目的:常规CT技术在严重钙化病变中评估冠状动脉狭窄的准确性不高。本文报道了本研究对超高分辨率CT(UHR-CT)评估严重钙化冠状动脉病变的潜力的初步观察。
方法:15名45岁或以上的患者,有冠状动脉疾病史,涉及侵入性冠状动脉造影,被前瞻性登记。患者在心导管插入前30天内接受UHR-CT检查。将使用UHR-CT的图像噪声水平和诊断置信度(1-5级)与模拟常规CT技术的重建图像进行比较。比较了UHR-CT和侵入性血管造影对主要冠状动脉和左主冠状动脉狭窄的评估。使用常规技术的临床驱动冠状动脉CT的结果可用于比较。
结果:患者平均年龄为67岁(范围,53-79岁)。13名患者是男性,九人肥胖。辐射剂量为9.3mSv,原因是X射线暴露扩大以适应研究软件应用(R-R周期的70%-99%)。UHR-CT的总体图像噪声(50.9±7.8[标准偏差])明显高于常规CT图像重建(19.5±8.3,P<0.01),然而,UHR-CT的诊断置信度评分较高(4.3±0.9).无支架患者(n=6)的平均钙评分为1205,对86条血管进行了评估,有创血管造影术描绘的22例狭窄为70%或更多(26%)。狭窄与侵入性血管造影的比较产生了86%(22个中的19个)的敏感性和88%(64个中的56个)的特异性(95%CI:65%,97%;和77%,95%,分别)。
结论:初步观察表明,UHR-CT可以有效克服常规CT的局限性,准确评估严重钙化血管的冠状动脉狭窄。关键词:CT-血管造影,冠状动脉,动脉硬化临床试验登记号。NCT04272060参见本期Shanbhag和Chen的评论。©RSNA,2021年。
OBJECTIVE: Conventional CT technology yields only modest accuracy of coronary artery stenosis assessment in severely calcified lesions. Reported herein are this study\'s initial observations on the potential of ultra-high-resolution CT (UHR-CT) for evaluating severely calcified coronary arterial lesions.
METHODS: Fifteen patients 45 years of age or older, with history of coronary artery disease, referred for invasive coronary angiography, were prospectively enrolled. Patients underwent UHR-CT within 30 days prior to cardiac catheterization. Image noise levels and diagnostic confidence (level 1-5) using UHR-CT were compared with reconstructed images simulating conventional CT technology. Stenosis assessment for the major coronary arteries and the left main coronary artery with UHR-CT and invasive angiography were compared. Results from clinically driven coronary CT using conventional technology were considered for comparison when available.
RESULTS: Mean patient age was 67 years (range, 53-79 years). Thirteen patients were men, nine had obesity. Radiation dose was 9.3 mSv owing to expanded x-ray exposure to accommodate research software application (70%-99% of R-R cycle). Overall image noise was considerably greater for UHR-CT (50.9 ± 7.8 [standard deviation]) versus conventional CT image reconstruction (19.5 ± 8.3, P < .01), yet diagnostic confidence scores for UHR-CT were high (4.3 ± 0.9). Average calcium score in patients without stents (n = 6) was 1205, and of 86 vessels evaluated, 22 had 70% or greater stenosis depicted with invasive angiography (26%). Stenosis comparison with invasive angiography yielded 86% (19 of 22) sensitivity and 88% (56 of 64) specificity (95% CI: 65%, 97%; and 77%, 95%, respectively).
CONCLUSIONS: Initial observations suggest UHR-CT may be effective in overcoming the limitation of conventional CT for accurately evaluating coronary artery stenoses in severely calcified vessels.Keywords: CT-Angiography, Coronary Arteries, ArteriosclerosisClinical trial registration no. NCT04272060See also commentary by Shanbhag and Chen in this issue.© RSNA, 2021.