Assessment of the Coronary Artery in High-Pitch, Dual-Source CT Aortography Without ECG Synchronization

Background: The high pitch, dual source computed tomography (CT) provides motion-free aortic imaging. Objectives: To evaluate the image quality of coronary artery using dual-source CT aortography without electrocardiogram (ECG) synchronization. Patients and Methods: One hundred fifty patients (87 men; mean age; 63.7 +/- 13.0 years, mean heart rate; 64.7 +/- 6.6 beats/min) with suspected or known aortic disease underwent non-ECG gated, high-pitch, dual-source CT aortography. No beta blocker or nitroglycerin was administered for the patients. The image quality of each coronary artery segment and its ostium was graded on a three-point scale (excellent, moderate, and non-diagnostic image quality). Results: Most patients (88.7%) showed diagnostic image quality in the ostia of the left main and right coronary artery. Among 1894 coronary arterial segments, 870 (45.9%) segments were rated as excellent image quality, 507 segments (26.8%) were rated as moderate image quality, and 517 segments (27.3%) were rated as non-diagnostic image quality. In the per-vessel analysis, non-diagnostic image qualities were often found in right coronary artery (44.0%) and left circumflex artery distribution (36.0%). In contrast, non-diagnostic image qualities were less frequently found in left main (0.67%) and left anterior descending distributions (9.9%). Conclusion: Non-ECG gated, high-pitch, dual-source CT can be useful to evaluate the coronary ostial involvement in patients with ascending aortic dissection. The left main and left anterior descending coronary arteries exhibit relatively good diagnostic image qualities compared with left circumflex and right coronary arteries.