Journal of Cardiovascular Computed Tomography (2009) 3, 143152

Review Article

Cardiac CT: How much can temporal resolution, spatial

resolution, and volume coverage be improved?
Thomas G. Flohr, PhDa,b*, Rainer Raupach, PhDa, Herbert Bruder, PhDa
a

Siemens Healthcare, CT PLM-E PA, Siemensstr. 1, D- 91301 Forchheim, Germany and bDepartment of Diagnostic
Radiology, Eberhard-Karls-Universitat, Tubingen, Germany
KEYWORDS:
Cardiac CT;
Dual-source CT;
Multidetector row CT;
Spatial resolution;
Temporal resolution;
Volume coverage

Abstract. In this article, we review the current status and discuss potential further improvements and
limitations of system parameters relevant for cardiac CT, in particular spatial resolution, temporal
resolution, and volume coverage.
2009 Society of Cardiovascular Computed Tomography. All rights reserved.

Challenges for cardiac CT

Scan data acquisition in computed tomography (CT)
imaging of the heart is controlled by the patients electrocardiogram (ECG) to provide images in the same relative
phase of the cardiac cycle. Cardiac CT requires high
temporal resolution, ie, short exposure time of the individual images, to avoid image distortion by cardiac motion.
Excellent spatial resolution (at best submillimeter) is a
prerequisite for adequate visualization of the hearts small
anatomical structures, such as the coronary arteries. Furthermore, the CT scanner should be able to examine the
complete heart volume in a short scan time, well within the
time of one breathhold.
Since 1999, 4-slice CT systems with 4 ! 1 mm or
4 ! 1.25 mm collimation and 0.5-second gantry rotation
time have been clinically used for ECG-triggered or
ECG-gated multidetector row CT (MDCT) examinations
Conflict of interest: The authors are employees of Siemens Healthcare,
Forchheim, Germany.
* Corresponding author.
E-mail address: thomas.flohr@siemens.com
Submitted December 8, 2008. Accepted for publication April 25, 2009.

at low to moderate heart rates.17 Despite all promising advances, limitations due to motion artifacts in patients with
higher heart rates, limited spatial resolution for the visualization of stents and calcified coronary arteries, and long
breathhold times up to 40 seconds remained for 4-slice cardiac CT.7,8 Introduced in 2001, 16-slice CT systems with
submillimeter collimation (16 ! 0.5 mm, 16 ! 0.625 mm,
16 ! 0.75 mm) and gantry rotation times down to 0.375
seconds provided improved spatial and temporal resolution,
whereas examination times were considerably reduced to
approximately 1518 seconds.9 CT angiography (CTA) of
the coronary arteries benefited from the increased performance of 16-slice technology.1014 Available since 2004,
64-slice CT systems that provided simultaneous acquisition
of 64 slices with 0.5-mm, 0.6-mm, or 0.625-mm collimated
slice width at gantry rotation times down to 0.33 seconds
were a further advance in integrating coronary CTA into
routine clinical algorithms. The wider coverage with thinner slices has shortened the scan time to 612 seconds,
which is an adequate breathhold time even for patients
with limited ability to cooperate. Although image quality
at higher heart rates and robustness of the method in clinical routine are significantly improved with 64-slice CT

1934-5925/$ -see front matter 2009 Society of Cardiovascular Computed Tomography. All rights reserved.
doi:10.1016/j.jcct.2009.04.004

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systems, most investigators still propose the administration

of b-blockers for patients with higher heart rates.1517
Meanwhile, new CT systems have been introduced that
aim at solving remaining challenges of cardiac CT. Dualsource CT (DSCT) scanners provide considerably improved temporal resolution, eg, 83 milliseconds.18,19 In
2008, a CT system with 128 collimated 0.625-mm slices
and 0.27-second gantry rotation time was introduced that
is capable of covering the heart with 2 sequential scans.
A CT scanner equipped with a detector providing
320 ! 0.5 mm collimation at 0.35-second gantry rotation
time is designed to image the entire heart in a single
scan.20,21 Currently, developments are ongoing to further
enhance spatial and temporal resolutions or to significantly
increase the volume coverage speed such that the entire
heart can be covered in one heartbeat without using area
detectors.22
In this article we review the current status and discuss
potential further developments and limitations of system
parameters relevant for cardiac CT, in particular spatial
resolution, temporal resolution, and volume coverage.

