The Importance of End-Systole for Optimal Reconstruction Protocol of Coronary Angiography With 16-Slice Multidetector Computed Tomography

Objectives:Multidetector-row computed tomography coronary images are usually analyzed in mid-diastole (MD). Because of slow coronary motion also in end-systole (ES), we evaluated the impact on image quality of including ES images and defined an efficient reconstruction protocol. Material and Methods:In 50 coronary multidetector-row computed tomography studies, 9 reconstructions (at 10% increments of the RR interval) were graded for image quality. Multiple combinations of reconstructions were compared. Results:MD (60–70% of the RR interval) offered the best image quality. In 44% patients, the best reconstruction for ≥1 coronary was found in ES (20–30%). Their heart rate was higher (68.2 ± 9.9 bpm vs. 59.2 ± 8.8 bpm, P = 0.0014). Combining ES and MD consistently offered superior image quality and less nonevaluable vessels than even larger numbers of diastolic reconstructions alone. A combination of 2–3 reconstructions was most efficient. Adding more reconstructions did not significantly improve results. Conclusions:Combining ES and MD reconstructions reduces nonevaluable coronary arteries, particularly with higher heart rates. A protocol including 2–3 reconstructions is the most efficient.

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