目的:冠状动脉CT血管造影(CCTA)最近已被确立为疑似冠状动脉疾病(CAD)患者的一线检查。由于CCTA的使用增加,减少辐射和造影剂(CM)暴露的策略非常重要。这项研究的目的是评估自动管电压选择(ATVS)适应的CM注射方案与临床建立的三相注射方案相比,CCTA在图像质量方面的性能。辐射暴露,和CM给药材料和方法:2021年7月至2023年7月,前瞻性纳入接受临床指示CCTA的患者。患者接受CCTA使用改良的三相CM注射方案,通过ATVS算法针对管电压进行调整,在70到130kV的范围内,间隔为10kV。注射方案由混合CM和盐水推注的两个阶段组成,比例不同,以确保特定电压的碘输送速率。然后是盐水冲洗的第三阶段。将该队列与回顾性识别的对照组进行比较,并在同一CT系统上进行扫描,但采用标准的三相CM方案。辐射和对比剂剂量,比较两组患者的主观和客观图像质量(对比噪声比[CNR]和信噪比[SNR]).
结果:最终人群由120名前瞻性患者和120名回顾性对照者组成,每组20名患者。由于样本量不足,将120kV组排除在统计分析之外。总体上,预期组中CM显着降低(46.0[IQR37.0-52.0]与51.3[IQR40.1-73.0]毫升,p<0.001),并且在所有kV水平下也是如此(所有成对p<0.001)。辐射剂量无显著差异(6.13±4.88vs.5.97±5.51mSv,p=0.81),主观图像质量(中位数得分4[3-5]与4[3-5],p=0.40),CNR,主动脉和左冠状动脉前降支的信噪比(均p>0.05)。
结论:适用于ATVS的CM注射方案允许诊断质量CCTA,减少CM体积,同时保持类似的辐射暴露,主观和客观的图像质量。
OBJECTIVE: Coronary CT angiography (CCTA) has recently been established as a first-line test in patients with suspected coronary artery disease (CAD). Due to the increased use of CCTA, strategies to reduce radiation and contrast medium (CM) exposure are of high importance. The aim of this study was to evaluate the performance of automated tube voltage selection (ATVS)-adapted CM injection protocol for CCTA compared to a clinically established triphasic injection protocol in terms of image quality, radiation exposure, and CM administration MATERIAL AND METHODS: Patients undergoing clinically indicated CCTA were prospectively enrolled from July 2021 to July 2023. Patients underwent CCTA using a modified triphasic CM injection protocol tailored to the tube voltage by the ATVS algorithm, in a range of 70 to 130 kV with a 10 kV interval. The injection protocol consisted of two phases of mixed CM and saline boluses with different proportions to assure a voltage-specific iodine delivery rate, followed by a third phase of saline flush. This cohort was compared to a control group identified retrospectively and scanned on the same CT system but with a standard triphasic CM protocol. Radiation and contrast dose, subjective and objective image quality (contrast-to-noise-ratio [CNR] and signal-to-noise-ratio [SNR]) were compared between the two groups.
RESULTS: The final population consisted of 120 prospective patients matched with 120 retrospective controls, with 20 patients in each kV group. The 120 kV group was excluded from the statistical analysis due to insufficient sample size. A significant CM reduction was achieved in the prospective group overall (46.0 [IQR 37.0-52.0] vs. 51.3 [IQR 40.1-73.0] mL, p < 0.001) and at all kV levels too (all pairwise p < 0.001). There were no significant differences in radiation dose (6.13 ± 4.88 vs. 5.97 ± 5.51 mSv, p = 0.81), subjective image quality (median score of 4 [3-5] vs. 4 [3-5], p = 0.40), CNR, and SNR in the aorta and the left anterior descending coronary artery (all p > 0.05).
CONCLUSIONS: ATVS-adapted CM injection protocol allows for diagnostic quality CCTA with reduced CM volume while maintaining similar radiation exposure, subjective and objective image quality.