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Int J Cardiovasc Imaging. 2013 Aug;29(6):1361-70. doi: 10.1007/s10554-013-0208-8. Epub 2013 Mar 24.

Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study.

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Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.


In this study, we sought to evaluate the image quality and effective radiation dose of prospectively ECG-triggered adaptive systolic (PTA-systolic) dual-source CTA versus prospectively triggered adaptive diastolic (PTA-diastolic) dual-source CTA in patients of unselected heart rate and rhythm. This retrospective cohort study consisted of 41 PTA-systolic and 41 matched PTA-diastolic CTA patients whom underwent clinically indicated 128-slice dual source CTA between December 2010 to June 2012. Image quality and motion artifact score (both on a Likert scale 1-4 with 4 being the best), effective dose, and CTDIvol were compared. The effect of heart rate (HR) and heart rate variability [HRV] on image motion artifact score and CTDIvol was analyzed with Pearson's correlation coefficient. All 82 exams were considered diagnostic with 0 non-diagnostic segments. PTA-systolic CTA patients had a higher maximum HR, wider HRV, were less likely to be in sinus rhythm, and received less beta-blocker vs. PTA-diastolic CTA patients. No difference in effective dose was observed (PTA-systolic vs. PTA-diastolic CTA: 2.9 vs. 2.2 mSv, p = 0.26). Image quality score (3.3 vs. 3.5, p < 0.05) and motion artifact score (3.5 vs. 3.8, p < 0.05) were lower in PTA-systolic CTAs than in PTA-diastolic CTAs. For PTA-systolic CTAs, an increase in HR was not associated with a negative impact on motion artifact score nor CTDIvol. For PTA-diastolic CTA, an increase in HR was associated with increased motion artifacts and CTDIvol. HRV demonstrated no correlation with motion artifact and CTDIvol for both PTA-systolic and PTA-diastolic CTAs. In conclusion, both PTA-diastolic CTA and PTA-systolic CTA yielded diagnostic examinations at unselected heart rates and rhythms with similar effective radiation, but PTA-systolic CTA resulted in more consistent radiation exposure and image quality across a wide range of rates and rhythms.

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