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High-pitch Helical Dual-source Computed Tomographic Pulmonary Angiography

Comparing Image Quality in Inspiratory Breath-hold and During Free Breathing

Ajlan, Amr M. MD*; Binzaqr, Salma MD*; Jadkarim, Dalia A. MD; Jamjoom, Lamia G. MD*; Leipsic, Jonathon MD

doi: 10.1097/RTI.0000000000000173
Original Articles

Purpose: The purpose of this study was to compare qualitative and quantitative image parameters of dual-source high-pitch helical computed tomographic pulmonary angiography (CTPA) in breath-holding (BH) versus free-breathing (FB) patients.

Materials and Methods: Ninety-nine consented patients (61 female individuals; mean age±SD, 49±18.7 y) were randomized into BH (n=45) versus FB (n=54) high-pitch helical CTPA. Patient characteristics and CTPA radiation doses were analyzed. Two readers assessed for pulmonary embolism (PE), transient interruption of contrast, and respiratory and cardiac motion. The readers used a subjective 3-point scale to rate the pulmonary artery opacification and lung parenchymal appearance. A single reader assessed mean pulmonary artery signal intensity, noise, contrast, signal to noise ratio, and contrast to noise ratio.

Results: PE was diagnosed in 16% BH and 19% FB patients. CTPAs of both groups were of excellent or acceptable quality for PE evaluation and of similar mean radiation doses (1.3 mSv). Transient interruption of contrast was seen in 5/45 (11%) BH and 5/54 (9%) FB patients (not statistically significant, P=0.54). No statistically significant difference was noted in cardiac, diaphragmatic, and lung parenchymal motion. Lung parenchymal assessment was excellent in all cases, except for 5/54 (9%) motion-affected FB cases with acceptable quality (statistically significant, P=0.03). No CTPA was considered nondiagnostic by any of the readers. No objective image quality differences were noted between both groups (P>0.05).

Conclusions: High-pitch helical CTPA acquired during BH or in FB yields comparable image quality for the diagnosis of PE and lung pathology, with low radiation exposure. Only a modest increase in lung parenchymal artifacts is encountered in FB high-pitch helical CTPA.

*Cardiothoracic Imaging Unit, Radiology Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Western Region

Radiology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Central Region, Saudi Arabia

Depatrment of Radiology and Division of Cardiology, Saint Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada

The authors declare no conflict of interest.

Correspondence to: Salma Binzaqr, MD, Cardiothoracic Imaging Unit, Radiology Department, King Abdulaziz University Hospital, King Abdulaziz University, Alnuzha dist, Heraa Street, P.O. Box 36529, Jeddah 21556, Saudi Arabia (e-mail:

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