16-Row CT-Coronary Angiography. Influence of Reconstruction Technique and Heart Rate upon Diagnostic Accuracy

  • Published 2004

Abstract

Background: To develop an optimal image reconstruction strategy for multidetector-row CT coronary angiography (MD-CTA) and to investigate its accuracy at different heart rates. Methodsl and Results: 70 patients consecutively underwent 16-row MD-CTA, 50 patients additionally had an invasive coronary angiography. Image reconstruction was performed both antegrade-proportional and antegrade-absolute in relation to the previous R-peak. Using a four-step Likert grading scale, optimal antegrade-proportional reconstruction intervals were derived from data sets differing by 5% each and optimal antegrade-absolute reconstruction intervals from data sets, differing by 10 ms each. Cluster, discrimination and regression analysis were applied to identify optimal reconstruction intervals for heart rates (HR) between 45 and 103 bpm. Antegrade-absolute image reconstruction led to significantly better image quality than antegrade-proportional image reconstruction (p<10-6). Best results were observed for LCA and LCX and for low HR. Cluster analysis showed a significant correlation between the amount of HR and the R-R position of the reconstruction interval, revealing optimal image quality almost exclusively for either end-diastolic (low HR) or end-systolic (elevated HR) reconstructions (cutoff HR: 64.5-67.5 bpm). Stenoses >75% were identified with 86.7 % sensitivity and 97.6% specificity by using antegrade-absolute reconstruction and with 83.3 % sensitivity and 97.9% %specificity by using antegrade-proportional reconstruction, showing no significant difference (p=0.98). Conclusion: Image quality in multidetector-row CT coronary angiography critically depends on both correct positioning of the reconstruction interval and choice of a suited reconstruction algorithm. Combined adequately, sufficient image evaluation is feasible even in the presence of elevated heart rates. 70 patients underwent 16-row CT coronary angiography. Image reconstruction was performed in steps of 5%, 10 ms respectively, antegrade-proportional and antegrade-absolute in relation to the previous R-peak. 30 patients additionally had coronary angiography. Antegrade-absolute reconstruction led to significantly better image quality (p<10-6). Best results were observed for LCA and LCX and for low HR. A significant correlation between the amount of HR and the R-R position of the reconstruction interval was observed, revealing optimal image quality only for end-diastolic (low HR) or end-systolic (elevated HR) reconstructions (cutoff HR: 64.5-67.5 bpm). Stenoses >75% were identified with 86.7 % sensitivity and 97.6% specificity by antegrade-absolute reconstruction showing no significant difference to antegrade-proportional reconstruction (p=0.98).

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Cite this paper

@inproceedings{200416RowCA, title={16-Row CT-Coronary Angiography. Influence of Reconstruction Technique and Heart Rate upon Diagnostic Accuracy}, author={}, year={2004} }