Spectral Photon-Counting Detector Coronary CTA With Reduced Radiation and Contrast Media Doses in Inflammation-Associated Coronary Artery Disease: A Prospective Study.

IF 6.1 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Cheng Xu, Yue Sun, Liang Wang, Limiao Zou, Ming Wang, Lu Lin, Yun Wang, Xiaonan Sun, Xiaoying Liu, Xianbo Yu, Christianne Leidecker, Lun Wang, Yifan Liu, Hao Qian, Ran Tian, Rozemarijn Vliegenthart, Zhenyu Liu, Yining Wang
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引用次数: 0

Abstract

Background: Patients with inflammation-associated coronary artery disease (CAD) may exhibit rapid progression and require regular coronary imaging. Objectives: To evaluate the diagnostic performance of spectral photon-counting detector (PCD) coronary CTA with reduced radiation and contrast media doses for detecting coronary stenosis and in-stent restenosis in patients with inflammation-associated CAD. Methods: This prospective study enrolled patients with inflammation-associated CAD from January 2023 to March 2024. Participants underwent spectral PCD coronary CTA using prospectively ECG-triggered sequential acquisition and an individualized low-dose contrast media protocol. Virtual monoenergetic images (VMI) at 55 keV and polychromatic (T3D) images were reconstructed with matching parameters, including 0.4-mm slice thickness. Two readers independently assessed subjective (5-point Likert scales) and objective image quality measures; readers also assessed images for obstructive stenosis and in-stent restenosis (both ≥50%) in patients with invasive coronary angiography (ICA) available as reference. Results: The analysis included 63 patients (mean age, 50.4±11.5 years; 45 women, 18 men). Median contrast media volume was 28.0 mL. Median DLP was 165.0 mG·cm. The 55-keV VMI, compared with T3D, showed better (p<.05) overall image quality, diagnostic confidence, SNR, and CNR in all three assessed vessels (e.g., right circumflex artery for reader 1: overall image quality of 4.5 vs 4.1, CNR of 12.1 vs 9.9). Diagnostic performance using ICA as reference was evaluated in 40 patients with 132 lesions and 75 stents. The 55-keV VMI, compared to T3D, demonstrated higher (p<.05) per-lesion accuracy for obstructive stenosis (reader 1: 96.2% vs 84.1%; reader 2: 97.0% vs 86.4%); these differences in accuracy were also observed for both readers for noncalcified and partly calcified plaques, lesions in mid and distal segments, and patients with BMI ≥24. The 55-keV VMI and T3D showed no significant difference (p>.05) in accuracy for in-stent restenosis (reader 1: 97.3% vs 96.0%; reader 2: 96.0% vs 94.7%). Conclusions: Spectral PCD coronary CTA, obtained using low radiation and contrast media doses and reconstructed using 55-keV VMI, demonstrated excellent diagnostic accuracy in detecting obstructive stenosis and in-stent restenosis in patients with inflammation-associated CAD. Clinical Impact: The proposed protocol could be used to guide clinical decision-making in inflammation-associated CAD.

减少辐射和造影剂剂量的光谱光子计数检测器冠状动脉CTA在炎症相关冠状动脉疾病中的应用:一项前瞻性研究
背景:炎症相关性冠状动脉疾病(CAD)患者可能表现出快速进展,需要定期进行冠状动脉成像。目的:评价光谱光子计数检测器(PCD)冠状动脉CTA在降低辐射和造影剂剂量下对炎症相关性冠心病患者冠状动脉狭窄和支架内再狭窄的诊断价值。方法:这项前瞻性研究纳入了2023年1月至2024年3月期间患有炎症相关CAD的患者。参与者使用前瞻性心电图触发的顺序采集和个体化低剂量造影剂方案进行了光谱PCD冠状动脉CTA。采用匹配参数重建55 keV下的虚拟单能图像(VMI)和多色图像(T3D),其中切片厚度为0.4 mm。两名读者独立评估主观(5点李克特量表)和客观图像质量措施;读者还评估了可作为参考的有创冠状动脉造影(ICA)患者的阻塞性狭窄和支架内再狭窄图像(均≥50%)。结果:共纳入63例患者,平均年龄50.4±11.5岁,女性45例,男性18例。造影剂中位体积28.0 mL,中位DLP为165.0 mG·cm。与T3D相比,55 kev VMI对支架内再狭窄的准确性更高(p < 0.05)(阅读器1:97.3% vs 96.0%;阅读器2:96.0% vs 94.7%)。结论:光谱PCD冠状动脉CTA,使用低剂量辐射和造影剂获得,并使用55 kev VMI重建,在检测炎症相关性CAD患者的阻塞性狭窄和支架内再狭窄方面具有出色的诊断准确性。临床影响:提出的方案可用于指导炎症相关CAD的临床决策。
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来源期刊
CiteScore
12.80
自引率
4.00%
发文量
920
审稿时长
3 months
期刊介绍: Founded in 1907, the monthly American Journal of Roentgenology (AJR) is the world’s longest continuously published general radiology journal. AJR is recognized as among the specialty’s leading peer-reviewed journals and has a worldwide circulation of close to 25,000. The journal publishes clinically-oriented articles across all radiology subspecialties, seeking relevance to radiologists’ daily practice. The journal publishes hundreds of articles annually with a diverse range of formats, including original research, reviews, clinical perspectives, editorials, and other short reports. The journal engages its audience through a spectrum of social media and digital communication activities.
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