Optimization of uniformity in coronary artery enhancement using a bolus tracking technique with a dual region of interest in coronary computed tomographic angiography

Background Consistent coronary artery enhancement is essential to achieve accurate and reproducible quantification of coronary plaque composition. Purpose To optimize coronary artery uniformity of enhancement using a bolus tracking technique with a dual region of interest (ROI) in coronary computed tomography angiography (CCTA) on a 320-detector CT scanner. Material and Methods This prospective study recruited 100 consecutive patients who underwent CCTA and were randomly divided into two groups, namely, a manual trigger group (n = 50), in which a manual fast start technique was used to start the diagnostic scan with the visual evaluation of attenuation in the left atrium and left ventricle, and an automatic trigger group (n = 50), in which a bolus tracking technique was used to automatically start the breath-holding command and diagnostic scan with two ROIs placed in the right and left ventricles. Coronary artery image quality was assessed using quantitative and qualitative scores. The enhancement uniformity was characterized by attenuation variability of the ascending aorta (AAO) and coronary arteries. Results No statistically significant differences in the image quality of the coronary arteries were observed between the two groups (all P > 0.05). The coefficients of variation (COVs) of arterial attenuation in the automatic trigger group were significantly smaller than in the manual trigger group (AAO: 9.89% vs. 17.93%; LMA: 10.35% vs. 18.98%; LAD proximal: 12.09% vs. 20.84%; LCX proximal: 11.85% vs. 20.95%; RCA proximal: 12.13% vs. 20.84%; all P < 0.05). Conclusion The automatic trigger technique accompanied with dual ROI provides consistent coronary artery enhancement and optimizes coronary artery enhancement uniformity in CCTA on a 320-detector CT scanner.