Pilot study of the multicentre DISCHARGE Trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography

Gianluca De Rubeis, Adriane E. Napp, Peter Schlattmann, Jacob Geleijns, Michael Laule, Henryk Dreger, Klaus Kofoed, Mathias Sørgaard, Thomas Engstrøm, Hans Henrik Tilsted, Alberto Boi, Michele Porcu, Stefano Cossa, José F. Rodríguez-Palomares, Filipa Xavier Valente, Albert Roque, Gudrun Feuchtner, Fabian Plank, Cyril Štěchovský, Theodor AdlaStephen Schroeder, Thomas Zelesny, Matthias Gutberlet, Michael Woinke, Mihály Károlyi, Júlia Karády, Patrick Donnelly, Peter Ball, Jonathan Dodd, Mark Hensey, Massimo Mancone, Andrea Ceccacci, Marina Berzina, Ligita Zvaigzne, Gintare Sakalyte, Algidas Basevičius, Małgorzata Ilnicka-Suckiel, Donata Kuśmierz, Rita Faria, Vasco Gama-Ribeiro, Imre Benedek, Teodora Benedek, Filip Adjić, Milenko Čanković, Colin Berry, Christian Delles, Erica Thwaite, Gershan Davis, Juhani Knuuti, Mikko Pietilä, The DISCHARGE Trial Group

Research output: Contribution to journalArticle (journal)peer-review

3 Citations (Scopus)


Objective: To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study. Materials and methods: From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB). Results: We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13). Conclusion: We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations. Key Points: • Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.

Original languageEnglish
Pages (from-to)1997-2009
Number of pages13
JournalEuropean Radiology
Issue number4
Publication statusPublished - 16 Dec 2019


  • Angiography, coronary
  • Coronary artery disease
  • CT angiography
  • Medical imaging
  • Trial protocols


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