Spatial resolution
The in-plane spatial resolution of a CT system is limited
by the number of active detector channels in a detector row
and by their aperture, ie, the width of each individual
detector channel. With 700900 detector channels covering
a scan field of view (SFOV) of usually 500 mm, the inplane sampling distance, ie, the distance between 2 detector
channels, is 0.560.71 mm in the isocenter of the scanner.
Modern CT scanners use techniques such as quarter detector offset or in-plane flying focal spot to double the number
of samples acquired across the SFOV. The quarter detector
offset, ie, a stationary shift of the entire detector by a quarter of the in-plane sampling distance relative to the isocenter, relies on complementary samples acquired half a
rotation earlier or later to provide interleaved samples.
The in-plane flying focal spot doubles the number of samples by dynamically shifting the focal spot position on the
anode plate from one reading to the next, such that subsequent readings interleave. The resulting sampling distance
of 0.280.36 mm obtained with both techniques defines
the theoretical limit of in-plane spatial resolution. In practice, it cannot be fully exploited in routine clinical modes
if excessive image noise and streak artifacts at high contrast
structures shall be avoided. Typically, an in-plane resolution of approximately 0.5 mm is not exceeded for low-contrast imaging with the use of standard body convolution
kernels; this is also the typical in-plane resolution in
ECG-synchronized images of the heart.
Whereas in-plane spatial resolution did not significantly
change from 4-slice CT to 64-slice CT, through-plane
(z-axis) resolution considerably improved since thinner
collimated slices became available for routine use: the

4-slice systems allowed to cover the heart with 1- to 1.25mm collimated slice width in an ECG-gated examination.
The 64-slice systems provide 0.5- to 0.625-mm collimated
slice width for routine cardiac scans. A flying-focal spot in
the z-direction can be applied to improve through-plane
resolution by better approaching the theoretical resolution
limit,23 comparable to the improvement of in-plane resolution by an in-plane flying-focal spot. The z-flying focal spot
technique has meanwhile been implemented in CT scanners
from 2 different vendors.
The progress in through-plane resolution from approximately 1 mm with 4-slice CT to less than 0.4 mm with 64slice CT can best be shown with a z-resolution phantom,
which consists of a Lucite plate with rows of cylindrical
holes with different diameters aligned in the z-axis direction (Fig. 1). The patient examples in Figure 2 show typical
coronary CT angiograms with 4-slice and 64-slice CT scanners. The improvement of detail visualization is obvious. In
sum, cardiac imaging with state-of-the-art CT systems providing simultaneous acquisition of at least 64 slices can be
performed at isotropic spatial resolution down to
0.4 ! 0.4 ! 0.4 mm3, if detail visualization of calcified
coronary arteries or stents is required.
In routine coronary CT angiography, the resolution is
typically reduced to 0.5 ! 0.5 ! 0.5 mm3 by smoother
convolution kernels and somewhat wider reconstructed slices, to obtain smoother images with less image noise. This

Figure 1 Evaluation of the spatial resolution in the z-axis direction

for ECG-gated cardiac spiral CT with 4-slice, 16-slice, and 64-slice
equipment with the use of a through-plane resolution phantom at
rest. The phantom comprises air-filled cylinders with 0.4- to 3.0-mm
diameter that can be examined with multiplanar reformations (MPR)
along the scan direction. A maximum through-plane resolution of
0.91.0 mm is achieved with 4-slice CT and 4 ! 1 mm collimation.
Sixteen-slice CT provides up to 0.6 mm through-plane resolution
based on 16 ! 0.75 mm collimation. Sixty-fourslice CT with
32 ! 0.6 mm collimation and z-flying focal spot (z-FFS) enables
the visualization of objects down to 0.4-mm diameter.

