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European Radiology

, Volume 28, Issue 8, pp 3432–3440 | Cite as

Coronary CT angiography in patients with atrial fibrillation: Standard-dose and low-dose imaging with a high-resolution whole-heart CT scanner

  • Anna Matveeva
  • Rainer R. Schmitt
  • Karoline Edtinger
  • Matthias Wagner
  • Sebastian Kerber
  • Thomas Deneke
  • Michael Uder
  • Sebastian Barth
Cardiac
  • 127 Downloads

Abstract

Objective

To compare image quality, observer confidence, radiation exposure in the standard-dose (SD-CCTA) and low-dose (LD-CCTA) protocols of coronary CT angiography (CCTA) in patients with atrial fibrillation (AF).

Material and methods

CCTA was performed in 303 patients using a CT scanner with 16-cm coverage (111 scans during sinus rhythm (SR); 192 during AF). LD-CCTA was used in 218 patients; SD-CCTA in 85 patients suspected of having coronary artery disease (CAD). Image quality and observer confidence were evaluated on 5-point scales. Radiation doses were recorded.

Results

Image quality was superior in the SD-CCTA compared to the LD-CCTA (SR 1.45±0.40; AF 1.72±0.46; vs. SR 1.83±0.48; AF 1.92±0.50; p < 0.001). Observers were more confident with SD-CCTA than with LD-CCTA (SR 1.38±0.33; AF 1.61±0.43; vs. SR 1.70±0.45; AF 1.82±0.50; p < 0.001). Radiation doses in AF were significantly higher than in the SR (LD-CCTA, 1.68±0.71 mSv; SD-CCTA, 3.72±1.95 mSv; vs. LD-CCTA, 1.3 ±0.52 mSv; SD-CCTA, 2.67±1.47 mSv; p < 0.001).

Conclusion

Using a low-dose protocol in AF, radiation exposure can be decreased by 50 % at the expense of 20 % impaired image quality. A low-dose CCTA protocol can be considered in young patients, whereas the standard-dose protocol is recommended for older patients and those suspected of having CAD.

Key Points

• Whole-heart CT allows visualization of the coronary arteries in atrial fibrillation.

• Low-dose CT decreases radiation exposure by 50%, image quality by 20%.

• Standard-dose CT seems advantageous when concomitant coronary artery disease is suspected.

Keywords

Atrial fibrillation Coronary artery disease Coronary CT angiography Image quality Radiation exposure 

Abbreviations

3D

Three-dimensional

AF

Atrial fibrillation

BMI

Body mass index

bpm

Beats per minute

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

CT

Computed tomography

DLP

Dose length product

DSCT

Dual-source computed tomography

ECG

Electrocardiography

HR

Heart rate

ICA

Invasive coronary angiography

LA

Left atrium

LAD

Left anterior descending artery

LCx

Left circumflex artery

LD-CCTA

Low-dose coronary computed tomography angiography

LM

Left main

MDCT

Multidetector-row computed tomography

MPR

Multiplanar reconstruction

PV

Pulmonary veins

PVI

Pulmonary vein isolation

RCA

Right coronary artery

SD

Standard deviation

SD-CCTA

Standard-dose coronary computed tomography angiography

SR

Sinus rhythm

SSCT

Single-source computed tomography

VRT

Volume-rendering technique

Notes

Funding

This study has received funding by Rhoen-Klinikum Aktiengesellschaft, Bad Neustadt, Germany (grant FB81).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Rainer R. Schmitt: Department of Diagnostic and Interventional Radiology, Cardiovascular Centre GmbH, Salzburger Leite 1, Bad Neustadt an der Saale, 97616, Germany.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Rainer R. Schmitt has received a speaker honorarium from GE Healthcare and Bracco Diagnostics. Matthias Wagner has received a speaker honorarium from GE Healthcare. All other authors report no conflict of interest to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyCardiovascular Centre GmbHBad Neustadt an der SaaleGermany
  2. 2.Department of CardiologyCardiovascular Centre GmbHBad Neustadt an der SaaleGermany
  3. 3.Department of RadiologyUniversity Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-NürnbergErlangenGermany

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