Evaluation of the proximal coronary arteries in suspected pulmonary embolism: diagnostic images in 51% of patients using non-gated, dual-source CT pulmonary angiography

Structured abstract Purpose This retrospective study reports the frequency and severity of coronary artery motion on dual-source high-pitch (DSHP), conventional pitch single-source (SS), and dual-source dual-energy (DE) CT pulmonary angiography (CTPA) studies. Methods Two hundred eighty-eight consecutive patients underwent CTPA scans for suspected pulmonary embolism between September 1, 2013 and January 31, 2014. One hundred ninety-four at DSHP scans, 57 SS scans, and 37 DE scans were analyzed. Coronary arteries were separated into nine segments, and coronary artery motion was qualitatively scored using a scale from 1 to 4 (non-interpretable to diagnostic with no motion artifacts). Signal intensity, noise, and signal to noise ratio (SNR) of the aorta, main pulmonary artery, and paraspinal muscles were also assessed. Results DSHP CTPA images had significantly less coronary artery motion, with 30.1% of coronary segments being fully evaluable compared to 4.2% of SS segments and 7.9% of DE segments ( p < 0.05 for all comparisons). When imaging with DSHP, the proximal coronary arteries were more frequently evaluable than distal coronary arteries (51% versus 11.3%, p < 0.001). Without ECG synchronization and heart rate control, the distal left anterior descending coronary artery and mid right coronary artery remain infrequently interpretable (7% and 9%, respectively) on DSHP images. Conclusions DSHP CTPA decreases coronary artery motion artifacts and allows for full evaluation of the proximal coronary arteries in 51% of cases. The study highlights the increasing importance of proximal coronary artery review when interpreting CTPA for acute chest pain.