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Eur Radiol. 2020 Apr;30(4):1997-2009. doi: 10.1007/s00330-019-06522-z. Epub 2019 Dec 16.

Pilot study of the multicentre DISCHARGE Trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography.

Author information

1
Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
2
Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
3
Department of Statistics, Informatics and Data Science, Jena University Hospital, Jena, Germany.
4
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
5
Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
6
Department of Radiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark.
7
Department of Cardiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark.
8
Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, CA, Italy.
9
Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari, AOU di Cagliari - Polo di Monserrato, 09042, Monserrato, CA, Italy.
10
Department of Radiology, Azienda Ospedaliera Brotzu, Cagliari, CA, Italy.
11
Department of Cardiology, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119, 08035, Barcelona, Spain.
12
Department of Radiology, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119, 08035, Barcelona, Spain.
13
Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
14
Department of Cardiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
15
Department of Cardiology, University Hospital Motol, Vuvalu 84, 150 06, Prague 5, Czech Republic.
16
Department of Radiology, University Hospital Motol, Vuvalu 84, 150 06, Prague 5, Czech Republic.
17
Department of Cardiology, ALB FILS KLINIKEN GmbH, Eichertstrasse 3, 73035, Goeppingen, Germany.
18
Department of Radiology, ALB FILS KLINIKEN GmbH, Eichertstrasse 3, 73035, Goeppingen, Germany.
19
Department of Radiology, University of Leipzig Heart Centre, Strümpellstrasse 39, 04289, Leipzig, Germany.
20
Department of Cardiology, University of Leipzig Heart Centre, Strümpellstrasse 39, 04289, Leipzig, Germany.
21
MTA-SE Cardiovascular Imaging Center, Heart and Vascular Center, Semmelweis University, Varosmajor u 68, Budapest, 1122, Hungary.
22
Department of Cardiology, Southeastern Health and Social Care Trust, Upper Newtownards Road Ulster, Belfast, BT16 1RH, UK.
23
Department of Radiology, Southeastern Health and Social Care Trust, Upper Newtownards Road Ulster, Belfast, BT16 1RH, UK.
24
Department of Radiology, St. Vincent's University Hospital and National University of Ireland, Belfield Campus, 4, Dublin, Ireland.
25
Department of Cardiology, St. Vincent's University Hospital, Belfield Campus, 4, Dublin, Ireland.
26
Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
27
Department of Cardiology, Paul Stradins Clinical University Hospital, Pilsoņu Street 13, Riga, 1002, Latvia.
28
Department of Radiology, Paul Stradins Clinical University Hospital, Pilsoņu Street 13, Riga, 1002, Latvia.
29
Department of Cardiology, Lithuanian University of Health Sciences, Eivelniu 2, 50009, Kaunas, Lithuania.
30
Department of Radiology, Lithuanian University of Health Sciences, Eivelniu 2, 50009, Kaunas, Lithuania.
31
Department of Cardiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Ul. Henryka Michala Kamienskiego, 51124, Wroclaw, Poland.
32
Department of Radiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Ul. Henryka Michala Kamienskiego, 51124, Wroclaw, Poland.
33
Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceicao Fernandes, 4434 502, Vila Nova de Gaia, Portugal.
34
Department of Cardiology, Cardio Med Medical Center, 22 decembrie 1989, 540156, Targu-Mures, Romania.
35
Radiology Department Imaging Center, Institute of Cardiovascular Diseases of Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Novi Sad, 212014, Serbia.
36
Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Novi Sad, 212014, Serbia.
37
Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place 126, Glasgow, G12 8TA, UK.
38
Department of Radiology, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
39
Department of Cardiology, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
40
Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20120, Turku, Finland.
41
Heart Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI 20120, Turku, Finland.
42
Department of Radiology, The Institute of Cardiology in Warsaw, Ul. Alpejska 42, 04-628, Warsaw, Poland.
43
Department of Cardiology, The Institute of Cardiology in Warsaw, Ul. Alpejska 42, 04-628, Warsaw, Poland.
44
Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade-Zemun, 11080, Serbia.
45
Department of Radiology, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain.
46
Department of Cardiology, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain.
47
Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Prescot Street, Liverpool, L7 8XP, UK.
48
Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. marco.francone@uniroma1.it.
49
Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena, 324 00161, Rome, Italy. marco.francone@uniroma1.it.

Abstract

OBJECTIVE:

To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study.

MATERIALS AND METHODS:

From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB).

RESULTS:

We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13).

CONCLUSION:

We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations.

KEY POINTS:

• Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.

KEYWORDS:

Angiography, coronary; CT angiography; Coronary artery disease; Medical imaging; Trial protocols

PMID:
31844958
DOI:
10.1007/s00330-019-06522-z

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