Skip to main content
SpringerLink
Log in

Image quality of low-dose CCTA in obese patients: impact of high-definition computed tomography and adaptive statistical iterative reconstruction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The accuracy of coronary computed tomography angiography (CCTA) in obese persons is compromised by increased image noise. We investigated CCTA image quality acquired on a high-definition 64-slice CT scanner using modern adaptive statistical iterative reconstruction (ASIR). Seventy overweight and obese patients (24 males; mean age 57 years, mean body mass index 33 kg/m2) were studied with clinically-indicated contrast enhanced CCTA. Thirty-five patients underwent a standard definition protocol with filtered backprojection reconstruction (SD-FBP) while 35 patients matched for gender, age, body mass index and coronary artery calcifications underwent a novel high definition protocol with ASIR (HD-ASIR). Segment by segment image quality was assessed using a four-point scale (1 = excellent, 2 = good, 3 = moderate, 4 = non-diagnostic) and revealed better scores for HD-ASIR compared to SD-FBP (1.5 ± 0.43 vs. 1.8 ± 0.48; p < 0.05). The smallest detectable vessel diameter was also improved, 1.0 ± 0.5 mm for HD-ASIR as compared to 1.4 ± 0.4 mm for SD-FBP (p < 0.001). Average vessel attenuation was higher for HD-ASIR (388.3 ± 109.6 versus 350.6 ± 90.3 Hounsfield Units, HU; p < 0.05), while image noise, signal-to-noise ratio and contrast-to noise ratio did not differ significantly between reconstruction protocols (p = NS). The estimated effective radiation doses were similar, 2.3 ± 0.1 and 2.5 ± 0.1 mSv (HD-ASIR vs. SD-ASIR respectively). Compared to a standard definition backprojection protocol (SD-FBP), a newer high definition scan protocol in combination with ASIR (HD-ASIR) incrementally improved image quality and visualization of distal coronary artery segments in overweight and obese individuals, without increasing image noise and radiation dose.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG et al (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368(9536):666–678

    Article  PubMed  Google Scholar 

  2. Yoshimura N, Sabir A, Kubo T, Lin PJ, Clouse ME, Hatabu H (2006) Correlation between image noise and body weight in coronary CTA with 16-row MDCT. Acad Radiol 13(3):324–328

    Article  PubMed  Google Scholar 

  3. 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(3):552–557

    Article  PubMed  Google Scholar 

  4. Chinnaiyan KM, McCullough PA, Flohr TG, Wegner JH, Raff GL (2009) Improved noninvasive coronary angiography in morbidly obese patients with dual-source computed tomography. J Cardiovasc Comput Tomog. 3(1):35–42

    Article  Google Scholar 

  5. Silva AC, Lawder HJ, Hara A, Kujak J, Pavlicek W (2010) Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol 194(1):191–199

    Article  PubMed  Google Scholar 

  6. Leipsic J, Heilbron BG, Hague C (2012) Iterative reconstruction for coronary CT angiography: finding its way. Int J Cardiovasc Imaging 28(3):613–620

    Article  PubMed  Google Scholar 

  7. Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY et al (2010) Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. AJR Am J Roentgenol 195(3):655–660

    Article  PubMed  Google Scholar 

  8. Pontone G, Andreini D, Bartorelli AL, Bertella E, Mushtaq S, Foti C et al (2012) Feasibility and diagnostic accuracy of a low radiation exposure protocol for prospective ECG-triggering coronary MDCT angiography. Clin Radiol 67(3):207–215

    Article  PubMed  CAS  Google Scholar 

  9. Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY et al (2010) Adaptive statistical iterative reconstruction: assessment of image noise and image quality in coronary CT angiography. AJR Am J Roentgenol 195(3):649–654

    Article  PubMed  Google Scholar 

  10. Kazakauskaite E, Husmann L, Stehli J, Fuchs T, Fiechter M, Klaeser B et al (2013) Image quality in low-dose coronary computed tomography angiography with a new high-definition CT scanner. Int J Cardiovasc Imaging 29(2):471–477

    Article  PubMed  Google Scholar 

  11. Desai GS, Uppot RN, Yu EW, Kambadakone AR, Sahani DV (2012) Impact of iterative reconstruction on image quality and radiation dose in multidetector CT of large body size adults. Eur Radiol 22(8):1631–1640

    Article  PubMed  Google Scholar 

  12. Ghadri JR, Kuest SM, Goetti R, Fiechter M, Pazhenkottil AP, Nkoulou RN et al (2011) Image quality and radiation dose comparison of prospectively triggered low-dose CCTA: 128-slice dual-source high-pitch spiral versus 64-slice single-source sequential acquisition. Int J Cardiovasc Imaging 28(5):1217–1225

