Image Quality and Diagnostic Accuracy of Third-Generation Dual-Source CT With High-Pitch Scanning for Coronary CTA in Patients With Atrial Fibrillation and Breath-Holding Inability

Objectives: To evaluate the image quality and diagnostic accuracy of third-generation dual-source CT with high-pitch scanning for coronary computed tomography angiography (CCTA) in patients with atrial fibrillation (AF) who were unable to hold their breath. Methods: A total of 144 patients with AF and inability to hold their breath were enrolled and assigned into 2 groups: the high-pitch scanning group (N=70) and the prospective ECG-triggered sequential scanning group (N=74). Image quality, radiation dose, and diagnostic performance were compared between the 2 groups. Results: The subjective image quality in the high-pitch group was significantly superior to that in the sequential group ( P <0.001), and it was particularly noticeable in mid-distal coronary artery segments. Radiation dose was significantly lower in the high-pitch group (effective dose: 1.52±0.57 vs. 6.23±3.41 mSv, P <0.001). The diagnostic performance for detecting significant coronary artery stenosis (≥50%), as assessed by the area under the curve (AUC) and diagnostic accuracy, was significantly superior in the high-pitch group compared with the sequential group ( P <0.05). Conclusion: Third-generation dual-source CT with high-pitch scanning demonstrated superior image quality, significantly reduced radiation dose, and enhanced diagnostic performance in CCTA for patients with AF who were unable to perform breath-holding. Therefore, it can be recommended as the preferred noninvasive imaging technique for this patient population.