Abstract

Dr. Mir Saiqa Shafi, Dr. Sabeeha Gul* and Dr. Tariq Gojwari

ABSTRACT

Background: Coronary artery disease (CAD) has emerged as the Epidemic of modern era leading both to mortality and morbidity. The Gold standard of reference for diagnosing CAD has been invasive coronary angiography, newly been challenged by the emergence & fast growing use of a less invasive imaging technique, multislice computerised tomography (MSCT) angiography. The diagnostic accuracy of MSCT angiography in CAD has been significantly augmented with the increased performance of MSCT from early generation of the 4-slice CT to 16-slice,64-slice,dual-source CT & the latest models such as 256-slice & 320-slice CT scanners, in conjunction with aggressive beta-blockade to reduce the heart rate during imaging has shown promise for detection of obstructive CAD in the major epicardial vessels. Aim: To assess & compare the image quality on a per segment basis between the prospective & retrospective ECG-gated coronary CT angiography in CAD patients. Methods: We performed our study ,a prospective comparative study conducted in the Department of Radiodiagnosis at a tertiary institute at ,Srinagar, Kashmir, India after taking due clearance from the Institutional Ethical Committee(IEC). Inclucluded Patients were low to intermediate risk for CAD and patients with high risk for CAD but were reluctant for undergoing an invasive procedure.99 patients were enrolled in the study for a total period of two years, underwent contrast-enhanced ECG-gated CT coronary angiography by either of the two methods (Group 1:n=66, retrospective ECG-gating; Group 2:n=33,prospective ECG-triggering). Results: The comparison of segment-wise image quality scores between the PGA CTA & RGH CTA techniques revealed significant difference in the image quality scores for majority of the segments between the two study groups. Image quality was significantly better in the RGH CTA as compared to PGA CTA for certain segments like(1, 2, 3, 4a, 10, 11, 12a , 12b, 13 & 14 ), whileas it was comparable between the two groups for the rest. Conclusion: Prospectively gated axial coronary CT angiography appears to be a robust diagnostic examination for coronary artery disease Patient selection & preparation is of utmost importance so far as the image quality is concerned. When performed in patients with stable heart rates typically less than 60 bpm, PGA yields image quality equivalent to retrospectively gated coronary CY angiography. Summary: In this study, we compared a new method of coronary CTA based on prospectively gated sequential axial acquisition (PGA CTA) with the retrospectively gated helical acquisition (RGH CTA) as the reference method in a total of 99 patients with above results.