Department of Radiology, New York University, 550 First Avenue, New York, NY 10016, USA.
Acad Radiol. 2012 May;19(5):554-61. doi: 10.1016/j.acra.2012.01.009. Epub 2012 Feb 24.
Cardiac computed tomographic angiography algorithms emphasize radiation reduction while maintaining diagnostic image quality (IQ). The aim of this study was to evaluate IQ and interreader variability using prospective electrocardiographically triggered high-pitch spiral cardiac computed tomographic angiography (FLASH-CT) compared to retrospective electrocardiographic gating (RETRO-CT) for coronary artery disease evaluation in a patient population including overweight and obese individuals.
Seventy patients (24 women; mean age, 60 years) matched for gender, age, body mass index (27.4 ± 5.5 kg/m(2)), and calcium score (184 ± 328) underwent cardiac computed tomographic angiography, 35 with FLASH-CT (Definition Flash) and 35 with RETRO-CT (Somatom Definition). Images were reconstructed using standard protocols and least motion phase for RETRO-CT acquisitions. Two independent, blinded readers evaluated the coronary arteries using an 18-segment model, grading IQ on a 5-point, Likert-type scale and coronary stenosis on a 5-point semiquantitative and binary scale.
Effective radiation dose (1.50 vs 17.3 mSv, P < .0001) and mean heart rate (58 vs 62 beats/min, P < .05) were significantly lower for FLASH-CT compared to RETRO-CT. Seven hundred forty segments (> 1.5 mm) were evaluated. There was no significant difference between FLASH-CT and RETRO-CT scans in overall per-segment IQ (3.11 ± 0.75 vs 3.10 ± 0.82, P = .94). FLASH-CT had noninferior IQ relative to RETRO-CT (95% confidence interval, -0.25 to 0.26). There was no significant difference in interreader variability in diagnosis between FLASH-CT and RETRO-CT for all coronary segments (77.5% vs 78.2%, P = .83).
FLASH-CT is an acceptable coronary computed tomographic angiographic method for reducing radiation dose without compromising IQ for a patient population including overweight and obese individuals.
心脏 CT 血管造影术算法强调在保持诊断图像质量（IQ）的同时减少辐射。本研究的目的是评估前瞻性心电触发高螺旋心脏 CT 血管造影术（FLASH-CT）与回顾性心电门控 CT（RETRO-CT）在包括超重和肥胖患者的患者人群中用于冠心病评估的 IQ 和读者间变异性。
70 例患者（24 例女性；平均年龄 60 岁）按性别、年龄、体重指数（27.4 ± 5.5 kg/m2）和钙评分（184 ± 328）匹配，行心脏 CT 血管造影术，其中 35 例行 FLASH-CT（Definition Flash），35 例行 RETRO-CT（Somatom Definition）。图像使用标准协议和最少运动相位进行 RETRO-CT 采集重建。两位独立的、盲法的读者使用 18 节段模型评估冠状动脉，采用 5 分 Likert 型量表评估 IQ，采用 5 分半定量和二进制量表评估冠状动脉狭窄。
与 RETRO-CT 相比，FLASH-CT 的有效辐射剂量（1.50 与 17.3 mSv，P <.0001）和平均心率（58 与 62 次/分，P <.05）明显降低。共评估了 740 个节段（> 1.5 mm）。FLASH-CT 和 RETRO-CT 扫描在整体节段 IQ 方面无显著差异（3.11 ± 0.75 与 3.10 ± 0.82，P =.94）。FLASH-CT 相对于 RETRO-CT 的 IQ 具有非劣效性（95%置信区间，-0.25 至 0.26）。在所有冠状动脉节段中，FLASH-CT 和 RETRO-CT 在诊断读者间变异性方面无显著差异（77.5%与 78.2%，P =.83）。
FLASH-CT 是一种可接受的冠状动脉 CT 血管造影方法，可在包括超重和肥胖患者的患者人群中减少辐射剂量，同时不降低 IQ。
