OBJECTIVES:
To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction.
METHODS:
We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients.
RESULTS:
In group A (231 patients, 146 men, mean heart rate 58\u2009\ub1\u20097 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P\u2009=\u20090.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P\u2009>\u20090.05) but radiation dose was lower (1.16\u2009\ub1\u20090.60 vs. 3.82\u2009\ub1\u20091.65 mSv, P\u2009\u20090.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12\u2009\ub1\u20092.58 vs. 8.13\u2009\ub1\u20094.52 mSv, P\u2009<\u20090.001). Diagnostic performance was comparable in both groups.
CONCLUSION:
Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose
