Prospective ECG-gated 320 row detector computed tomography: implications for CT angiography and perfusion imaging

  • Kakuya Kitagawa
  • Albert C. Lardo
  • Joao A. C. Lima
  • Richard T. George
Original Paper


Cardiac multidetector computed tomography has evolved from early four detector systems that first demonstrated the feasibility of non-invasive angiography to today’s wide-area detector computed tomography systems, such as 320-row detector computed tomography. As detector arrays have widened, there have been great improvements in image quality that have improved test accuracy. In addition, wider detector arrays have allowed for the application of prospective ECG-gating for CT angiography, although the current 64-row detector systems have some limitations. 320-row detector computed tomography with full cardiac coverage allows for cardiac imaging in a single heart beat. This technology has realized some of the great advantages provided by full cardiac coverage in regards to image quality (elimination of step artifacts and variation in contrast enhancement), patient safety (reductions in overall radiation and contrast dose), and the prospects for combined CT angiography and myocardial perfusion imaging are very promising. We will review the technical aspects of 320-row detector computed tomography and their implications for coronary angiography and perfusion imaging.


Myocardial perfusion Non-invasive angiography Wide-area computed tomography 320-Row detector computed tomography Dynamic volume computed tomography Prospective ECG-gating 


Research support:

Donald W. Reynolds Foundation, Las Vegas, Nevada, American College of Cardiology Foundation; PJ Schafer Memorial Research Grant, Timonium, MD; Toshiba American Medical Systems, Tufton, CA; Astellas Pharma US, Inc., Deerfield, IL.

Disclosure information

Dr. George, Dr. Lima and Dr. Lardo are, in part, funded by a research grant from Toshiba American Medical Systems, Inc. Dr. George and Dr. Lima is, in part funded by a research grant from Astellas Pharma US, Inc. Dr. Lardo and Dr. George have received speaker’s fees from Toshiba American Medical Systems, Inc. The terms of these arrangements are being managed by Johns Hopkins University in accordance with its conflict of interest policies.

Funding sources

American College of Cardiology Foundation Career Development Award, Donald W. Reynolds Foundation Clinical Cardiovascular Research Center Award, PJ Schafer Memorial Research Grant, Toshiba Medical Systems Corporation, Astellas Pharma, Inc.


