

The mean CTDI(vol) of protocol-B/C (38.9 mGy) was lower than that of protocol-A (49.7 mGy). Mean image noise of protocol-B [12.6 ± 1.3 Hounsfield units (HU)] was higher than that of protocol-A (10.3 ± 1.2 HU). There was no significant difference in arterial attenuation between protocol-A (327.5 ± 57.5 HU) and C (327.7 ± 59.4 HU). Venous attenuation of protocol-C (148.5 ± 50.4 HU) was lower than that of protocol-A (185.9 ± 50.6 HU). In qualitative analysis, the image noise of protocol-B was higher than that of protocol-A/C. Venous enhancement of protocol-B/C was more inconspicuous than that of protocol-A.

CONCLUSIONS

3D-CTA with a high-pitch protocol and HIR can reduce radiation dose while decreasing venous enhancement and image noise to an adequate level for diagnosis.