    Article  PubMed  Google Scholar 

  13. Buechel RR, Husmann L, Herzog BA, Pazhenkottil AP, Nkoulou R, Ghadri JR et al (2011) Low-dose computed tomography coronary angiography with prospective electrocardiogram triggering: feasibility in a large population. J Am Coll Cardiol 57(3):332–336

    Article  PubMed  Google Scholar 

  14. Husmann L, Herzog BA, Gaemperli O, Tatsugami F, Burkhard N, Valenta I et al (2009) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 30(5):600–607

    Article  PubMed  Google Scholar 

  15. Herzog BA, Husmann L, Burkhard N, Valenta I, Gaemperli O, Tatsugami F et al (2009) Low-dose CT coronary angiography using prospective ECG-triggering: impact of mean heart rate and heart rate variability on image quality. Acad Radiol 16(1):15–21

    Article  PubMed  Google Scholar 

  16. Raff GL, Goldstein JA (2007) Coronary angiography by computed tomography: coronary imaging evolves. J Am Coll Cardiol 49(18):1830–1833

    Article  PubMed  Google Scholar 

  17. McNulty PH, Ettinger SM, Field JM, Gilchrist IC, Kozak M, Chambers CE et al (2002) Cardiac catheterization in morbidly obese patients. Catheter Cardiovasc Interv 56(2):174–177

    Article  PubMed  Google Scholar 

  18. Leschka S, Stinn B, Schmid F, Schultes B, Thurnheer M, Baumueller S et al (2009) Dual source CT coronary angiography in severely obese patients: trading off temporal resolution and image noise. Invest Radiol 44(11):720–727

    Article  PubMed  Google Scholar 

  19. Kropil P, Rojas CA, Ghoshhajra B, Lanzman RS, Miese FR, Scherer A et al (2012) Prospectively ECG-triggered high-pitch spiral acquisition for cardiac CT angiography in routine clinical practice: initial results. J Thorac Imaging 27(3):194–201

    Article  PubMed  Google Scholar 

  20. Srichai MB, Lim RP, Donnino R, Mannelli L, Hiralal R, Avery R et al (2012) Low-dose, prospective triggered high-pitch spiral coronary computed tomography angiography: comparison with retrospective spiral technique. Acad Radiol 19(5):554–561

    Article  PubMed  Google Scholar 

  21. Paul NS, Kashani H, Odedra D, Ursani A, Ray C, Rogalla P (2011) The influence of chest wall tissue composition in determining image noise during cardiac CT. AJR Am J Roentgenol 197(6):1328–1334

    Article  PubMed  Google Scholar 

  22. Xu L, Zhang Z (2010) Coronary CT angiography with low radiation dose. Int J Cardiovasc Imaging 26(Suppl 1):17–25

    Article  PubMed  CAS  Google Scholar 

  23. Gebhard C, Fiechter M, Fuchs TA, Ghadri JR, Herzog BA, Kuhn F et al (2012) Coronary artery calcium scoring: influence of adaptive statistical iterative reconstruction using 64-MDCT. Int J Cardiol. doi:10.1016/j.ijcard.2012.08.003

Download references

Acknowledgments

The study was supported by grants from the Swiss National Science Foundation (SNSF) to P.A.K., C.G. and to M.F.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. The need for written informed consent in this study was waived by the institutional review board (local ethics committee) since, according to Swiss law on clinical investigations, informed consent is not required if the nature of the study is purely retrospective.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, 8091, Zurich, Switzerland

    Cathérine Gebhard, Tobias A. Fuchs, Michael Fiechter, Julia Stehli, Barbara E. Stähli, Oliver Gaemperli & Philipp A. Kaufmann

  2. Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland

    Philipp A. Kaufmann

Authors
  1. Cathérine Gebhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tobias A. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Fiechter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia Stehli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara E. Stähli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oliver Gaemperli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philipp A. Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp A. Kaufmann.

Additional information

Cathérine Gebhard and Tobias A. Fuchs contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gebhard, C., Fuchs, T.A., Fiechter, M. et al. Image quality of low-dose CCTA in obese patients: impact of high-definition computed tomography and adaptive statistical iterative reconstruction. Int J Cardiovasc Imaging 29, 1565–1574 (2013). https://doi.org/10.1007/s10554-013-0228-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-013-0228-4

Keywords

Search

Navigation