Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scanner

Objectives: To test the image quality and feasibility of a sequential low radiation dose protocol for hybrid cardiac PET/CT angiography (CTA). Background: Multidetector computed tomography (MDCT) is a non‐invasive method for coronary angiography. The negative predictive value of MDCT is high but perfusion imaging has a role in detecting functional significance of coronary lesions. This has encouraged combining these techniques. However, radiation dose is of concern. We report our first experiences with a low dose sequential CTA mode applicable to hybrid imaging. Methods: In the first phase, 10 consecutive cardiac MDCT angiographies were performed with spiral acquisition and compared in terms of image quality and dose with the following 10 patients performed with a new sequential mode. In the second phase, feasibility and radiation dose of a combined ¹⁵O‐water rest‐stress PET perfusion/sequential CTA protocol were assessed in another group of 61 consecutive patients. Results: Mean effective radiation dose was 60% lower in the sequential group than in the spiral group (19·3 versus 7·6 mSv, P<0·001). In the second phase, the new sequential hybrid protocol proved possible in 87% of the patients given the preconditions determined by the manufacturer. Mean effective dose of the CT acquisition was 7·6 mSv and total dose from the PET/CTA hybrid study 9·5 mSv. Conclusion: Low dose PET/CT allows cardiac hybrid studies with <10 mSv. The protocol can be applied to almost nine out of 10 patients with CT image quality comparable to spiral acquisition.