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Figure 2 Patient examples depicting similar clinical situations (a stent in the proximal left anterior descending [LAD] artery) to compare
the clinical performance of ECG-gated cardiac CT with a 4-slice CT system (4 ! 1 mm collimation, 0.5-second rotation time) and a
64-slice CT system (32 ! 0.6 mm collimation with z-flying focal spot, 0.33-second rotation time). Because of the significantly improved
spatial and temporal resolutions with the 64-slice system, the in-stent lumen can be evaluated (4-slice case courtesy of Hopital de Coracao,
Sao Paulo, Brazil; 64-slice case courtesy of Peking Union Medical Center (PUMC), Beijing, China).

level of spatial resolution is adequate for evaluation of the

hearts anatomy, bypass grafts, or coronary artery malformations and for the assessment and quantification of significant coronary artery stenosis. It is not yet sufficient,
however, for a reliable evaluation of stent patency and instent restenosis, at least in smaller stents, and for the assessment of the residual lumen in severely calcified coronary
arteries. The typical calcium blooming artifact is caused
by insufficient spatial resolution (and, at least at higher
heart rates, insufficient temporal resolution). Furthermore,
the limited ability of todays CT scanners to reliably and
unambiguously characterize plaque composition (eg, to distinguish lipid-rich and fibrous plaques) is a consequence of
limited spatial resolution.
Will future CT systems be able to provide significantly
improved spatial resolution for routine cardiac examinations, at best to a level of 0.20.25 mm comparable to catheter angiography? A definite answer to this question is
difficult, because the history of CT is characterized by several breakthrough innovations such as the invention of

spiral CT or the introduction of multidetector row CT, but

from todays perspective it is unlikely. Increased spatial resolution goes hand in hand with increased image noise. The
variance of the pixel noise in the image is proportional to
the fourth power of the resolution in 3-dimensional space:
it increases linearly with an increase in through-plane
(z-axis) resolution and with the third power of the in-plane
resolution. Consequently, to maintain a desired contrast-tonoise ratio (CNR), one has to increase the applied radiation
dose by the power of 4 if resolution is increased in all 3 spatial directions. To double the resolution without affecting
image noise, eg, to achieve 0.25-mm isotropic resolution
instead of 0.5 mm, the dose needs to be increased by a factor of 24 (16-fold increase). It is not expected that radiation
dose to the patient can be increased this much for routine
cardiac scanning. If, however, spatial resolution is increased without adequate adaptation of the radiation dose,
excessive image noise can severely degrade the visualization of small coronary arteries and atherosclerotic plaques,
such that the gain in spatial resolution will not necessarily

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translate into improved image quality and clinical benefit

(Fig. 3). A way out of this dilemma cannot be expected
by hardware progress, eg, by the potential introduction of
new detector materials or improved detector electronics
that provide the desired spatial resolution at significantly
reduced image noise. State-of-the-art CT systems use
solid-state detectors that convert the absorbed x-rays into
visible light which is then detected by a Si photodiode.
Key requirements for a suitable detector material are
good detection efficiency, ie, high atomic number, and
very short afterglow time to enable the fast gantry rotation
speeds that are essential for cardiac imaging. The detection
efficiency of the scintillators used in modern CT detectors
is better than 90%; thus, there is not much room for
improvement.
Nevertheless, there may be some opportunities for progress in spatial resolution. Currently, alternative image
reconstruction approaches are being investigated that have
the potential to selectively improve high-contrast resolution
without affecting image noise in low-contrast areas. Whereas
increased spatial resolution is directly correlated with increased image noise in standard filtered backprojection
reconstructions as they are used in CT scanners today,
iterative reconstruction approaches, to a certain extent, allow
decoupling of spatial resolution and image noise. In an
iterative reconstruction, a correction loop is introduced into
the image reconstruction process.24 Once an image has been
reconstructed from the measured projections, a ray tracing in
the image is performed to calculate new projections that exactly represent the reconstructed image. This step, called reprojection, simulates the CT measurement process, but with
the image as the measurement object. If the original image
reconstruction was perfect, measured and calculated projections would be identical. In reality they are not, and the deviation is used to derive correction projections, reconstruct a
correction image, and update the original image. Then the

