Department of Diagnostic Radiology, University Hospital, Goettingen, Germany.
Am Heart J. 2013 Feb;165(2):154-63.e3. doi: 10.1016/j.ahj.2012.10.026. Epub 2012 Nov 26.
In coronary computed tomography (CT) angiography (CTA) prospective electrocardiography triggering requires less radiation dose than retrospective electrocardiography gating but provides less cardiac phases for interpretation. This meta-analysis presents a concise and comprehensive head-to-head comparison of image quality, diagnostic accuracy, and radiation dose of prospectively triggered coronary CTA vs retrospectively gated CTA in patients with suspected or known coronary artery disease (CAD).
In patients with CAD and without tachyarrhythmia, eligible studies (selected from 4 databases) compared prospectively triggered vs retrospectively gated CTA (performed with ≥64-slice CT or dual-source CT) in 2 groups having approximately similar patient characteristics, scored CTA image quality, and/or assessed how accurately CTA diagnoses ≥50% coronary stenoses compared with catheter angiography and reported the radiation dose. The data were meta-analyzed by random-effects models, with CIs provided in the text.
Among 3,330 patients from 20 included studies, 91.3% of CTAs (segments: 97.8%) had diagnostic quality with prospective triggering and 93.3% of CTAs (segments: 98.4%) with retrospective gating (P > .05). Among 664 patients from 5 studies, the pooled sensitivity/specificity of diagnostic CTAs was 98.7%/91.3% (segment level: 91.3%/97.7%) with prospective triggering and 96.9%/95.8% (segment level: 93.1%/97.6%) with retrospective gating (P > .05). The pooled effective dose was 3.5 mSv with prospective triggering and thus, by a factor of 3.5, lower than the pooled effective dose of retrospective gating, which was 12.3 mSv (P < .01).
In patients with CAD and without tachyarrhythmia, prospectively triggered coronary CTA provides image quality and diagnostic accuracy comparable with retrospectively gated CTA, but at a much lower radiation dose.
在冠状动脉计算机断层扫描（CT）血管造影（CTA）中，前瞻性心电图触发所需的辐射剂量低于回顾性心电图门控，但提供的心脏相位用于解释。这项荟萃分析简明而全面地比较了前瞻性触发冠状动脉 CTA 与回顾性门控 CTA 在疑似或已知冠状动脉疾病（CAD）患者中的图像质量、诊断准确性和辐射剂量。
在 CAD 患者且无心动过速或心动过速的患者中，合格的研究（从 4 个数据库中选择）比较了前瞻性触发与回顾性门控 CTA（使用≥64 层 CT 或双源 CT 进行），两组患者具有相似的患者特征，对 CTA 图像质量进行评分，并且/或评估 CTA 诊断≥50%冠状动脉狭窄的准确性与导管血管造影相比，并报告了辐射剂量。数据通过随机效应模型进行荟萃分析，文本中提供了置信区间。
在 20 项纳入研究的 3330 名患者中，91.3%的前瞻性触发 CTA（节段：97.8%）和 93.3%的回顾性门控 CTA（节段：98.4%）具有诊断质量（P>.05）。在 5 项研究的 664 名患者中，诊断性 CTA 的汇总敏感性/特异性为 98.7%/91.3%（节段水平：91.3%/97.7%）与前瞻性触发和 96.9%/95.8%（节段水平：93.1%/97.6%）与回顾性门控（P>.05）。前瞻性触发的有效剂量为 3.5 mSv，因此，与回顾性门控的有效剂量 12.3 mSv（P<.01）相比，前瞻性触发的有效剂量低 3.5 倍。
在 CAD 患者且无心动过速的患者中，前瞻性触发冠状动脉 CTA 提供的图像质量和诊断准确性与回顾性门控 CTA 相当，但辐射剂量要低得多。
