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Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute

Pontone, Gianluca, MD, PhD, FESC, FSCCT*; Muscogiuri, Giuseppe, MD*; Baggiano, Andrea, MD*; Andreini, Daniele, MD, PhD, FESC, FSCCT*,†; Guaricci, Andrea I., MD, FESC‡,§; Guglielmo, Marco, MD*; Fazzari, Fabio, MD; Mushtaq, Saima, MD*; Conte, Edoardo, MD*; Annoni, Andrea, MD*; Formenti, Alberto, MD*; Mancini, Elisabetta, MD*; Verdecchia, Massimo, MD*; Fusini, Laura, MSc*; Bonfanti, Lorenzo, MSc*; Consiglio, Elisa, MSc*; Rabbat, Mark G., MD, FSCCT¶,#; Bartorelli, Antonio L., MD*,**; Pepi, Mauro, MD, FESC*

doi: 10.1097/RTI.0000000000000320
Original Articles

Purpose: Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm.

Materials and Methods: One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ2 test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant.

Results: cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01).

Conclusion: MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.

*Centro Cardiologico Monzino, IRCCS

Department of Cardiovascular Sciences and Community Health

**Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, Milan

Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital “Policlinico” of Bari, Bari

§Department of Medical and Surgical Sciences, University of Foggia, Foggia

Department of Cardiology, University Hospital P. Giaccone, Palermo, Italy

Loyola University of Chicago, Chicago

#Edward Hines Jr. VA Hospital, Hines, IL

P.G. and M.G. contributed equally.

Gianluca Pontone declared institutional fee as speaker and/or institutional reserach grant from General Electric, Bracco, Bayer, Medtronic, and Heartflow. Daniele Andreini declared institutional fee as speaker and/or institutional reserach grant from General Electric, Bracco, and Heartflow.

Correspondence to: Gianluca Pontone, MD, PhD, FESC, FSCCT, Via C. Parea 4, Milan 20138, Italy (e-mail:

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