loop starts again, and it is continued until the deviation between measured and calculated projections is smaller than
a predefined limit. Iterative reconstruction has the potential
to enhance spatial resolution at higher object contrasts and
to reduce image noise in low-contrast areas. It is not unlikely
that the visualization of calcified plaques can be considerably
improved and calcium blooming can be significantly reduced
with the use of such techniques (see Fig. 4). As a drawback,
iterative reconstruction is computationally more demanding
than conventional filtered backprojection reconstruction, and
hardware efforts are currently needed to avoid long image reconstruction times. Furthermore, the noise texture of the images may be different from standard filtered backprojection,
and the users may have to get used to an image impression
that they are currently not familiar with. Nevertheless, iterative reconstruction appears to be the most promising
approach to reduce or even solve the problem of heavily calcified coronary arteries in cardiac CT.
One should keep in mind, however, that any further
increase in spatial resolution in cardiac CT without simultaneous improvement of temporal resolution is doubtful and
will not necessarily result in sharper images. Much of the
blurring and unsharp contours that limit the visualization of
calcified plaques in coronary arteries are caused by object
motion. Clinical experience with the improved temporal
resolution of newer generations of CT systems has shown
that better temporal resolution translates into visually
perceived improvement of image sharpness, although the
actual spatial resolution of the system may not have
changed (Fig. 5).

Temporal Resolution
In ECG-synchronized cardiac MDCT, scan data acquisition and image reconstruction are controlled by the

Figure 3 Small coronary artery phantom with calcified and noncalcified plaques (computer simulation). Constant radiation dose was
applied both for 0.5 mm (left) and 0.35 mm (right) isotropic resolution. Because of the significantly increased image noise at 0.35 mm
isotropic resolution, detail visualization is hampered.

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147

Figure 4 Detail of a coronary CTA in a patient with significant coronary calcifications. The scan data were acquired on a dual-source CT
system. Standard filtered backprojection reconstruction (top); iterative reconstruction, start image with filtered backprojection, 2 iterations
(bottom). Calcium blooming is significantly reduced.

patients ECG. In prospectively ECG-triggered sequential

CT, the patients ECG signal is used to trigger axial scans at
different z-positions (different anatomical levels) with a
user-defined temporal offset relative to the R waves.25,26 A
volume image of the heart consists of several image slabs
reconstructed from axial scan data acquired in multiple
consecutive heart beats. The number of axial images within
an image slab corresponds to the number of active detector
slices, the width of an image slab is defined by the detector
z-coverage (Fig. 6). In retrospectively ECG-gated spiral
CT,1,3 the heart volume is covered by a spiral (helical)
scan while the patients ECG is recorded simultaneously
to allow for a retrospective selection of the data segments
used for image reconstruction (Fig. 7).
Both in ECG-triggered axial CT and in ECG-gated spiral
CT, partial scan data segments are used for image reconstruction to minimize the exposure time per image and to
optimize temporal resolution. A partial scan consists of 180
degrees of fan-beam data plus the total fan angle of the
detector (approximately 50 degrees) plus a transition angle
for smooth data weighting, in total 240260 degrees of fanbeam data. This is the minimum data interval needed for
image reconstruction throughout the entire SFOV with a
typical diameter of 50 cm. In the center of rotation, where
the heart is usually positioned, 180 degrees of scan data (a
half-scan segment) are sufficient for image reconstruction,
and the temporal resolution equals half the gantry rotation
time of the respective CT system.27 Because of faster gantry rotation, temporal resolution has been improved from

