High-Pitch ECG-Synchronized Pulmonary CT Angiography Versus Standard CT Pulmonary Angiography: A Prospective Randomized Study

OBJECTIVE: The purpose of this study was to compare high-pitch ECG-synchronized pulmonary CT angiography (CTA) with standard pulmonary CTA with regard to radiation dose and image quality in patients with suspected pulmonary embolism. SUBJECTS AND METHODS: This prospective study was approved by the institutional review board, and participants provided informed consent. Patients with suspected pulmonary embolism (60% women; mean age, 57 ± 14 years) were randomized to undergo high-pitch ECG-synchronized pulmonary CTA (n = 26) or standard pulmonary CTA (n = 21). Two independent readers assessed subjective image quality of pulmonary arteries, cardiovascular structures, and pulmonary parenchyma. Signal intensity (SI) was measured in one segmental and three central pulmonary arteries. RESULTS: High-pitch ECG-synchronized pulmonary CTA showed higher SI (p < 0.001) for pulmonary arteries. Image quality scores indicated improvement in assessment of cardio-vascular structures (p < 0.001), minimization of motion of central (p < 0.001) pulmonary arteries, and an increase in pulmonary arterial enhancement (p = 0.01) with high-pitch ECG-synchronized pulmonary CTA. Image quality scores for lung assessment were higher for standard pulmonary CTA (p < 0.001). The amount of contrast agent administered was similar between techniques (p = 0.86). Radiation dose was lower for high-pitch ECG-synchronized pulmonary CTA (p < 0.001). CONCLUSION: High-pitch ECG-synchronized pulmonary CTA provides higher pulmonary arterial SI, decreased motion of central pulmonary arteries, and improved assessment of cardiovascular structures with similar contrast dose and lower radiation compared with standard pulmonary CTA.