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

Emerg Radiol. 2019 Apr;26(2):189-194. doi: 10.1007/s10140-018-01661-0. Epub 2018 Dec 12.


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.

Keywords: CTPA; Coronary motion; Dual-source CT; Pulmonary embolism; Ultra high pitch CT.

MeSH terms

  • Artifacts
  • Computed Tomography Angiography / methods*
  • Contrast Media
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / diagnostic imaging*
  • Radiation Dosage
  • Retrospective Studies
  • Signal-To-Noise Ratio
  • Triiodobenzoic Acids


  • Contrast Media
  • Triiodobenzoic Acids
  • ioversol