250 milliseconds with the first generation of 4-slice CT systems3,27 to 135 milliseconds with the latest generation of
64-slice and 128-slice CTs, which improved image quality
at higher heart rates and robustness of the method1517 and
constituted a fundamental step in the ongoing process of
introducing cardiac CT into routine clinical practice.
Nevertheless, further improved temporal resolution
down to 50 milliseconds is desirable to improve image
quality in particular in patients with irregular heart rates28
and to reduce the need for b-blocker medication. The temporal resolution of MDCT scanners can be improved by
dividing the half-scan data segment into N 5 24 subsegments acquired in subsequent cardiac cycles. When using
multisegment reconstruction, the patients heart rate and
the gantry rotation time of the scanner have to be desynchronized to enable improved temporal resolution.
Two requirements have to be met: first, the subsegments
have to fit together in projection space to build up a halfscan interval. As a consequence, the start projections of
subsequent subsegments have to be shifted relative to
each other. Second, all subsegments have to be acquired
in the same relative phase of the patients heart cycle to reduce the exposure time per image. If the patients heart beat
and the rotation of the scanner are completely synchronous,
the 2 requirements are contradictory. In this case, temporal
resolution will not improve with multisegment reconstruction. Depending on the relation of rotation time and patient
heart rate, temporal resolution in an N-segment reconstruction varies between one-half and 1/(2N) times the gantry

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Figure 5 Improved visualization of calcified plaques (reduced blooming artifact) because of improved temporal resolution. A followup examination in a patient with calcified LAD artery is shown both for a conventional 64-slice CT system with 165-millisecond temporal
resolution (top left) and a DSCT system with 83-millisecond temporal resolution (top right). The spatial resolution of both systems is similar (courtesy of Dr S. Achenbach, Erlangen University, Germany). At least part of the blooming artifact is caused by residual coronary
motion. This clinical result is supported by a computer simulation study of a moving coronary artery at identical spatial resolution but different temporal resolution (165 milliseconds, bottom left, versus 83 milliseconds, bottom right).

rotation time. There are sweet spots, heart rates with optimum temporal resolution, and heart rates at which temporal resolution cannot be improved beyond half the gantry

Figure 6 Principle of ECG-triggered MDCT axial scanning. The

patients ECG is schematically shown as a function of time on the
horizontal axis. The z-positions of the detector slices relative to
the patient (8 slices in this example) are indicated by the dashed
white lines. Usually, partial scan data intervals (which are marked
as red boxes) are acquired at a user-defined temporal offset to the
R waves. An ECG-triggered volume image of the heart consists of
several image slabs acquired in multiple consecutive heart beats.
The width of an image slab corresponds to the z-width of the
detector.

rotation time. Figure 8 shows the temporal resolution at

various gantry rotation times, both for single-segment reconstruction and for 2-segment reconstruction. An approach to improve the performance of multisegment
reconstruction is to prospectively adjust the rotation time
of the scanner to the patients heart rate to obtain best possible temporal resolution, provided the heart rate is predictable and stable during examination.
Multisegment reconstruction approaches rely on a complete periodicity of the heart motion. They can improve
image quality at higher heart rates, but they encounter their
limitations for patients with arrhythmia. Furthermore, the
radiation dose to the patient is directly correlated with the
number of heart cycles used for reconstruction of an image,
both in ECG-triggered sequential scanning (multiple exposures at the same z-position) and in ECG-gated spiral
scanning (reduced table feed compared with single segment
reconstruction).
A straightforward way to improve temporal resolution is
faster gantry rotation. Obviously, significant development
efforts are needed to account for the substantial increase in
mechanical forces. Rotation times of less than 0.2 second,

