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EKG-triggered CT Data Acquisition to Reduce Variability in Coronary Arterial Calcium Score¹

¹ From the Department of Radiology, FuWai Cardiovascular Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (B.L., N.Z.); and the Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center and Saint John’s Cardiovascular Research Center, 1124 W Carson St, RB-2, Torrance, CA 90502 (S.S.M., J.C., S.C., H.B., M.J.B.). Received August 7, 2001; revision requested September 28; revision received November 26; accepted January 18, 2002. Address correspondence to M.J.B. (e-mail: mbudoff@rei.edu).

PURPOSE: To test the hypothesis that computed tomographic (CT) scanning during optimal electrocardiographic (EKG) triggering can minimize image motion artifact and reduce interexamination variation of coronary arterial calcification (CAC) score at electron-beam CT.

MATERIALS AND METHODS: Two hundred patients underwent electron-beam CT once and again 5 minutes later to evaluate interexamination variability of CAC score. Group 1 (104 patients) underwent scanning with use of an optimal EKG-triggering protocol (EKG triggering performed individually at the time of least coronary arterial motion during the cardiac cycle); group 2 (96 patients) underwent scanning with use of conventional 80% R-R interval triggering (the most common protocol with the electron-beam CT scanner). Interexamination, intraobserver, and interobserver variations of CAC measurements were compared between groups by using unpaired t tests for both Agatston and volumetric scores (in square millimeters).

RESULTS: Coronary arterial motion artifacts were found in 26% (27 of 104) versus 80% (77 of 96) of patients in groups 1 and 2, respectively (P < .0001). Intraobserver, interobserver, and interexamination variabilities in volumetric score were derived, with values of 1.2%, 9.2%, and 15.9% in group 1 and 2.1%, 11.3%, and 25.9% in group 2, respectively. Interexamination variabilities in both Agatston and volumetric score were significantly reduced with individualized EKG triggering, as compared with conventional triggering (P < .05), but intra- and interobserver variabilities were not (P > .05).

CONCLUSION: Optimal EKG triggering improves the reproducibility of CAC measurement by reducing coronary arterial motion artifacts.

© RSNA, 2002

Index terms: Computed tomography (CT), electron beam, 54.12118 • Coronary vessels, calcification, 54.81 • Coronary vessels, CT, 54.12118

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