  1. 1.
    Achenbach S, Ulzheimer S, Baum U, Kachelriess M, Ropers D, Giesler T, Bautz W, Daniel WG, Kalender WA, Moshage W (2000) Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT. Circulation 102:2823–2828PubMedGoogle Scholar
  2. 2.
    Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, Hunink MG (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428. doi: 10.1148/radiol.2442061218 PubMedCrossRefGoogle Scholar
  3. 3.
    Garcia MJ, Lessick J, Hoffmann MH (2006) Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. JAMA 296:403–411. doi: 10.1001/jama.296.4.403 PubMedCrossRefGoogle Scholar
  4. 4.
    Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557. doi: 10.1016/j.jacc.2005.05.056 PubMedCrossRefGoogle Scholar
  5. 5.
    Husmann L, Valenta I, Gaemperli O, Adda O, Treyer V, Wyss CA, Veit-Haibach P, Tatsugami F, von Schulthess GK, Kaufmann PA (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197. doi: 10.1093/eurheartj/ehm613 PubMedCrossRefGoogle Scholar
  6. 6.
    Kondo C, Mori S, Endo M, Kusakabe K, Suzuki N, Hattori A, Kusakabe M (2005) Real-time volumetric imaging of human heart without electrocardiographic gating by 256-detector row computed tomography: initial experience. J Comput Assist Tomogr 29:694–698. doi: 10.1097/01.rct.0000173844.89988.37 PubMedCrossRefGoogle Scholar
  7. 7.
    Mori S, Kondo C, Suzuki N, Hattori A, Kusakabe M, Endo M (2006) Volumetric coronary angiography using the 256-detector row computed tomography scanner: comparison in vivo and in vitro with porcine models. Acta Radiol 47:186–191. doi: 10.1080/02841850500479669 PubMedCrossRefGoogle Scholar
  8. 8.
    Mori S, Endo M, Komatsu S, Kandatsu S, Yashiro T, Baba M (2006) A combination-weighted Feldkamp-based reconstruction algorithm for cone-beam CT. Phys Med Biol 51:3953–3965. doi: 10.1088/0031-9155/51/16/005 PubMedCrossRefGoogle Scholar
  9. 9.
    Kitagawa K, Arab-Zadeh A, Hannon KM, George RT, Lima JA, Lardo AC (2007) Comparison of 256 × 0.5 mm and 64 × 0.5 mm multidetector computed tomography image quality and accuracy in a custom-designed, motion-simulating phantom of coronary artery stenosis. Circulation 116:II_408–II_409Google Scholar
  10. 10.
    Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, Ersoy H, Mather RT, Judy PF, Cai T, Coyner K, Schultz K, Whitmore AG, Di Carli MF (2008) Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 24:535–546. doi: 10.1007/s10554-008-9308-2 PubMedCrossRefGoogle Scholar
  11. 11.
    Steigner ML, Otero HJ, Cai T, Mitsouras D, Nallamshetty L, Whitmore AG, Ersoy H, Levit NA, Di Carli MF, Rybicki FJ (2009) Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int J Cardiovasc Imaging 25:85–90. doi: 10.1007/s10554-008-9347-8 PubMedCrossRefGoogle Scholar
  12. 12.
    Mori S, Endo M, Nishizawa K, Murase K, Fujiwara H, Tanada S (2006) Comparison of patient doses in 256-slice CT and 16-slice CT scanners. Br J Radiol 79:56–61. doi: 10.1259/bjr/39775216 PubMedCrossRefGoogle Scholar
  13. 13.
    Mori S, Nishizawa K, Kondo C et al (2008) Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner. Eur J Radiol 65(3):442–448. doi: 10.1016/j.ejrad.2007.05.001 PubMedCrossRefGoogle Scholar
  14. 14.
    George RT, Lima JA, Mahesh M (2007) Radiation dose measurements on subjects undergoing combined CT perfusion and CT angiography imaging with a prototype 256-row MDCT scanner. Circulation 116:II_343Google Scholar
  15. 15.
    George RT, Silva C, Cordeiro MA, DiPaula A, Thompson DR, McCarthy WF, Ichihara T, Lima JA, Lardo AC (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160. doi: 10.1016/j.jacc.2006.04.014 PubMedCrossRefGoogle Scholar
  16. 16.
    George RT, Lardo AC, Silva C, Bluemke DA, Resar J, Lima JA (2007) Subendocardial perfusion deficits predict the functional significance of coronary stenoses during adenosine stress multidetector computed tomography in patients with chest pain. J Am Coll Cardiol 49(suppl):161AGoogle Scholar
  17. 17.
    George RT, Yousef O, Kitagawa K, Chang HJ, Bluemke DA, Lardo AC, Lima JA (2007) Quantification of myocardial perfusion in patients using 256-row multidetector computed tomography: evaluation of endocardial vs. epicardial blood flow. Circulation 116:II–563Google Scholar
  18. 18.
    George RT, Kitagawa K, Laws K et al (2008) Combined adenosine stress perfusion and coronary angiography using 320-row detector dynamic volume computed tomography in patients with suspected coronary artery disease. Circulation 118:S_936Google Scholar
  19. 19.
    George RT, Lardo AC, Kitagawa K, Yousef O, Chang HJ, Zadeh A, Miller JM, Bluemke DA, Lima JA (2007) Combined MDCT perfusion and non-invasive coronary angiography using a 256-row MDCT prototype scanner. Circulation 116:II–573Google Scholar
  20. 20.
    George RT, Jerosch-Herold M, Silva C, Kitagawa K, Bluemke DA, Lima JA, Lardo AC (2007) Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 42:815–822PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2009

Authors and Affiliations

  • Kakuya Kitagawa
    • 1
  • Albert C. Lardo
    • 2
    • 3
  • Joao A. C. Lima
    • 4
    • 5
  • Richard T. George
    • 6
  1. 1.Department of Diagnostic RadiologyMie University HospitalTsu CityJapan
  2. 2.Department of Medicine, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of Medicine, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Department of RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Medicine, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreUSA

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