Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
J Digit Imaging. 2012 Feb;25(1):129-36. doi: 10.1007/s10278-011-9385-y.
Cardiovascular disease is the leading cause of global mortality, yet its early detection remains a vexing problem of modern medicine. Although the computed tomography (CT) calcium score predicts cardiovascular risk, relatively high cost ($250-400) and radiation dose (1-3 mSv) limit its universal utility as a screening tool. Dual-energy digital subtraction radiography (DE; <$60, 0.07 mSv) enables detection of calcified structures with high sensitivity. In this pilot study, we examined DE radiography's ability to quantify coronary artery calcification (CAC). We identified 25 patients who underwent non-contrast CT and DE chest imaging performed within 12 months using documented CAC as the major inclusion criteria. A DE calcium score was developed based on pixel intensity multiplied by the area of the calcified plaque. DE scores were plotted against CT scores. Subsequently, a validation cohort of 14 additional patients was independently evaluated to confirm the accuracy and precision of CAC quantification, yielding a total of 39 subjects. Among all subjects (n = 39), the DE score demonstrated a correlation coefficient of 0.87 (p < 0.0001) when compared with the CT score. For the 13 patients with CT scores of <400, the correlation coefficient was -0.26. For the 26 patients with CT scores of ≥400, the correlation coefficient yielded 0.86. This pilot study demonstrates the feasibility of DE radiography to identify patients at the highest cardiovascular risk. DE radiography's accuracy at lower scores remains unclear. Further evaluation of DE radiography as an inexpensive and low-radiation imaging tool to diagnose cardiovascular disease appears warranted.
心血管疾病是全球死亡率的主要原因，但早期检测仍然是现代医学的一个难题。虽然计算机断层扫描（CT）钙评分可以预测心血管风险，但相对较高的成本（250-400 美元）和辐射剂量（1-3 毫希沃特）限制了其作为筛查工具的普遍适用性。双能数字减影放射摄影术（DE；<60 美元，0.07 毫希沃特）能够以高灵敏度检测钙化结构。在这项初步研究中，我们研究了 DE 射线照相术定量冠状动脉钙化（CAC）的能力。我们确定了 25 名患者，他们在 12 个月内接受了非对比 CT 和 DE 胸部成像，主要纳入标准是有记录的 CAC。DE 钙评分是根据像素强度乘以钙化斑块的面积来确定的。DE 评分与 CT 评分进行比较。随后，对另外 14 名患者的验证队列进行了独立评估，以确认 CAC 定量的准确性和精密度，总共 39 名患者。在所有患者（n=39）中，与 CT 评分相比，DE 评分的相关系数为 0.87（p<0.0001）。对于 CT 评分<400 的 13 名患者，相关系数为-0.26。对于 CT 评分≥400 的 26 名患者，相关系数为 0.86。这项初步研究表明，DE 射线照相术可用于识别心血管风险最高的患者。DE 射线照相术在较低评分时的准确性尚不清楚。进一步评估 DE 射线照相术作为一种廉价且低辐射的成像工具来诊断心血管疾病似乎是合理的。