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Journal of Cardiovascular Computed Tomography

Figure 7 Principle of retrospectively ECG-gated MDCT spiral

scanning with the use of single-segment reconstruction. The patients ECG is schematically shown as a function of time on the
horizontal axis. The z-positions of the detector slices (8 slices in
this example) relative to the patient are indicated by the dashed
white lines. The table moves continuously, and continuous spiral
scan data of the heart volume are acquired. Only scan data acquired in a predefined cardiac phase, usually the diastolic phase,
are used for image reconstruction (marked as red boxes). The
white horizontal lines represent axial images at 2 z-positions
zima1 and zima2. Because no axial scan data are available, spiral interpolation to the desired z-positions is needed. To ensure gapless
volume coverage of the heart, the spiral pitch has to be adapted to
the patients heart rate. Typically, very low pitch values (0.20.25)
are required.

which are required to provide a temporal resolution of less

than 100 milliseconds independent of the heart rate, appear
to be beyond todays mechanical limits because of excessive gravitational forces. As an additional challenge, the
more the gantry rotation time is decreased the more the
x-ray tube power has to be increased. Although an x-ray
power of 100 kW appears to be adequate for cardiac imaging at 0.3- to 0.35-second gantry rotation time, more than
150 kW would be needed to maintain the CNR in the images for rotation times less than 0.2 second. The required
power densities in a small focal spot on the anode plate appear to be beyond todays technical limits.
An alternative scanner concept that provides enhanced
temporal resolution but does not require faster gantry rotation
is a DSCT with 2 tubes and the corresponding detectors. In a
commercial realization, the 2 acquisition systems are
mounted onto the rotating gantry with an angular offset of
90 degrees.18 Because of the 90-degree angle between both
detectors, the half-scan segment needed for image reconstruction can be split up into two 90-degree data segments
that are simultaneously acquired by the 2 acquisition systems
in the same relative phase of the patients cardiac cycle and at
the same anatomical level. With this approach, temporal
resolution equivalent to a quarter of the gantry rotation time
trot/4 (eg, 83 milliseconds at 0.33-second gantry rotation)
and independent of the patients heart rate can be achieved
in a sufficiently centered region of the SFOV. Meanwhile,
several clinical studies have shown the potential of DSCT

149

Figure 8 Temporal resolution for ECG-gated spiral scanning with

MDCT systems at various gantry rotation times as a function of
the patients heart rate. With the Adaptive Cardio Volume (ACV)
reconstruction illustrated here, the system automatically switches
between single-segment reconstruction at low heart rates and 2-segment reconstruction at higher heart rates. Note the heart-rate dependent temporal resolution with 2-segment reconstruction. DSCT
systems provide constant temporal resolution equivalent to a quarter
of the gantry rotation time by single-segment reconstruction.

to accurately rule out significant coronary artery stenoses

with little or no dependence on the patients heart rate.2934
How much can the temporal resolution of CT be
improved in the future? Will it be possible to routinely
achieve 25-millisecond temporal resolution similar to conventional angiography? If we assume a technical limit of
approximately 0.2 second for the shortest feasible gantry
rotation time, a MDCT scanner could provide images
with temporal resolution of approximately 100 milliseconds, whereas a DSCT system could reduce the exposure
time per image to 50 milliseconds. Prerequisite in both
cases is adequately increased x-ray tube power such that
the CNR of the images remains acceptable. Further improvements in temporal resolution could only be achieved
by multisegment reconstruction, with the above-mentioned
challenges for clinical stability at irregular heart rates and
radiation dose to the patient.

