Diagnostic image quality of a comprehensive high-pitch dual-spiral cardiothoracic CT protocol in patients with undifferentiated acute chest pain

Abstract Objective To evaluate diagnostic image quality of high-pitch dual source comprehensive cardiothoracic CT protocol in patients presenting with acute undifferentiated chest pain. Materials and methods Consecutive symptomatic subjects ( n = 51) with undifferentiated acute chest pain underwent ECG-synchronized high-pitch dual-spiral chest CT angiography (Definition Flash, Siemens Medical Solutions, 2 × 100 kVp or 2 × 120 kV if BMI > 30, collimation: 128 × 0.6 mm, pitch: 3.2). Independent investigators determined the image quality of each cardiac and pulmonary vessel segment, measured contrast-to-noise-ratio (CNR), and determined radiation exposure. In addition, the prevalence of CT findings (pulmonary embolism (PE), aortic dissection (AD) and significant coronary stenosis (≥50%)) was determined. Univariate and multivariate analysis were performed to determine the subpopulation with highest diagnostic quality. Results Among 51 subjects (66% male, average age: 63 ± 15.8), the prevalence of positive CT findings was moderate (overall: 11.7%). Overall, image quality of the pulmonary, aortic and coronary vasculature was good (1.26 ± 0.43 and CNR: 2.52) with an average radiation dose of 3.82 mSv and 3.2% of segments rated non-evaluable. The image quality was lowest in the coronary arteries ( p = 0.02), depending on the heart rate ( r = 0.52, p < 0.001). In subjects with a heart rate of ≤65 bpm ( n = 30) subjective image quality and CNR of the coronary arteries were higher (1.6 ± 0.5 vs. 2.1 ± 0.5, p = 0.03 and 1.21 ± 0.3 vs. 1.02 ± 0.3, p = 0.05) with only 1.5% segments classified as non-evaluable. Conclusion High-pitch dual-spiral comprehensive cardiothoracic CT provides low radiation exposure with excellent image quality at heart rates ≤65 bpm. In subjects with higher heart rates, image quality of the aortic and pulmonary vasculature remains excellent, while the assessment of the coronary arteries degrades substantially.