Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy
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First Published Online January 17, 2011
NOTICE: this is the author’s version of a work that was accepted for publication in European Journal of Radiology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to thiswork since it was submitted for publication. A definitive version was subsequently published in European Journal of Radiology [In Press, 2011] DOI 10.1016/j.ejrad.2011.01.070
Purpose. To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and methods. A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies.Results. 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p < 0.001). The mean dose length product was 225 mGy cm (95% CI: 188, 262 mGy cm) and 822 mGy cm (95% CI: 630, 1013 mGy cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p < 0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p = 0.047). Conclusion. Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value.
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