Third generation dual-source CT coronary angiography with high-pitch spiral mode versus prospectively-gated sequential mode: comparison of radiation exposure and image quality

Abstract

Objectives: To compare high-pitch spiral (HPS) and prospectively-gated step-and-shoot (SAS) coronary CT angiography (CCTA) using third generation dual-source CT regarding objective and subjective image quality parameters and radiation exposure. Methods: Eighty pairs of patients matched for gender, age, heart rate and BMI were enrolled in this retrospective study. High-pitch spiral and prospectively ECG-gated sequential CCTA were performed using third generation dual-source CT. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the left ventricle were calculated for each group. Image quality were also scored using four-point scale. Student t-test was used to compare SNR, CNR and mean effective dose values (ED) and Wilcoxon test was used to compare image quality scores. Interrater aggreement were evaluated using Cohen’s kappa statistics. Results: Between-group differences in terms of age, gender, BMI, heart rate, and Agatston score were statistically not significant. Mean SNR and CNR was higher in prospective SAS protocol (16.5 ± 6.2 vs. 14.7 ± 4.9, p = 0.047 and 13.0 ± 5.2 vs. 11.2 ± 4.3, p = 0.02). Image quality scores showed no significant difference between two scan protocols (p > 0.05). Regarding radiation exposure, CT dose index (CTDIvol), dose length product (DLP) and ED was significantly lower for high-pitch group (p < 0.0001). Conclusions: HPS CCTA using DSCT enables > 70% dose reduction while maintaining the image quality compared to prospectively ECG-gated SAS protocol. Therefore, HPS CCTA protocol can be preferred in patients appropriate for prospective ECG-triggered protocol.