Salvage of diagnostic quality of image acquired by low-radiation-dose prospectively ECG-triggered coronary CTA during ventricular trigeminy: A case report of a novel image processing method

Introduction Cardiac arrhythmias, whether ventricular or supraventricular, initially presented a challenge for coronary computed tomography angiography (CCTA) because they could result in motion artifact during image acquisition, increased acquisition times, and increased radiation dose. Cardiac motion and misregistration artifacts in a scan performed during premature ventricular contractions can significantly compromise image quality and prevent diagnostic evaluation of the coronary arteries. Even the so-called “regularly irregular” rhythms, which are predictable, can trigger arrhythmia rejection algorithms during electrocardiogram (ECG)-gated imaging, delaying image acquisition to the next cardiac cycle and hence increasing the total radiation dose. We present an interesting CCTA case in a patient with ventricular trigeminy and introduce a novel postprocessing method used to derive diagnostic-quality images for coronary artery evaluation.