低剂量 256 层多排探测器冠状动脉 CT 血管成像迭代重建技术在疑似冠心病患者中的诊断准确性。
Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease.
机构信息
Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China,
出版信息
Eur Radiol. 2014 Jan;24(1):3-11. doi: 10.1007/s00330-013-2969-9. Epub 2013 Jul 26.
OBJECTIVES
To evaluate the accuracy of low-dose coronary CTA with iterative reconstruction (IR) in the diagnosis of coronary artery disease (CAD) in patients with suspected CAD.
METHODS
Ninety-six patients with suspected CAD underwent low-dose prospective electrocardiogram-gated coronary CTA, with images reconstructed using IR. Image quality (IQ) of coronary segments were graded on a 4-point scale (4, excellent; 1, non-diagnostic). With invasive coronary angiography (ICA) considered the "gold standard", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of coronary CTA were calculated on segment-, vessel- and patient-based levels. The patient data were divided into two groups (Agatston scores of ≥ 400 and <400). The differences in diagnostic performance between the two groups were tested.
RESULTS
Diagnostic image quality was found in 98.1 % (1,232/1,256) of segments. The sensitivity, specificity, PPV, NPV and accuracy were 90.8 %, 95.3 %, 81.8 %, 97.8 % and 94.3 % (segment-based) and 97.2 %, 83.3 %, 94.6 %, 90.9 % and 93.8 % (patient-based). Significant differences between the two groups were seen in specificity, PPV and accuracy (92.1 % vs. 97.9 %, 76.0 % vs. 86.7 %, 91.7 % vs. 96.6 %, P < 0.05; segment-based). The average effective dose was 1.30 ± 0.15 mSv.
CONCLUSION
Low-dose prospective coronary CTA with IR can acquire satisfactory image quality and show high diagnostic accuracy in patients with suspected CAD; however, blooming continues to pose a challenge in severely calcified segments.
KEY POINTS
• Coronary artery disease (CAD) is increasingly investigated using coronary CTA. • The iterative reconstruction (IR) algorithm is promising in decreasing radiation doses. • Low-dose prospective coronary CTA with IR can acquire satisfactory image quality. • Low-dose prospective coronary CTA with IR can show high diagnostic accuracy.
目的
评估低剂量冠状动脉 CT 血管造影（CTA）结合迭代重建（IR）在疑似冠状动脉疾病（CAD）患者中的 CAD 诊断准确性。
方法
96 例疑似 CAD 患者行前瞻性低剂量心电门控冠状动脉 CTA 检查，采用 IR 重建图像。冠状动脉节段的图像质量（IQ）按 4 分制（4 分，极好；1 分，无法诊断）进行评分。以有创冠状动脉造影（ICA）为“金标准”，计算节段、血管和患者水平的冠状动脉 CTA 敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。将患者数据分为两组（Agatston 评分≥400 和＜400），并检验两组间诊断性能的差异。
结果
98.1%（1,232/1,256）的节段可获得诊断性图像质量。节段水平的敏感性、特异性、PPV、NPV 和准确性分别为 90.8%、95.3%、81.8%、97.8%和 94.3%，患者水平分别为 97.2%、83.3%、94.6%、90.9%和 93.8%。两组间的特异性、PPV 和准确性存在显著差异（92.1%比 97.9%、76.0%比 86.7%、91.7%比 96.6%，P<0.05）。平均有效剂量为 1.30±0.15 mSv。
结论
低剂量前瞻性冠状动脉 CTA 结合 IR 可获得满意的图像质量，对疑似 CAD 患者具有较高的诊断准确性；然而，在严重钙化节段仍存在 blooming 伪影的挑战。
重点
CAD 越来越多地采用冠状动脉 CTA 进行检查。
迭代重建（IR）算法有望降低辐射剂量。
低剂量前瞻性冠状动脉 CTA 结合 IR 可获得满意的图像质量。
低剂量前瞻性冠状动脉 CTA 结合 IR 可显示较高的诊断准确性。
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