Coronary CT angiography in patients with atrial fibrillation: Standard-dose and low-dose imaging with a high-resolution whole-heart CT scanner
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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.
• 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.
KeywordsAtrial fibrillation Coronary artery disease Coronary CT angiography Image quality Radiation exposure
Body mass index
Beats per minute
Coronary artery disease
Coronary computed tomography angiography
Dose length product
Dual-source computed tomography
Invasive coronary angiography
Left anterior descending artery
Left circumflex artery
Low-dose coronary computed tomography angiography
Multidetector-row computed tomography
Pulmonary vein isolation
Right coronary artery
Standard-dose coronary computed tomography angiography
Single-source computed tomography
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.
Written informed consent was obtained from all patients in this study.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
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