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Modified Subtraction Coronary CT Angiography Method for Patients Unable to Perform Long Breath-Holds: A Preliminary Study.

Abstract：

RATIONALE AND OBJECTIVES:Severe calcifications of the coronary arteries are still a major challenge in coronary computed tomography (CT) angiography (CCTA). Subtraction CCTA using a 320-detector row CT scanner has recently been introduced for patients with severe calcifications. However, the conventional subtraction CCTA method requires a long breath-holding time of approximately 20-40 seconds. This is a major problem in clinical practice because many patients may not be able to perform such a long breath-hold. We explored a modified subtraction CCTA method with a short breath-holding time to overcome this problem. MATERIALS AND METHODS:This study was approved by our institutional review board, and all patients gave written informed consent. A total of 12 patients with a coronary calcium score of >400 were enrolled in this study. All patients were unable to hold their breath for more than 20 seconds. Modified subtraction CCTA was performed using the bolus-tracking method. The acquisition protocol was adjusted so that the mask scan was acquired 10 seconds after the postcontrast scan during a single breath-hold. The subtraction image was obtained by subtracting the mask image data from the postcontrast image data. The breath-holding times were recorded. Enhancement of the coronary arteries in the subtraction images was assessed. Subjective image quality was evaluated in a total of 32 segments using a 4-point scale. RESULTS:The mean breath-holding time was 12.8 ± 0.8 seconds (range, 12-14 seconds). The average CT number in the coronary arteries was 288.6 ± 80.5 Hounsfield units (HU) in the subtraction images. Average image quality was significantly increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA (P < 0.001). With subtraction CCTA, the number of non-diagnostic segments was significantly reduced from 53% to 19% (P = 0.001). CONCLUSIONS:This preliminary study has shown that our modified subtraction CCTA method allows the breath-holding time to be shortened to <15 seconds. This may substantially improve the success rate of subtraction CCTA by reducing artifacts and allowing this technique to be applied to patients who are unable to perform a long breath-hold.

journal_name

Acad Radiol

journal_title

Academic radiology

authors

Yoshioka K,Tanaka R,Nagata K,Sasaki T,Takeda K,Ueda T,Sugawara T,Ueyama Y,Chiba T,Sasaki A,Kikuchi K

doi

10.1016/j.acra.2016.04.012

subject

Has Abstract

pub_date

2016-09-01 00:00:00

pages

1170-5

issue

eissn

1076-6332

issn

1878-4046

pii

S1076-6332(16)30085-X

journal_volume

pub_type

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Modified Subtraction Coronary CT Angiography Method for Patients Unable to Perform Long Breath-Holds: A Preliminary Study.