Volume Coverage
With typical MDCT detector z-coverages of 40 mm and
recently up to 80 mm (the z-direction is the patients longitudinal direction), an ECG-synchronized volume image of the
heart still consists of several image slabs reconstructed from
data acquired in multiple consecutive heart beats (Fig. 6 and
Fig. 7). As a consequence of insufficient temporal resolution
and variations of the heart motion from one cardiac cycle to
the next, in particular in the case of arrhythmia, these image

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Figure 9 Influence of scattered radiation on the contrast-to-noise ratio (CNR) of the images and on cupping artifacts. (Left) Axial image
of a coronary CTA acquired on a CT system with 2-cm detector coverage. (Right) Simulated scattered radiation corresponding to a CT
system with 16-cm detector coverage. Note the decreased CNR.

slabs can be blurred or shifted relative to each other, resulting

in banding artifacts in multiplanar reformations, maximum
intensity projections, or volume-rendered images. With increasing detector z-coverage the number of heart beats contributing to the volume image decreases, and so does the
number of steps in case of banding artifacts. Recently, a CT
system with a 320-slice detector (Toshiba Medical Systems,
Tokyo, Japan) was introduced that is wide enough to cover
the entire heart in one axial scan without table movement,
in this way avoiding stairstep and banding artifacts.21 First
clinical studies have meanwhile shown the potential of this
device for coronary CTA.21,35
However, as a downside of increasing detector width,
larger portions of the data can be distorted in the case of
arrhythmia or ectopic beats during scan data acquisition.
Another challenge of larger detector z-coverage is increased
x-ray scatter.36 Scattered radiation may cause hypodense
cupping or streaking artifacts, and the scatter induced noise
may reduce the CNR in the images. The magnitude of scatter
artifacts scales linearly with the illuminated z-width of the
detector. An additional challenge in DSCT is cross-scattered
radiation, ie, scattered radiation from an x-ray tube detected
in the other detector (offset by 90 degrees). Compared with an
ideal scatter-free case, the CNR degrades between 2.2% and
12% for a single-source CT system with z-coverages between
2 cm and 16 cm (see Fig. 9), requiring between 4.5% and
29% more radiation dose to restore the CNR.36 If an algorithmic correction of scattered radiation is performed to reduce
cupping and streaking artifacts, even more dose might be
needed to restore an optimal CNR.
As a summary, technical feasibility, growing detector
costs, and excessive scattered radiation will probably limit
the z-coverage of medical CT detectors, making further
steps in this direction (eg, by the introduction of even larger
detectors that could cover the entire thorax) rather unlikely.
DSCT systems offer an alternative way to scan the heart
within one heartbeat by increasing the spiral pitch (defined

as the ratio of the table feed per rotation divided by the

nominal beam-width at isocenter) up to p 5 3.2 in a limited
SFOV that is covered by both detectors.22 Each of the individual axial images has a temporal resolution of a quarter
of the rotation time trot/4, the phase of images adjacent in
the z-direction is slightly shifted (see Fig. 10). Clinical
studies will be needed to evaluate the potential and the limitations of the new high-pitch scan mode for cardiac CT.

Figure 10 Principle of an ECG-triggered DSCT scan mode at a

very high pitch of 3.2. The scan is triggered and starts at a userselectable phase of the patients cardiac cycle. The phase of images
adjacent in the z-direction is slightly shifted. The volume-rendered
image of the heart is a patient example acquired with this scan technique. With 38.4-mm detector coverage and 0.28-second gantry rotation time, a table feed of 430 mm/s was achieved, which was
sufficient to cover the heart (12 cm) in approximately 0.27 second.
Each of the axial images has a temporal resolution of approximately
75 milliseconds (courtesy of Dr. S. Achenbach, Erlangen University,
Germany).

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Conclusion
We presented various approaches to improve temporal
resolution, spatial resolution, and volume coverage in ECGsynchronized cardiac CT, and we discussed the technical
and practical limitations. Technical progress alone, however, does not necessarily translate into better diagnostic or
prognostic value of cardiac imaging or into improved
patient outcomes. Complementary to the ongoing refinement of imaging techniques clinical studies are required as
a basis for establishing cardiac CT in routine clinical
practice.

14.

15.

16.

17.

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