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



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.


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).


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.


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





Atrial fibrillation


Body mass index


Beats per minute


Coronary artery disease


Coronary computed tomography angiography


Computed tomography


Dose length product


Dual-source computed tomography




Heart rate


Invasive coronary angiography


Left atrium


Left anterior descending artery


Left circumflex artery


Low-dose coronary computed tomography angiography


Left main


Multidetector-row computed tomography


Multiplanar reconstruction


Pulmonary veins


Pulmonary vein isolation


Right coronary artery


Standard deviation


Standard-dose coronary computed tomography angiography


Sinus rhythm


Single-source computed tomography


Volume-rendering technique



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

Compliance with ethical standards


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.


• 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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