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Eur Radiol. 2014 Jan;24(1):3-11. doi: 10.1007/s00330-013-2969-9. Epub 2013 Jul 26.

Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease.

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Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China,



To evaluate the accuracy of low-dose coronary CTA with iterative reconstruction (IR) in the diagnosis of coronary artery disease (CAD) in patients with suspected CAD.


Ninety-six patients with suspected CAD underwent low-dose prospective electrocardiogram-gated coronary CTA, with images reconstructed using IR. Image quality (IQ) of coronary segments were graded on a 4-point scale (4, excellent; 1, non-diagnostic). With invasive coronary angiography (ICA) considered the "gold standard", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of coronary CTA were calculated on segment-, vessel- and patient-based levels. The patient data were divided into two groups (Agatston scores of ≥ 400 and <400). The differences in diagnostic performance between the two groups were tested.


Diagnostic image quality was found in 98.1 % (1,232/1,256) of segments. The sensitivity, specificity, PPV, NPV and accuracy were 90.8 %, 95.3 %, 81.8 %, 97.8 % and 94.3 % (segment-based) and 97.2 %, 83.3 %, 94.6 %, 90.9 % and 93.8 % (patient-based). Significant differences between the two groups were seen in specificity, PPV and accuracy (92.1 % vs. 97.9 %, 76.0 % vs. 86.7 %, 91.7 % vs. 96.6 %, P < 0.05; segment-based). The average effective dose was 1.30 ± 0.15 mSv.


Low-dose prospective coronary CTA with IR can acquire satisfactory image quality and show high diagnostic accuracy in patients with suspected CAD; however, blooming continues to pose a challenge in severely calcified segments.


• Coronary artery disease (CAD) is increasingly investigated using coronary CTA. • The iterative reconstruction (IR) algorithm is promising in decreasing radiation doses. • Low-dose prospective coronary CTA with IR can acquire satisfactory image quality. • Low-dose prospective coronary CTA with IR can show high diagnostic accuracy.

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