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First Head-to-Head Comparison of Effective Radiation Dose from Low-Dose CT with Prospective ECG-Triggering versus Invasive Coronary Angiography
  1. Bernhard A Herzog (bernhard.herzog{at}usz.ch)
  1. Universtiy Hospital Zurich, Switzerland
    1. Christophe A Wyss (christophe.wyss{at}usz.ch)
    1. Universtiy Hospital Zurich, Switzerland
      1. Lars Husmann
      1. Universtiy Hospital Zurich, Switzerland
        1. Oliver Gaemperli
        1. Universtiy Hospital Zurich, Switzerland
          1. Ines Valenta
          1. Universtiy Hospital Zurich, Switzerland
            1. Valerie Treyer
            1. Universtiy Hospital Zurich, Switzerland
              1. Ulf Landmesser
              1. Universtiy Hospital Zurich, Switzerland
                1. Philipp A Kaufmann (pak{at}usz.ch)
                1. Universtiy Hospital Zurich, Switzerland

                  Abstract

                  Background: Reduction of radiation burden of multidetector CT coronary angiography (CTCA) has remained an important task.

                  Objectives: To compare effective radiation dose of low-dose 64-slice CTCA using prospective ECG-triggering versus diagnostic invasive coronary angiography (CA).

                  Methods: Forty-two patients referred for elective invasive CA due to suspected coronary artery disease (CAD) were prospectively enrolled to undergo a low-dose CTCA without calcium scoring within the same day prior to CA. Dose-area product of diagnostic invasive CA and dose-length product of CTCA were measured, converted into effective radiation dose and compared using Man-Whitney-U tests. In addition, accuracy of CTCA to detect CAD (coronary artery narrowing ≥ 50%) was assessed using invasive CA as standard of reference. On an intention-to-diagnose-base all non-evaluative vessels were included in the analysis and censored as positive.

                  Results: The estimated mean effective radiation dose was 8.5 ± 4.4mSv (range: 1.4 – 20.5mSV) for diagnostic invasive CA, and 2.1 ± 0.7mSv (range: 1.0 – 3.3mSv) for CTCA (P<0.001). Nineteen patients (42.9%) had no CAD by invasive CA. Forty (95.2 %) patients have been correctly classified as having CAD (23/23) or no CAD (17/19). Over 97 % (551/567) of segments were evaluable. Vessel-based analysis revealed sensitivity, specificity, positive and negative predictive value of 94.2 % (CI: 0.8-1.0), 94.8% (CI: 0.9-1.0), 89.0% (CI: 0.8-1.0), 97.4% (CI: 0.9-1.0), and an accuracy of 94.6%.

                  Conclusions: Low dose CTCA allows evaluation of CAD with high accuracy, but significantly less effective radiation dose to patients compared to diagnostic invasive CA.

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