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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