Systolic High-Pitch Coronary CT Angiography for Evaluation of the Coronary Arteries in Heart Transplant Recipients
Gorka Bastarrika 1 , Marta Calvo 1 , Ana Ezponda 1 , Alejandra García-Baizán 1 , Meylin Caballeros 2 , Gregorio Rábago 3
(1) Department of Radiology, Cardiothoracic Imaging Division, Clínica Universidad de Navarra, Pamplona 31008, Spain.
(2) Department of Radiology, Cardiothoracic Imaging Division, Clínica Universidad de Navarra, Madrid, Spain.
(3) Department of Cardiovascular Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients.
SUBJECTS AND METHODS
Twenty-two consecutive OHT recipients (16 men, six women; median age, 66.5 years [interquartile range, 51.3-70.3 years]; median heart rate, 91 beats/min [interquartile range, 79.3-97.3 beats/min]) underwent CCTA with a third-generation dual-source CT scanner in high-pitch mode to rule out coronary allograft vasculopathy. Data acquisition was triggered at 30% of the R-R interval.
Two independent observers blindly assessed image quality on a per-segment, per-vessel, and per-patient basis using a 4-point scale (4, excellent; 1, not evaluative). Scores 2-4 indicated diagnostic quality. Studies were compared with previously performed retrospective ECG-gated examinations, when available. Interobserver agreement on the image quality was assessed with kappa statistics. Radiation dose was recorded.
A total of 322 coronary segments were evaluated. Diagnostic image quality was observed in 97.5% of the segments. Interobserver agreement for image quality assessment was very good on a per-patient (k = 0.82), per-vessel (k = 0.83), and per-segment basis (k = 0.89). The median per-patient image quality score was 4.0 (3.0-4.0) for the entire coronary tree.
A comparison of image quality scores between high-pitch and retrospective ECG-gated CCTA examinations showed no significant differences, but the estimated mean radiation dose was significantly lower for the high-pitch mode (median dose-length product, 31.6 mGy × cm [interquartile range, 23.1-38.8 mGy × cm] vs 736.5 mGy × cm [interquartile range, 655.5-845.7 mGy × cm], p < 0.001).
Performing single-heartbeat high-pitch CCTA during the systolic phase of the cardiac cycle in OHT recipients results in diagnostic image quality in coronary angiograms at very low radiation dose.
CITA DEL ARTÍCULO AJR Am J Roentgenol. 2020 Aug 12;1-6. doi: 10.2214/AJR.19.22639