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Radiation Dose, Image Quality, Stenosis Measurement, and CT Densitometry Using ECG-Triggered Coronary 64-MDCT Angiography: A Phantom Study

Jun Horiguchi1, Masao Kiguchi1, Chikako Fujioka1, Yun Shen2, Ryuichi Arie1, Kenichi Sunasaka3 and Katsuhide Ito4

1 Department of Clinical Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
2 CT Lab of Great China, GE Healthcare, Mongkok, Kowloon, Hong Kong.
3 GE Yokogawa Medical Systems, Tokyo, Japan.
4 Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.


Figure 1
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  		Fig. 1 —Drawing of coronary arterial plaque models shows size, D-shape, and three levels of stenosis of coronary arterial plaque models. Plaque diameters of 1, 2, and 3 mm correspond to area stenosis of 18%, 50%, and 82%. Three coronary artery models of different plaque densities ({approx} 50, {approx} 110, and {approx} 1,000 H) were used.

 

Figure 2
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  		Fig. 2 —Diagram of cardiac balloon phantom shows balloon was filled with mixture of water and contrast medium (45 H) to simulate unenhanced blood and was submerged in corn oil (–112 H), simulating epicardial and pericardial fat. Coronary artery models (n = 4) were attached to balloon surface. ABS = acrylonitrile-butadiene-styrene.

 

Figure 3
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  		Fig. 3 —Prospective ECG-triggered coronary 64-MDCT software (SnapShot Pulse, GE Healthcare) shows X-ray beam of 40 mm (64 rows x 0.625 mm collimation) is exposed when table is stationary, and then table moves by 35 mm, allowing 5-mm overlapping to next location for another scan. Four exposures cover 14 cm in z-axis. Overlap of 5 mm is used for minimizing cone-beam artifacts.

 

Figure 4
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  		Fig. 4 —Drawing shows region of interest (ROI) placement in plaque. ROI of 1 mm2 is set at center of plaque to minimize influence of intracoronary artery enhancement.

 

Figure 5
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  		Fig. 5 —Graph shows measurement error of stenosis of soft ({approx} 50 H), intermediate ({approx} 110 H) and calcified ({approx} 1,000 H) plaques on five selected heart rate sequences (55–75 beats per minute, satisfactory image quality) on retrospective ECG-gated CT angiography (CTA) (gray bars) and prospective ECG-triggered CTA (white bars). Bars and vertical lines indicate mean and SD, respectively.

 

Figure 6
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  		Fig. 6 —Graph shows measured CT density of soft ({approx} 50 H) and intermediate ({approx} 110 H) plaques on five selected heart rate sequences (55–75 beats per minute, satisfactory image quality) on retrospective ECG-gated CT angiography (CTA) (gray bars) and prospective ECG-triggered CTA (white bars). Bars and vertical lines indicate mean and SD, respectively.

 

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