Image Quality of Coronary 320-MDCT in Patients with Atrial Fibrillation: Initial Experience

AJR. 2009; 193(6):1514-1521

Sundeep S. Pasricha, Dee Nandurkar, Sujith K. Seneviratne, James D. Cameron, Marcus Crossett, Michal E. Schneider-Kolsky, John M. Troupis

OBJECTIVE: Noninvasive coronary angiography has generally been contraindicated in patients with atrial fibrillation because of the difficulty in synchronizing an irregular heartbeat with table gantry movement. The objective of this study was to evaluate and compare the quality of 320-MDCT images obtained in patients with atrial fibrillation and in a control group of patients in sinus rhythm.

METHODS: Two reviewers were blinded to the patient groups and evaluated images of 15 coronary artery segments for each patient using 320-MDCT. The images were printed on glossy paper and scored subjectively as 1 or 2, meaning of diagnostic quality, or 3, meaning poor quality.

RESULTS: No statistical difference between the groups was noted in patient age: The mean age of the patients with atrial fibrillation was 67 years (age range, 52–82 years) and that of the patients in sinus rhythm was 59 years (36–86 years) (p = 0.3). Scores of 1 and 2 (diagnostic quality) were assigned to 100% in sinus rhythm and 96% in atrial fibrillation (p < 0.05). Scores of 3 were seen only in the atrial fibrillation group (7/175, 4%). Segment 15, the distal circumflex artery, was the segment that was most frequently assigned a score of 3 (2/7, 28.6%). A discrepancy in the two reviewers’ scores was seen in 25 segments (7%), requiring joint consensus. The segments that most frequently required consensus reading were segments 12 and 15. The overall mean image quality score for all three coronary arteries in atrial fibrillation was 1.25 ± 0.47 (SD) and 1.08 ± 0.26 in sinus rhythm (p < 0.001). The median effective dose was 19.28 and 13.55 mSv in the atrial fibrillation and sinus rhythm groups, respectively.

CONCLUSION: The analysis of our initial experience shows that imaging in patients with atrial fibrillation is possible using 320-MDCT, with images of most segments obtained being of diagnostic quality. Segment 15 was the most difficult to see on 320-MDCT because of the small caliber of the vessel; poor visualization of that segment mostly occurred in the setting of a dominant right coronary arterial system.

PMID: Pending

3 Responses

  1. Jacobo Kirsch, MD  on November 25th, 2009

    Important paper for groups looking into acquiring this technology!
    It is a concern of some when dealing with temporal resolutions lower than some of the state-of-the-art 64-row MDCT. While the image quality was diagnostic in almost all the cases, the patients in atrial fibrillation required a higher dosage of beta-blockers than those in normal sinus rhythm. This may represent a challenge for maintaining patient flow in the busiest centers.

  2. Paul Schoenhagen, MD  on November 27th, 2009

    Also consider the following:
    1. Depending on the heart rate (65 bpm) single- or multi-segment acquisition is used. With multi-segment acquisition, acquisition is performed over several heart beats with increase in dose.
    2. The dose of 19.28 mSv in A. Fib group and 13.55 mSv in sinus rhythm group is relatively high compared to recent prospective scanning.
    3. Images were prepared by a CT technologist and printed on glossy paper, resulting in the final analysis being performed from the printed images.

  3. Paul Schoenhagen, MD  on November 27th, 2009

    In comparison in Dewey’s Circulation paper (See Post November 1); the dose for sinus rythm group was reported as “effective radiation dose median, 4.2 versus”.

    Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation.
    Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dübel HP, Schlattmann P, Knebel F, Rutsch W, Hamm B.
    Circulation. 2009; 120(10):867-875.
    PMID:19704093


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