Author + information
- Benjamin Cheong, MD, MRCP (UK), FACC and
- Scott D. Flamm, MD⁎ ()
- ↵⁎Cardiovascular Imaging, Hb-6, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
We congratulate Hendel et al. (1) on their detailed documentation of appropriateness criteria for cardiac computed tomography (CT) and cardiac magnetic resonance imaging, which they published in the October 3, 2006, issue of the Journal.We are, however, concerned regarding the apparent recommendation for use of non-electrocardiographic (ECG)-gated CT angiography in the evaluation of potential aortic dissection (Tables 8 and 10 in Hendel et al. ).
The aortic root and ascending thoracic aorta move in concert with the left ventricle and have the greatest motion during systole. It is well documented that motion artifacts from aortic wall motion can simulate the appearance of a dissection flap, particularly in the aortic root and ascending thoracic aorta, leading to an erroneous diagnosis of ascending aortic dissection (2–4). The prevalence of this finding is described as being as high as 57% in non–ECG-gated CT angiographic studies (5).
The use of ECG gating (either prospective or retrospective gating) has been shown to effectively “freeze” cardiac pulsation and aortic wall motion and to reduce motion artifacts when compared to results of non–ECG-gated studies (6,7). Furthermore, the application of ECG gating by adequately trained technologists has no impact on the workflow of the CT examination (7). In our own practice, we prefer the use of prospective ECG gating to minimize radiation exposure to our patients.
Therefore, we believe that ECG gating should be mandatory for thoracic aortic CT angiograms performed to detect potential aortic dissection. We hope that the investigators agree and will promptly make this critical and appropriate correction.
- American College of Cardiology Foundation
- Hendel R.C.,
- Patel M.R.,
- Kramer C.M.,
- et al.