Department of Cardiovascular Sciences, Section of Arrhythmology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium, Europe.
Europace. 2013 Dec;15(12):1718-24. doi: 10.1093/europace/eut140. Epub 2013 May 31.
The effective radiation dose (ED) of three-dimensional rotational angiography (3DRA) is 5-8 mSv, leading to reticence on its use. We evaluated the potential of 3DRA with a reduced number of frames (RNF) and a reduced dose per frame.
Three-dimensional rotational angiography was performed in 60 patients (52.5 ± 9.6 years, 16 females) referred for ablation in the right (RA; n = 10) and left atrium (LA; n = 50). In a simulation group (n = 20), the effect of dropping frames from a conventional 248 frames 3DRA LA acquisition was simulated. In a prospective group (n = 40), RNF 3DRA were acquired of LA (n = 30) and RA (n = 10) with 67 frames (0.24 Gy/frame) and 45 frames (0.12 μGy/frame), respectively. Accuracy was evaluated qualitatively and quantitatively. Effective radiation dose was determined by Monte Carlo simulation on every frame. In the simulation group, surface errors increased minimally and non-significantly when reducing frames from 248 to 124, 83, 62, 50, 42, and 31: 0.49 ± 0.51, 0.52 ± 0.46, 0.61 ± 0.49, 0.62 ± 0.47, 0.71 ± 0.48, and 0.81 ± 0.47 mm, respectively (Pearson coefficient 0.20). All 3D LA images were clinically useful, even with only 31 frames. In the prospective group, good or optimal 3D image quality was achieved in 80% of LA and all of RA reconstructions. These accurate models were obtained with ED of 2.6 ± 0.4 mSv for LA and 1.2 ± 0.5 mSv for RA.
Three-dimensional rotational angiography is possible with a significant reduction in ED (to the level of prospectively gated cardiac computed X-ray tomography) without compromising image quality. Low-dose 3DRA could become the preferred online 3D imaging modality for pulmonary vein isolation and other anatomy-dependent ablations.
三维旋转血管造影（3DRA）的有效辐射剂量（ED）为 5-8mSv，这导致其应用受到限制。我们评估了使用较少帧数（RNF）和降低每帧剂量的 3DRA 的潜力。
对 60 例（52.5±9.6 岁，16 例女性）因消融术而转至右心房（RA；n=10）和左心房（LA；n=50）的患者进行了 3DRA。在模拟组（n=20）中，模拟了从常规的 248 帧 LA 3DRA 采集中断帧的效果。在前瞻性组（n=40）中，使用 67 帧（0.24Gy/帧）和 45 帧（0.12μGy/帧）分别采集了 LA（n=30）和 RA（n=10）的 RNF 3DRA。通过对每个帧进行蒙特卡罗模拟来确定有效辐射剂量。在模拟组中，当帧数从 248 减少到 124、83、62、50、42 和 31 时，表面误差仅略有增加且无统计学意义：分别为 0.49±0.51、0.52±0.46、0.61±0.49、0.62±0.47、0.71±0.48 和 0.81±0.47mm（皮尔逊系数 0.20）。所有 3D LA 图像都具有临床意义，即使只有 31 帧。在前瞻性组中，LA 的 80%和所有 RA 重建均获得了良好或最佳的 3D 图像质量。这些准确的模型的 ED 分别为 2.6±0.4mSv（LA）和 1.2±0.5mSv（RA）。
通过显著降低 ED（降至前瞻性门控心脏计算机 X 射线断层扫描水平），同时不影响图像质量，3DRA 是可行的。低剂量 3DRA 可能成为肺静脉隔离和其他解剖相关消融术首选的在线 3D 成像方式。
