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Coronary computed tomography angiography and endocardial leads - Image quality in 320-row CT using iterative reconstruction

      Highlights

      • Pacemakers show impairment in CCTA using current technique with iterative reconstruction.
      • SNR and CNR are reduced in coronary CT angiography with endocardial leads.
      • Significant image deterioration is found predominantly in segment 8.
      • CCTA is feasible with slight restrictions for patients with pacemakers.

      Abstract

      Purpose

      To investigate whether the presence of endocardial leads has an impact on image quality in coronary computed tomography angiography (CCTA), when current technique is employed using a 320-row computed tomography and iterative reconstruction.

      Materials and methods

      CCTA was performed in 1641 patients, from these we identified 51 patients (study group) with endocardial leads and 51 matched partners (control group) without endocardial leads.
      Noise was determined in the ascending aorta and the left ventricle; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were determined in the left and right coronary artery.
      Subjective image quality was rated separately for the 15 segments of the coronary arteries by 2 radiologists.

      Results

      Current CCTA technique still shows slight impairment of objective image quality in patients with endocardial leads with inferior SNR in the aorta (median 15.04 versus 16.6; p = 0.004) and inferior SNR in the left/right coronary artery (median 15.3/13.81 versus 16.1/15.41; p = 0.013/0.002). CNR of the left/right coronary artery was also inferior (median 17.4/16.46 versus 19.26/19.24; p = 0.002/<0.001).
      The subjective image quality was rated significantly inferior only in segment 8 (p = 0.001) compared to the control group. Artifacts by ventricular leads were found in 65% of the patients in segment 8 with non-diagnostic rating in 9 cases (18%). Atrial leads resulted in artifacts predominantly in segment 1 (45%) with non-diagnostic rating in only 2 cases (4%).

      Conclusion

      CCTA is feasible with slight restrictions for patients in the presence of implanted cardiac devices when current technique is used.

      Abbreviations:

      AIDR 3D (adaptive-iterative-dose-reduction in 3D), BMI (body mass index), CCTA (coronary computed tomography angiography), CNR (contrast-to-noise ratio), CRT (cardiac resynchronization therapy), CT (computed tomography), HU (Hounsfield units), ICD (implanted cardioverter-defibrillator), kVp (kilovoltage peak), LCA (left coronary artery), LV (left ventricle), mAs (tube current – exposure time product), mSv (effective radiation dose), RCA (right coronary artery), SD (standard deviation), SEMAR (single-energy metal artefact reduction), SNR (signal-to-noise ratio)

      Keywords

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